Patient, heal thyself

It's not supposed to be like this. When you're sick and need help, you're supposed to be able to rely on a doctor - a doctor who is knowledgeable, who really cares what happens to you, and who will leave no stone unturned in seeing that you get exactly what you need.

Unfortunately, having such a "model" doctor is becoming rare. Patients are on their own much more often, and to a much greater extent, than they used to be - and it's getting worse all the time.

If you've glanced at the Understanding It section of this website, you're acquainted with our contention that patients are feeling abandoned by the healthcare system because they really have been abandoned; and that (because widespread covert rationing is systematically destroying the doctor-patient relationship,) the abandonment of patients is happening by design rather than by chance.

When you're sick and find yourself engaged in a hostile healthcare system, you need somebody in your corner who knows what she's doing, and who cares about you.

Choosing the right doctor for yourself, and nurturing a good relationship with him, is one of the most critical steps you can take in becoming an effective patient. With the right doctor at your side, the path to good healthcare becomes clear and wide. Without that doctor, you're lost and alone in the enchanted forest.

Qualities to seek

The following discussion pertains mainly to choosing your primary care physician (PCP). Your PCP is the one who will get to know you the best, and for the longest period of time. When you become sick she will have the best notion of your values and desires regarding your healthcare. Your PCP will be the gatekeeper to the wider world of medical care. She's the one with whom you'll decide on the details of your healthcare, and the one who will negotiate on your behalf with the broader healthcare system. She will recommend specialists to you when you are in need of one. Her actions (or possibly, her inactions) will do more to determine the adequacy of your healthcare than those of any other doctor you may see. Thus, when it comes to choosing a doctor, picking your PCP is generally the most important decision you will have to make.

Rule # 1: You hired him; you can fire him.

Choosing a doctor is different than, say, choosing a car. When you buy a new car, you can shop around to your heart's content, but once you plunk down your money and bring that baby home, you're pretty much stuck with it. If it's not everything you hoped it would be, you can't just get rid of it - why, it lost 50% of its original value the minute you drove it off the lot. Besides, it's not life and death, it's just a car. So if your new car turns out to be a disappointment, you'll usually shrug your shoulders and resolve to live with it for a few years, at least until you can justify buying another one.

It's different with doctors. For one thing, it's harder to shop around before you make your move. For another, starting with a new doctor doesn't require an up-front investment of tens of thousands of dollars. Early on, all you've invested is some time and inconvenience. And finally, choosing the right doctor potentially is a matter of life and death.

Many patients have the same attitude when they're dissatisfied with their doctors that they would have if they were dissatisfied with a car - "Oh, well, guess I'll just have to live with it." This is the wrong attitude, since, indeed, in this case you may not live with it. Doctors are serious business.

Choosing a doctor is an important decision, but it's not an irreversible one. It's not uncommon for discerning patients to run through two or three doctors before finding the right match. And there's nothing wrong with doing it that way. So if you've tried a new doctor and you're not satisfied with him, get another one. Remember: You hired him; you can fire him.

The most important factor in choosing a doctor

That would be communication.

If you can't communicate well with your doctor, you're in trouble. This is the person, after all, who will need to understand your wishes and values regarding your healthcare. She is the one who will need to explain to you, so that you can understand it, the nature of your medical problems - the causes, the testing that may be needed, the potential treatments, the pros and cons of the various therapeutic options, and why she's recommending one option over the others. She's also the one who has to convince your insurance carrier that the course of action you and she have decided upon is the right one, that it's medically necessary, and that they - the insurance carrier - ought to pay for it. Communication has always been important in medicine. Now it's vital.

Is your doctor really listening to what you are saying? Does he show he understands your concerns by responding meaningfully to them? When he explains medical issues to you, does he make them understandable? Does he have more than one way of explaining a difficult concept? Is he patient with you, waiting for you to grasp what he's saying, or does he try to embarrass you into saying you understand, with shakes of his head or rolling of his eyes? Do you like him, and more importantly, does he seem to like you? (This may become very important when it's time for him to go to bat for you.)

The inability to communicate effectively with your doctor is sufficient reason to move on to someone else. Without communication, you've got nothing.

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