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16 June 2011

Time for a new doctor? [More:]So, I don't like my doctor and I haven't for some time. The practice itself is annoying (long waits) and if you need bloodwork you have to go to a seperate testing company, which seems to be staffed with DMV rejects. My doctor seems to only care about my weight...which is an issue (although I have low BP and low cholesterol levels) but not the only issue, you know? She seems uninterested in finding a reason for my fatigue problem...thyroid tested fine, so it's just because I'm fat.

Anyway it's time for my annual physical, and I've been looking for a new doctor...but I'm not seeing any decent online reviews for anyone on my plan taking new patients.

I'm not anticipating this being anything other than a routine physical. Should I stick with the ok but not great doctor or take a chance? It's such a pain to switch, I'm not even sure how to move my records over.
In my experience, if I asked "time for a new doctor?", then the time had come to find a new doctor. Anyone you find may not give you an appointment for 3 to 6 months, however you still have the old one until then. As well, you have that time to get your records updated (!) before transferring.
posted by Ardiril 16 June | 12:49
I can understand your frustration at not being able to rule out weight as a cause of fatigue, as I am in a similar situation, but it is the 'expect horses' answer and it's difficult to isolate other causes while that potential cause is present. It can be singularly unhelpful, though, when doctors just tell you 'lose weight' without being able to provide a much more meaningful analysis of your health, holistically.

That's not to say you shouldn't find a new doctor - the only reason you need to find a new doctor is that you don't like your doctor (or their office, or their listening skills, etc.)

I have been thinking recently how badly the idea of 'doctor' needs a redesign. It's so hopelessly outdated - send someone in to look at you for 15 minutes and deliver some sort of useful feedback, when they probably don't remember you visit to visit, couldn't pick you out of a lineup, and have absolutely no sense of the context in which you live the rest of your life. When you look at the other personal care services people expect nowadays, it really stands out. I can make an appointment with a hairstylist, masseuse, nutritionist, fitness trainer, psychologist, etc. and expect a thorough consultation with lots of discussion of my goals, past approaches and their relative successes, consistent problems, parameters and life challenges. From there you can expect to agree together on a plan of action, work within that program for a while, guage results, and revise the plan as needed. Personal attention, a truly individualized approach, a relationship aimed to meet your goals. Why is the physician not like this? Why do we begin, at my first appointment with a new doctor, with me in a paper dress having my first anonymous encounter with their charts and instruments, rather than beginning in a comfy chair in a nice consultation room where I introduce myself, outline the reasons I am coming, define my health goals and discuss my health history before there's ever a physical exam? Why is the physical exam the focus of the visit, and not the treatment consultation and making of an action plan, with follow-up?

If we were building this system today, we'd do it a lot differently. Instead we built a system based on the patriarchal attempt to remove health care from the hands of home physicians and nurses and create a sense of authority and supremacy based on division and detachment from the patient. It's really very strange and I'm surprised we still use this archaic and rigid approach.

(And out of pocket, when there are no major problems to treat requiring multiple visits or the like, I pay my hairstylist more per visit than I pay my primary...and I pay it every 6 weeks, instead of once a year if I'm lucky). This system is nutso.
posted by Miko 16 June | 13:32
I think Matt Smith is doing a perfectly adequate job. *ducks*

Seriously, seconding Ardiril, this is one of those questions which, if you're asking it, probably should be answered YES. And if a new doctor can't handle the records transfer after having you sign a few forms and provide the names of your current and not-too-far-in-the-past doctors, then that should be a red flag. Treat it as "getting a second opinion" which if your current doctor isn't too crappy, he should handle.
posted by oneswellfoop 16 June | 13:36
the idea of 'doctor' needs a redesign - Does it ever! What I really need is a case worker: 3 parts secretary, 2 parts personal assistant, and 1 part liaison to nurses and doctors. A 3-month certificate position at best. Oh, and someone I choose freely from a pool, not someone assigned to me blindly from a queue. I am supposed to be disabled, but quite often the demands of various players in the medical industry are for me to perform actions (generally of an administrative nature or similar, not anything therapeutic) beyond that of someone who is supposed to be disabled.

However, in the defense of doctors, quite often one look at you seems to satisfy [a substantial portion] of all visits.
posted by Ardiril 16 June | 14:19
Applauding that post, Miko! Ideally, I'd like to take a day and interview 4 or 5 doctors, but who can do that? I'm grateful to have health insurance at all (and it's one of the better plans) but I wish the whole system operated differently.

I do have one doctor recommended by a friend, but she didn't have great online reviews. Maybe that's a place to start though.

Thanks, all!
posted by JoanArkham 16 June | 14:49
I do not trust online reviews at all. This may be a skewed perception but those who scream the loudest online often strike me as people who did not follow instructions.
posted by Ardiril 16 June | 14:57
Beautifully said, Miko.
posted by tangerine 16 June | 15:07
I haven't really had a doctor in ages. I just go the the clinic approved by my insurance and see whoever is there. I've never seen the same doctor twice and I couldn't tell you the name of the last one I saw. Mostly doctors are pretty useless unless you already know what's wrong with you, I've never had one that could diagnose worth a damn.
posted by octothorpe 16 June | 16:42
I went to a new practice, as the old one didn't have experienced docs available when my doc moved. The newbs were really varied, and I didn't feel like my needs were worth much. At the new practice, the doc is okay, but is now moving, so I feel your pain. Look for Board Certified, 5 years experience, and try to find a trait from a doc you liked to ask for, like good listener. Ask for someone like that as you make your phone calls. It's really disruptive.
posted by theora55 16 June | 17:56
Octo- I couldn't agree more. Unless you walk in and tell them what's wrong with you, forget it. This isn't 'House'. Dr Google and the nurses I know IRL are the ones who really help.

JoanArkham, I had 4 doctors over a 10 year period refuse to treat me for a thyroid condition even though I had pretty much every symptom because they said my lab tests didn't indicate a need. The fifth dr said, well why don't we try putting you on thyroid pills. If you feel better, you were right. If you don't, it's something else. I was right.

posted by toastedbeagle 16 June | 18:02
It's really disruptive.

posted by Miko 16 June | 21:36
the idea of 'doctor' needs a redesign

Needed to be quoted yet again.
posted by Obscure Reference 17 June | 07:46
Fatigue problems? Get thee to a rheumatologist. Many primary doctors aren't interested in fatigue because it often falls into the murky realm of mild autoimmune disorders. I fought fatigue for years before seeing a rheumatologist who treated me (effectively!) and literally turned my life around.

Also, it does sound like you could use a different primary doc, if for no other reason than your doctor doesn't take you seriously. I'd probably do the annual exam with Current Doc and ask your friends and co-workers for recommendations.
posted by workerant 17 June | 09:10
The wife and I have actually been considering this very thing for a while now. Our primary care physician is going through a nasty divorce and recently hired obnoxious office help. He is forgetful and takes forever to refill prescriptions with the pharmacy. His receptionist is a total bitch. The office wait is often over an hour and a half. Especially when he arrives late on his lime green Harley.

OTOH he's a great doctor and totally up to date on the latest therapeutics and diagnostics. I'd hate to end up with a sweet and kind doctor with a lovely receptionist who is a quack.

It's a hard choice, I wish you much luck.
posted by Splunge 17 June | 12:20
I was poking around online, trying to find info (OMG does everything that comes up in a search for a doctor have to look so skeezy?) and I started wondering whatever happened to my previous doctor, who I loved, after she moved away. Well, she is apparently back in the area! Her office is closed Friday afternoons, but I'm going to call on Monday. Thanks, again for everyone's advice!
posted by JoanArkham 17 June | 15:01
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