In the last blog, we looked at things you can do to advocate for yourself before a visit with a doctor or any medical practitioner. This post covers some things to pay attention to while you are in the office, to get a feel for whether or not this practitioner is a good fit for you and to get the most out of your visit.
Things to Pay Attention to While You are There:
1. How are you treated by the office staff? Are they friendly, cheerful, capable? Or are they rushed, distant, condescending? A lot of information can be gleaned from noticing the office staff’s overall attitude towards patients…and towards each other. A general feeling of happiness and satisfaction bodes well for a good working relationship between physicians and upper management with nurses and other office staff. An unhappy crew can indicate fundamental unrest and dissatisfaction among the “underlings”, which can be a reflection on how they are treated by those in higher authority. There are of course multiple exceptions to this rule, as the staff may be treated with respect, but also be extremely busy and harried. It’s definitely not a perfect correlation…but I HAVE noticed a connection between how the staff treats me, other patients, and each other with an overall sense of competence and good will in the office. My foot surgeon is a perfect example. I like him and everyone associated with him. From the reception staff, to the nurses, to the PA (Physicians Assistant), I have not ONCE had a bad visit or feeling of negativity associated with visits to see him or his staff. Everything about these visits has been positive, and it makes it much less anxiety producing when things like surgery are on the agenda. I have confidence in all steps of the process, and I know that I will be listened to and treated with respect.
2. Look for a good rapport with your physician or practitioner. As indicated above, I have this with my foot surgeon. I feel heard, understood, and valued as a human being. As you are being evaluated by a practitioner, ask yourself the following questions:
- Does the practitioner hear and respect my concerns, or do they just pat me on the hand and reassure me that all will be OK and I shouldn’t worry?
- If they don’t know something, do they say so, or do they need to play God and know it all?
- Do I feel comfortable in the presence of this person, or somehow “less than”?
- Do they speak my language? If I don’t understand something, do they take the time to explain it in language I can understand?
- Do they get what’s most important to me, in terms of clarity of diagnosis, treatment plan, desired outcome?
- How well do I feel understood?
This last one is hard to pinpoint, but important to pay attention to. What matters to you should matter to the doctor, to the degree that it relates to what you are being seen for. My recent ACL knee surgery provides a case in point in which this didn’t happen from the get go, and I ended up with an unsatisfactory surgery and experience as a result of not paying attention to this feeling of disconnect with the surgeon. As mentioned, I had an ACL repair and medial and lateral meniscus repairs last February. For various reasons, I chose to go with a doctor who I didn’t have a good rapport with. I went with this doctor as he was in the same office as my foot surgeon, and my foot and knee surgeries were scheduled five weeks apart and required coordination of care. I did not feel heard by the knee surgeon, and he didn’t understand my level of commitment to a very active lifestyle. As a result, I ended up with an ACL repair that was not sufficient to withstand the amount of activity I routinely undergo. Even though I was forthcoming about my hiking and backpacking, as well as desire to be able to run some, I received a cadaver tendon for a graft, which I have since learned is not the best choice for active individuals. Since I was an “over 50 female”, I think he just assumed I wasn’t that active, and went with what he was most comfortable or familiar with. The results were not stellar, and have likely contributed to the recent degeneration of the knee and subsequent follow-up arthroscopic surgery. I am not placing blame here, as I was equally as much to blame for not listening to what my intuition was telling me. But I did learn something for sure, and that is to always pay attention to that inner voice that tells you when a provider doesn’t feel like a good fit for you.
3. How many layers of separation exist between doctor and patient? Is the doctor accessible if needed for a follow-up phone call, or must you always go through a receptionist, nurse, or PA? What is the office policy on emailing…directly to the doctor, to his or her staff, or not at all? If there is a problem following surgery or between visits, what is the protocol? I have had results all over the board with this. In one of my offices, thankfully the one I have the most providers in, I can email directly to the doctor, nurse, or staff…and I have always gotten a response. Other offices, I have called on a concern well within the “call your physician if you experience any of the following…”, and received no call back. I find this troubling, and it makes me feel like I am an inconvenience or a “needy” patient…neither of which I want to be viewed as when I have a legitimate concern. When I get a direct response to a direct question, I feel heard and validated. When there is no response, I lose some respect for the practitioner and/or their office. I may also start to question the legitimacy of my concern, and hesitate to bring it up again. This can undermine the effectiveness of doctor/patient communication, and in the long run the effectiveness of overall health care. I realize fully that doctors are busy people, and they have to balance the reality of their available time and resources with the needs of the patient. But dismissing a patient by not returning a call, or at least having an office staff do so, leaves a bad taste in the mouth of the patient.
4. What do you walk away from the visit with? Clear answers? Possible alternative therapies to try? Greater understanding? A plan of action? Just medications? If medications, do you understand the risks, benefits, and possible side effects? Are treatment options clearly outlined, with a sense of cost attached and/or possible alternative, lower cost options? There are a hundred other questions, and just as many “right” and “wrong” answers. Again, it comes back to that question to ponder before your visit, “What is my objective for this visit?” And afterwards, “Was that objective met?” In thinking back to my recent ER visit to rule out a post-surgical knee infection, once the determination was made that there was no infection, I got to witness the ER doc struggle with how to explain my symptoms. He wanted to offer me both assurance and explanation…but could only offer assurance that there was no infection. Instead of just sending me away, which would have been OK, I let the nurse struggle me into a knee immobilizer…which hurt intensely and came off just as soon as I walked in the door at home. It’s like they had to send me with something. In retrospect, I could and should have said “I only needed reassurance, and you gave me that. I am OK with pain and swelling, and I will take your word for it that both will subside in time. Thank you for taking good care of me.” I wish I had thought to say that…it would have simplified things and left me without yet another knee brace taking up space in my house!
5. How are the questions of cost and insurance coverage handled? This is another HUGE topic which I would rather not even touch on were it not such a big reality of how health care coverage plays out. It’s actually a blog post in and of itself, as the questions and time spent haggling over insurance costs and benefits can be astounding. All I can say with assurance is find out all you can, about what’s covered and what’s not, and what you need to do as the patient to insure that what you expect to be paid and what actually gets paid are the same thing. I have spent countless hours on the phone with my insurance company this past year, mostly AFTER the fact, trying to sort out where the communication breakdowns and misunderstandings took place in what I expected to be paid for and what was actually paid…and even more hours on phone calls where my insurance was clearly at fault, and I had to follow up two, three and four times to actually get payment. I am not even sure how I would do it differently in retrospect…many unexpected events led to all of the hassles. But I have learned that checking everything out and assuming nothing is a good, although highly time-consuming, strategy!
In summary, pay attention to and trust your instincts about your provider and his or her office staff. If something feels unclear or unsatisfactory, ask for more information. Most importantly, if you feel in your gut that this provider is not a good match for you, pay attention to that and act accordingly.