Thursday, August 30, 2007

Physicians 50/50

While trying to decide where to begin, I decided that it would be appropriate to address the variables I have encountered with physicians I have come in contact with since 1996. I decided to break down the list into three categories consisting of: primary doctors, surgeons, and specialists.

The specialists consist of three neurologists, four movement disorder specialists, and one rheumatologist. For obvious reasons, names of these physicians are not revealed.

On this list, I have included a few sub-categories of opinions and treatments rendered by doctors, based on my personal experiences. I have also included the number of physicians in each category that I would consider as indifferent / difficult to deal with or as concerned / patient friendly.

Additionally, for specialists only, I included the number of specialists that I was referred to by my HMO insurance, and the number of specialists that I self referred to, as well as paid cash to see. (This is for reference only, and the issue of self-referral will be addressed in a future writing.)

Number of Primary Care Physicians 5
Ordered x-rays only 2
Ordered no tests 1
Ordered Multiple Tests 2
Stated symptoms due to depression 4
Prescribed anti-depressants 3
Stated symptoms due to gender 2
Indifferent / difficult to deal with 3
Concerned / patient friendly 2

Number of Surgeons 3
Ordered Tests 3
Performed needed surgery 3
Concerned / patient friendly 3

Number of Specialists 8
Stated symptoms due to depression 1
Prescribed anti-depressants 1
Stated symptoms due to age / gender 1
Indifferent / difficult to deal with 4
Covered by insurance 3
Private Pay, Self-Referred 1
Concerned / patient friendly 4
Covered by insurance 2
Private Pay, Self-Referred 2

Although this list only represents my experiences with physicians, as I look at the numbers, they increase my understanding of why it was so difficult to find concerned / patient friendly physicians over the years. For example:

- Four out of five primary care physicians attributed physical symptoms to depression, and three of the five prescribed anti-depressants, after little or no testing.

- Surgeons ranked higher than any other physician did. Three out of three surgeons ordered needed testing and performed necessary surgeries with satisfactory outcomes.

- Four out of eight specialists were indifferent / difficult to deal with.

From this point on, I will only address primary care physicians and specialists. Based on my list, the surgeons I dealt with, not only were thorough, but also were concerned / patient friendly physicians. My theory is that, outside of emergencies, surgeons deal primarily with specific conditions that can be confirmed through testing, prior to any surgery taking place. More often than not, if a patient is referred to a surgeon, an existing condition has already established. Additional testing requested by a surgeon, in addition to the examination by the surgeon, confirms whether a surgery is necessary or not.

As I looked at the number of indifferent / difficult to deal with physicians and compared it to the number of concerned / patient friendly physicians, it dawned on me that there were almost equal numbers of each. Therefore, 50% of the physicians were indifferent / difficult to deal with, and 50% of physicians were concerned / patient friendly. Consequently, each time I saw a new physician, there was a 50/50 chance that physician would be someone I could establish a good relationship with. Of the five primary care physicians, there were only two that I established a long-term doctor / patient relationship with. I consider both to be exceptional physicians.

Like me, if you have an HMO, you do not have much choice with respect to the specialists you are referred to. The choice that you do have is to choose a primary care physician that is not only concerned / patient friendly, but also one who you have the ability to build a strong doctor / patient relationship with. This type of physician will be willing to listen, be more willing to request the appropriate testing, and will not hesitate to refer you to a specialist if needed. If your primary care physician appears not to be looking out for your best interest, contact your HMO and find a new primary care physician immediately. Your primary care physician is the key to your health, even if you are not experiencing symptoms of a chronic condition. Having a good relationship with your primary care physician can save time when trying to obtain a diagnosis.

Although I do not have personal experience with a PPO, it is my understanding that having a PPO enables you to see any affiliated physician of your choosing. If you choose to see a primary care physician, and he / she appears not to be looking out for your best interest, immediately find another physician. Again, it is my understanding that you have the option to self refer, even to a specialist, without having to contact your PPO. This availability will save time, which is so important to any patient who is seeking a diagnosis. If your situation is urgent, and you do have this option, seek out an appropriate specialist first, and replace your primary care physician afterward. Having a PPO does not mean you should give up finding a concerned / patient friendly primary care physician. It only means that you have more options when faced with a potentially urgent or chronic medical condition.

If you have spent a significant amount of time searching for a diagnosis for your symptoms, and you have experienced difficulties, sit down and make a list of the physicians you have met with and what the results of your visits were. If you find that you also are having difficulty finding concerned / patient friendly physicians, you now recognize that finding the right physician needs to be the primary goal that will enable you to move forward.

The bottom line is that we need to increase our odds of finding physicians who we can have a good doctor / patient relationship with. In my next post, I will offer some tips that I found useful, that may be of assistance to patients who are searching for a new primary care physician or a specialist. These suggestions can be applied to patients who have either an HMO or a PPO.

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