You deserve a doctor who’s a good fit for you [PODCAST]

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“I implore you — even if it’s difficult — if you don’t like your doctor, take the time and find a new one!

How do you do that? Check your insurance for who they cover, and then ask your friends who they see and like. Google the physician. Google the practice. Google the hospital.

Put as much effort into this as you would buying a car. This person needs to be reliable, safe, up-to-date and needs to make sense for you.

Let’s all make 2021 the year we take better care of ourselves.

You deserve excellent care and goodness of fit.”

Caitlin Bass is a hospice and palliative care fellow.

She shares her story and discusses her KevinMD article, “You deserve a doctor who’s a good fit for you.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Caitlin Bass. She is a hospice and palliative medicine fellow, and she wrote the KevinMD article “You deserve a doctor who’s a good fit for you.” Caitlin, welcome to the show.

Caitlin Bass: Thank you, Kevin. It’s a pleasure to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Caitlin Bass: Sure. I am, as you said, a hospice and palliative care fellow. I just finished up my internal medicine residency right around the time when COVID was hitting, and I had this whole glorious plan to do palliative care. And then, I think, you know, we’re all kind of in it right now. The world caught on fire, basically, and everybody’s plans went up in smoke.

Kevin Pho: So I understand you practice in Florida, and we’re speaking towards the end of August, and certainly there’s a surge of COVID cases going on. So tell me some of the challenges, and some of the cases and patients that you’re seeing from the palliative care standpoint.

Caitlin Bass: We are inundated right now. I think all of Florida, and not even just Florida, but the South and Southeast, is pretty much in a giant surge. We are seeing younger patients. We are seeing mostly unvaccinated patients. And we’re having a hard time because we have shut down our hospitals to visitors again, just because we don’t want to expose them, or them to expose us.

It is really a huge struggle to be able to explain to families why they can’t be with their loved ones. Most of them get it and are grateful to just hear from us and hear that we are taking good care of their relatives, but it just adds such a layer of complexity and, honestly, horror to what’s happening now.

Kevin Pho: Over the last 18 months of the pandemic, from your view as a palliative care fellow, what would you say are some of the biggest things that you’ve learned over the last 18 months of the pandemic?

Caitlin Bass: Being a palliative care provider really inspires you and teaches you and gets you into this really deep level of bluntness. We are the team who is going to tell you the truth, no matter what, no matter how bad it is. And I think we’ve all seen this as clinicians in the past 18 months: The truth is something that is so precious and so twisted.

As things change, and as the rules change, and as the guidelines change, everybody is so stinking confused. It’s so hard and so important for us as clinicians, not just palliative care but everybody. I know you’ve said it 16 times today. I know you’ll have to say it 16 times tomorrow. But we just keep explaining and keep telling the truth.

Kevin Pho: All right, let’s transition now into the KevinMD article that you wrote. It’s titled “You deserve a doctor who’s a good fit for you.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Caitlin Bass: Absolutely. A dear friend of mine, whose mother was recently diagnosed with breast cancer, had had surgery and had done everything that she needed to do. She had followed her surgeon’s plan. It was great. And then she saw the oncologist and left that meeting unclear as to whether or not she actually still had cancer. She didn’t know. She couldn’t figure it out. And she’s an intelligent person. She’s a reasonable patient. You know, she had tried to do everything that you would do.

And I said to her, “You know, maybe you need a second opinion. Maybe you need to talk to someone else. It’s OK. If you didn’t understand what your oncologist said, to the point that we don’t know whether or not you still have cancer, you need a new guy.” And that was so hard for her to accept: that it was OK to ask for a second opinion, or that you could even ask the oncologist that you had spoken to to recommend someone else, or that we as clinicians aren’t going to be offended when you ask for a second opinion.

And then, once this kind of story came to light, there were so many stories of people that I know: “Oh, well, I told my doctor that, but I don’t know that they heard me,” or “I don’t really understand what they said.” And I think that also ties back into the COVID thing, where nobody understands what the truth is anymore. We have to keep spreading the truth as much as we possibly can, and to do that, we need our patients to trust us. And if they don’t, it’s OK if they find a new doctor.

Kevin Pho: Now, for that patient in your story, you said it was very difficult for her to perhaps move on or get a second opinion from that oncologist. Why do you think it was so difficult for that patient?

Caitlin Bass: I think it was big and scary. When patients hear that cancer word, right, they kind of shut down, and I think she shut down. And again, because of COVID, she wasn’t allowed to have anyone in the room with her, so she didn’t have any backup to say, “Hey, what happened? Hey, whatever. Hey, no one understood what you just said.” So she ended up refusing to get a second opinion, but she did allow her daughter to be on speakerphone with her going forward. So they did have some sort of medical translation, and a level of trust was built up among them.

But my thing is, you know, you wouldn’t just buy the first car that you test-drove, right? You would look at cars. You would look at different cars. You would see what you needed. And I don’t like to throw around the word “research” lightly, because we know all of our patients do their research, and we’ve gone through probably a minimum of 12 years of school to get to where we are, and that hurts a little bit. But really, you should research your doctor. See what their accreditation is. Make sure that they are affiliated with people that you trust, and institutions, and that they follow guidelines.

Kevin Pho: What kind of advice do you have for patients when it may be in their best interest to seek another opinion? Because I always say, especially in primary care, which I practice in, that every patient-physician partnership isn’t necessarily going to work out, right? It’s almost like a marriage, right? So I think that sometimes, no matter how well intentioned both sides are, it’s just not going to work out for whatever reason. Now, for patients where that fit isn’t necessarily right, what kind of advice do you have for them?

Caitlin Bass: I think, as you said, the marriage analogy there is really great, because I need my patients to be incredibly honest with me, and I’m going to talk about things that maybe no one has ever talked about with them. And if they don’t feel comfortable saying those things to me, I’m happy to help, even facilitate: “Hey, let’s find you a second opinion,” or “Maybe you need to see someone of a different gender,” or “Maybe you need to see someone who speaks your language natively.” And if I can help figure that out, I will.

I would tell the patients that if you genuinely feel like you’re not getting through, or you don’t understand what your doctor said, find a new one. There are lots of us. It’s OK. We won’t be offended.

Kevin Pho: Sometimes, though, there aren’t a lot of us, right? I think for a lot of patients who live in rural areas, for instance, there may be a shortage of clinicians, or clinicians may have long waiting lists. And I think that is one of the reasons why patients stick with physicians that may not be good matches. So I guess, what kind of recourse do you have for patients where there is, in fact, a primary care shortage, or where, if they move on from that clinician, they may have to wait months to see another one?

Caitlin Bass: So I would say that your health is priceless to you. So if we’re not talking a time issue, if you have to drive, you have to drive. But also, bring it up to your clinician in some way: “Hey, I don’t know that you are understanding what I’m saying,” or “I don’t feel like you heard me when I said this, and this is really bothering me,” knowing that hopefully those things will be well received.

Kevin Pho: We’re talking to Caitlin Bass. She is a palliative care and hospice fellow, and she wrote the KevinMD article “You deserve a doctor who’s a good fit for you.” So Caitlin, speaking from the physician’s standpoint, what kind of signs can physicians pick up on to make them realize that, hey, this partnership may not work out? And how much do you try to salvage that partnership before saying to that patient, “Hey, maybe you need to see someone else”?

Caitlin Bass: I’ve actually said, “Hey, maybe I’m not the best fit for you.” And I have those patients, and they will keep coming back to see you in clinic, and you’re like, “I don’t understand why you don’t do anything that I say.” And then it’ll come down to, “Well, everyone else was mean to me,” or “Everyone else was dismissive.” So I absolutely recommend that they see someone else if we’re on the second or even third visit where I’ve tried to suggest something that I or you would consider super basic: “Take your blood pressure medication. Take your thyroid medicine.” Take something that is just the answer, that is black and white, right? You have high blood pressure, you take an antihypertensive.

And I will tell them, “Hey, if it doesn’t make sense, we can try different things.” But I just keep seeing them. You know, I think you have to be appropriate and honest: “This is a bad plan. You’re following a bad plan. I do not support your bad plan, and this is why.”

Kevin Pho: Switching back to the topic of palliative care and hospice, what kind of messages do you have for your primary care colleagues who may be listening to this show?

Caitlin Bass: Genuinely and truly, we don’t get a commission from hospice. We’re not trying to send all your patients to hospice. That is not what we do. I tell all my patients, and sometimes their providers as well, “I have no skin in this game. I just want what your patient wants.” I am their medical translator. I am their voice in a system that is easy to get lost in. We are all on the same side, I promise. Sometimes your patients are just tired, and they love you as much as you love them, and they don’t want to tell you that.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Caitlin Bass: That even if it feels awkward and weird, if you don’t like your doctor, and you find yourself not telling them all the truth, even if you are a fellow clinician (sometimes I’ve had to do that), find a new one. Even if it’s hard, find a new one.

Kevin Pho: Caitlin, thank you so much for sharing your time and insight, and thanks again for being on the show.

Caitlin Bass: Thank you.

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