fire your doctor

Decades ago, the relationship between a patient and a doctor was often asymmetrical. The doctor decided what treatment was needed and issued “doctor’s orders.” Patients were expected to follow through, no questions. In most cases, they couldn’t ask questions because they didn’t have access to enough information to formulate reasonable queries. How 20th century!

Today, patients have far more information available to them, and they expect to participate in making decisions about their health and their treatment. When the doctor is enthusiastic about shared decision-making, the relationship should go smoothly. But if either the doctor or the patient expects a different type of relationship, there may be problems. How can you resolve them?

Should You Fire Your Doctor?

Sometimes, a patient may discover that she doesn’t like the treatments her doctor has recommended. If a discussion of the options doesn’t yield a more acceptable treatment she feels she can follow, she may need to seek a different doctor. What is the best way to do this? How do you make sure that your medical records make the change as well? Do you as a patient have a right to fire your doctor?

Will Your Doctor Fire You?

Occasionally, a doctor will tell a patient that unless he follows through on the medical recommendations, he will no longer be welcome as a patient. Does a doctor have a right to do this? When is this action justified?

A doctor-patient relationship is two-sided. Patients who skip appointments or fail to pay their bills can expect consequences from that behavior. Likewise, doctors who appear uninterested in a patient’s health concerns may also anticipate that the patient could react. We get perspectives from both sides of the stethoscope.

JAMA has just published a viewpoint on Trust in Health Care that is relevant to the relationship between patients and healthcare providers (Jan. 24, 2019).

This Week’s Guests:

Trisha Torrey founded Every Patient’s Advocate. After a frightening misdiagnosis in 2004, she decided that we all need to learn to take better responsibility for our own medical care. Since no one teaches us to be smart patients, she started on her journey to change that.

Since then she has written 6 books, including her You Bet Your Life books, and has worked toward development of an entirely new profession – that of independent, professional healthcare advocate.
You Bet Your Life! The 10 Mistakes Every Patient Makes: How to Fix Them to Get the Healthcare You Deserve
You Bet Your Life! The Top 10 Reasons You Need a Professional Patient Advocate by Your Side
Her websites include: EveryPatientsAdvocate.comwww.AdvoConnection.com/blogYouBetYourLifeBooks.com and www.AdvoConnection.com

David Meyers, MD, is the Chief Medical Officer (CMO) of the Agency for Healthcare Research and Quality, where he assists in strategic planning. He also leads AHRQ’s response to the nation’s opioid crisis and directs EvidenceNOW, AHRQ’s $110 million initiative to help primary care practices improve the heart health of their patients through quality improvement support and the implementation of new evidence.

Prior to his appointment as CMO, he directed AHRQ’s Center for Evidence and Practice Improvement. He also has led the Agency’s primary care Practice-Based Research Network initiatives and served as the Acting Scientific Director for the U.S. Preventive Services Task Force.

Before joining AHRQ in 2004, he practiced family medicine, including maternity care, in a community health center in southeast Washington, D.C., and directed the Georgetown University Department of Family Medicine’s practice-based research network, CAPRICORN. He is a graduate of the University of Pennsylvania School of Medicine and completed his family medicine residency at Providence Hospital/Georgetown University. After residency, he completed fellowship training in primary care health policy and research in the Department of Family Medicine at Georgetown University.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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Air Date:January 26, 2019

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  1. Cherish Life
    New Bern, NC
    Reply

    I have “fired” two doctors and have nearly fired a third doctor.

    I. Doctor #1, Oncologist #1
    This doctor was fired because:
    A). S/he was 3-hours away (round-trip).
    B). Sent letters “informing” as to when my next appointment would be held (instead of allowing me to schedule my own appointments).
    C). Constantly changed my doctors (in the same practice), without warning. Because I was also seeing a team of doctors in my city of residence and was in the whirlwind of cancer treatments, this became very confusing.
    D). Requested to cancel/reschedule 68% of my appointments within 2.5 years (see A-B, above).
    E). Never communicated with me about why these changes were being made.
    In hindsight, I suspect that Oncologist #1 was going through her own crisis. Thankfully, Oncologist #2 has been wonderful.

    II. Doctor #2, Oncologic Surgeon
    This doctor was fired because:
    A). S/he was 3-hours away (round-trip).
    B). Sent letters “informing” as to when my next appointment would be held (instead of allowing me to schedule my own appointments).
    C). 4-5 years after my surgery, this doctor changed the appointment-hour and wait-time for my appointments.
    *Final Appointment #1 required a 3-hour wait. I finally left the office without ever seeing the doctor because of a prior commitment.
    *Final Appointment #2 required a 4+ hour wait. When I entered the office at 1:20 for my 1:40 appointment, the waiting room was packed.
    *At 2:00, the receptionist informed me that there would be a 1+-hour delay.
    *I asked if I could leave and grab lunch since 1). There was a delay. 2). My early morning mammogram (scheduled by this office) was delayed due to technical problems and 3). I had not eaten anything in 8-hours.
    *The receptionist informed me that I could leave and get lunch, but that I would “lose (my) place in line” if I left the office.
    *When I pointed-out these issues to my doctor, he did not apologize and only made excuses for the delay.
    *This single doctor’s appointment “cost” nearly 4+ hours of my life.
    D). Large-cities with university medical schools are no guarantee of quality care. I have been much happier with my doctors in New Bern, NC.

  2. Mary
    Reply

    After reading the article, I want to say that you, the patient/patients must be very careful. When you get up to a certain age, and want to fire your dr. and start to look for another dr., many medical clinics will not take you because of your age. My sister-in-law for several years had trouble in finding another dr to take her. Her other dr was just no good. Finally, and I mean finally, she found a new dr that took her and my brother. But it took over 2 years to find a dr.

  3. JamesKig
    Spain
    Reply

    CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

  4. Mary Lou
    Florida
    Reply

    We just fired our doctor. Having just moved to this area, we sought out new friends for recommendations and researched the internet. Finally chose an Internist, who inherited his father’s practice. Many things set off alarms–condescending attitude and abrupt to the point of rudeness and unfriendly demeanor– but the reason we finally fired him after only three visits was because he marked some lab tests as “Medically Unnecessary” without advising us they were not necessary or that this was what he was going to do. Being new, we explained that our previous doctor always ordered these certain tests annually. He refused one, but ordered the others.

    When we received a bill for over $300, we found out that he had coded some of the tests as Medically Unnecessary. We gave him the benefit of the doubt when his office manager said they were mis-coded….and that doctors make mistakes sometimes. When we said we were not going back to him until this was corrected, they promised to correct. But it was never corrected and we waited beyond the date we could appeal through Medicare. We learned that he made a note in my husband’s file that we had requested the tests.

    If he had just explained that he didn’t think we needed these tests, we would have accepted that. But, instead, he showed us who’s in charge and thought he would teach us a lesson to not ask for something he didn’t suggest. So Unprofessional. We were so disappointed and wonder now how such a doctor survives. I guess elderly patients, for sure, realize they are vulnerable and are too afraid to question someone they want to trust for their health. Very sad.

  5. Kate
    NC
    Reply

    I was listening this morning and agreeing with your first guest (I missed the second as I had to work). It would be lovely to be able to assess if a physician is a good fit for you but, how can that realistically be done when it takes a new visit appointment ($250 out of pocket) to even talk to them? I have been without a steady PCP for 2 years and had one picked out but he was moved by the large health system he worked for. I am looking for someone who is willing to be a partner and work together on a healthy future but how can that realistically be done?

  6. Virginia
    GA
    Reply

    I am the luckiest of people because my internist is everything a doctor should be. I can ask him anything and he never makes fun of some of my questions. BUT, he is the exception not the rule. Our hospital has Hospitalists which means strangers, who change shifts every 12 hours, handling your hospital care. They all follow Care Plans and woe unto you if you vary from that because they are then done. We are all lucky to survive hospital stays. And yes, change doctors if possible because you just might get lucky. I changed Oncologists mid-stream and was glad I did, but it took nerve! She was in the same practice so no record transferring etc.. Remember that you should do all this without making a scene or being slanderous which is not good for anyone concerned. Advocate for yourself.

  7. Tom
    Virginia
    Reply

    Accross the street from Duke medical school, is the Durham VA. I injured my knee, so after an ER visit on a Sunday, when no one could do an MRI on my knee, I had an appointment in the ortho clinic to schedule one. During the months long nightmare I experienced in that clinic one quote will never leave me. “You don’t need an MRI to diagnosis a knee injury, we did it for years before MRI’s.”

    Also, how is it even remotely ok for a doctor to practice medicine in a VA Medical Center and not be board certified in that state?

    They will not be touching my knee and I have transferred all my care away from that facility. Duke doctors work there. I was shocked to say the least. Right or wrong, I lost all confidence in Duke as a medical facility as well.

  8. Michael
    James Island, SC
    Reply

    Show #1150: I want to mention a problem I’ve encountered and was unable to resolve with two of my primary care physicians. I had to leave these physicians because of their assistants. When results of tests were relayed by telephone by the assistants, there were times I could not understand the message. When calling back for clarification, you typically were required to leave a message and request a call-back.

    Unfortunately, the return calls was never made so finally I complained to their office managers but nothing was ever done to correct the situation. I thought I had a good relationship with both doctors but it appeared that their relationship with their assistants were more important than correcting the problem. As a result, I felt I was left with little alternative but to seek another physician. Thank you for your consideration.

  9. Jamie
    Virginia
    Reply

    At age 87 I have had serious problems, first from a pcp who did not know how to read thyroid testing and recently, after much research with several symptoms leaving me very fatigued and foggy brained, I realized the cause was probably Crestor.

    After getting off it one symptom disappeared in 3 days. After five months, I am slowly getting better. My present pcp never asked about symptoms, (had about 90% of those listed on Mayo clinic site , etc.), and suggested my only problem was arthritis and several of his patients my age were happy in a nursing home! I am not ready for living in one corner of a shared room and still actively pursue several interests.

  10. Mary
    Albany, NY
    Reply

    I am struggling with the decision to “fire” my doctor.

    My previous m.d. was a wonderful man who listened to my situations and gave good advice. He retired last year and, before he did, he recommended a female doctort for me and a male doctor for my husband; both M.D.s are young, starting their careers.

    Both my husband and I have visited our respective new doctors on several occasions since we began seeing them. Husband is satisfied with his new M.D. I, on the other hand, am not only not satisfied but somewhat alarmed about my new physician. I’m a senior citizen who has several health issues and need to see a number of specialists; my new doctor is an internist.

    I set up an appointment to see her for an annual physical exam for which I had to wait six months. On the day of the exam, I was very happy to be seeing this doctor and get a complete exam. I waited for her in the exam room for one hour after my appointment time; when she arrived in the room, I said I had several questions for her. Her response was that she was behind in her appointment times and “didn’t have time for questions.” !!!!

    Somehow, as she questioned me about my health and recorded my answers in her computer, I managed to ask my questions and received very terse responses. Then she moved on to the exam. She touched several different parts of my body, but did not do a number of things that are part of a normal annual physical examination. The entire exam took about NINETY SECONDS. No exaggeration.

    Then she complained that our city was a “medical wasteland” and that she couldn’t wait to return to the large metropolitan area she had relocated from. Maybe it was a bad day for her, but I was truly shocked and turned off and very upset that THIS was my internist, the person I was supposed to trust with my health, my body, my life.

    I have another appointment with her in a few months. Maybe I’ll chalk up that bad experience to the doc having a very bad day; or maybe I’ll get a different M.D. before then.

  11. Marie
    San Diego
    Reply

    I like everything about my doctor, but I’ve recently learned that he supports and prescribes the death with dignity meds that I oppose. When I asked him why he did that instead of favoring the “right to try” approach, he told me he knew nothing of it. This has given me serious second thoughts although I’m not in need of, nor a candidate for, these meds.

  12. Mike
    Charlotte, NC
    Reply

    My cardiologist was wonderful, but the administrative folks in his office were a disaster. I mentioned this to him several times and he said that he understood and would attempt to fix it, but he was in a very large practice with lots of inertia. Making an annual appointment required multiple calls and often having to get the physician in the middle of the process!!! Getting access to my records (even though they said I was entitled to them) required continuous headaches after every procedure. I filled out Every survey, with my name and phone number and asked them to call me for further details; I never received a call.

    After several years of this inconvenience I finally left the practice and went to another office, owned by the same corporate hospital group. I explained to my new cardiologist why I left and he said he would explain it to my former doctor.

  13. Bob
    South Carolina
    Reply

    This is a huge problem in that finding a doctor that can not only work “outside the current medical box” so to speak, but one who will consider alternative medicines. In the past most primary care doctors and internists often disregarded conditions that were not recognized by the current medical teachings. Years ago hypoglycemia was such a medical condition where the doctors we visited would laugh or smirk when this condition was suggested. It took many years for them to finally faced reality.

    I find that most doctors are in the “throw a pill at it” mode and therefore won’t entertain alternative solutions. This is sad. In two cases that I’m very familiar with the patients were given med after med and test after test for specific conditions only to find out that a simple diet change resolved their problems. Recently I’ve had a doctor highly recommend a vaccination as if it was absolutely necessary. Upon looking up the actual research reports on this item what the doctor was saying was not true, and the side affects were not even mentioned.

    So “YES”, you should fire your doctor if he/she is not providing the service properly. That is your right. Do your research, and especially get input from patient feedback in order to make your decisions.

  14. Mary Jane
    NYC
    Reply

    My two cents: We patients are the customers, and are entitled to expect good service. Second,
    we patients should accept responsibility for our healthcare, informing ourselves about choices, developing awareness of our bodies, availing ourselves of the abundance of information. Even though I said “two cents,” here’s a third: doctors are not always right, and their authority is only that which we confer upon them.

  15. Duke
    14209
    Reply

    When I “messaged” my doctor that I wanted to schedule the appointment to discuss my EOL [end of life] preferences that I understood is covered by Medicare, his complete response was: “Not in this practice.” So I “fired” him. I sent him a letter via USPS thanking him for having taken care of me so well for so long — he is a good diagnostician — but added something to the effect that I was not comfortable dealing with someone whose ethics and values differed so sharply from mine.

  16. Dave
    Asheville
    Reply

    I am having serious reservations about continuing with my doctor, as I wonder if he is paying attention. As you and all the drug ads on TV state “Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm”. I decided to stop taking two medications , that he prescribed, because I did not think them necessary. On follow up visits the nurse always asks about the drugs I am taken. I did not list these two drugs. The doctor did not question or ask about them.

  17. Linda
    Sparta NJ
    Reply

    Get a 2nd opinion if you do not feel comfortable. This goes for Docs that treat patients in Nursing Homes as well. I had to do this, as the Doc would prescribe without seeing me. He visited the Home and went into the Chart Room. I had to rent ambulances to go see a doctor who would actually examine and check out health concerns. Cost me a ton of money but at least an exam was given. This happened in 2 homes. You have to be your own advocate.

  18. mary
    Indiana
    Reply

    my last internist sent me a certified letter saying that he would no longer be my doctor. it was a relief as i wasn’t pleased with him either. For 10 yrs now i have someone who is willing to work with me in caring for my mind and body. I am well informed. It is a team effort. The trend today is sharing facts that you know abt your body that is unknown to him/her and then they will share medical facts unknown to you. It works!

  19. luke
    Reply

    Doctors are now afraid of poor satisfaction surveys affecting Medicare reimbursement from the government.

  20. george m.
    West Virginia
    Reply

    Doctors are only human with specialized education and experience. The personalities of doctor and patient need to mesh for there to be a mutual effort on handling health related issues. Nurse practitioners are a vital part of the medical team since they, in my humble opinion, are the equivalent of the old time MD general practice family doctor of many decades ago.

    Patients like myself can become irritants to the medical profession if we don’t observe proper respect for the members of the medical team. It is offensive for a novice to tell the trained professional that they know something better than the medically trained person. I approached it this way: I told my doctor about some new research I stumbled upon and interested me. Then I asked him to clear up some questions I have and that it might be of use in one of my treatments. This approach presented the question in a respectful manner, and I acknowledged my doctor’s level of experience. The doctor was pleased to have a patient who also shared medical interest yet was not treading on the doctor’s turf.

    I never fired a doctor. Only our moving out of state caused us to seek new team. 18 years ago a doctor helped me to quit smoking. He moved away but I tracked him down recently and left a message of thanks.

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