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Thursday, February 23, 2012

Dr. Shopping- a No or a Yes?

The term "Dr. Shopping" comes up frequently.

When you have a Dr. you like and trust, you don't need to go further. However, There are good reasons to try another Dr.

1)If you have an undiagnosed disease- 50 percent of the Drs. you see will try to convince you that you are just depressed and pills will fix all. The other 50 percent recognize that there is a disease process and encourage you to hunt for an answer.

2)Personality clash. Fact is, Drs. are humans and their personalities greatly influence how they do medicine. I am noticing that more and more practices are putting up autobiographies or bio's on each Dr. It does help us decide if we might click with a Dr. We are not runners, mountain climbers, and if the Dr. is, they tend to either not understand why we would not embrace their lifestyle, or they judge us- hands down societal boundaries and expectations are not left at the door of a dr. office, no matter how badly we want to believe our Drs. are past that.

3)Busy practice. If you start with a practice and despite really liking a Dr. you find that they are not available when needed or are unorganized and it can take weeks to get a simple prescription filled- probably time to change Drs.

4)Treatment. Today we all google. Many of us go into the Dr. office understanding our disease/issue and what treatments are available. Sometimes as the patient we are anti intervention unless no choice, some of us want the quickest fix, some of us want the newest fix.. As patients we should work harder to trust our Dr.s judgement, but he/she needs to work a little harder to listen to our needs- no two patients are a like.

5)Sub speciality. So you need to see a Neurologist because you have MS. Your internal medicine Dr. gives you a name. You show up to your appointment and this Neurologist doesn't seem to know a lot about MS. IF it is a good Neurologist, he/she will say that though they understand the basics, MS is not their sub speciality but they know a guy who is MS focused. A bad Neurologist will not refer you to someone who has the expertise to help you. Some Neurologists focus on MD, some on Parkinsons, some on Mito... you often can research the Dr. and see if they have a sub speciality or special interest, but sometimes you have to pay for that first appointment to find out. Even within the Mito Specialists they often specialize in different types of Mito. So one Mito Specialist may be most helpful if you have GI issues, where another is more focused on the metabolic aspects. It seems that each year Specialists become more and more specialized in certain aspects of their speciality. Insurance companies do not make the distinction though, and based on some of the referrals we have had from various family and Ped Drs. their local Dr. guide doesn't clarify sub speciality either.

6)The "team" Dr. vs the "independent". Some Drs. rely very heavily on their team. If you see Drs. from various Teams it can be a problem. When you have a rare or complex disease and personality to boot, it can be difficult getting a specialist to feel comfortable working with drs. from other Teams. Just like a strong office, these specialists develop strong working relationships, communication and methods. It works for them and makes them better Drs. But, if you take their team away, it increases their work load since they will have to reach outside their team and develop new relationships- I am more of the type of person that though I love my "team" I enjoy getting to know other teams- new teams offer new ideas and methods which make me wiser. However, not all people are programmed that way.

7)Sometimes good medicine is good medicine. You might hate the Drs. personality, but hands down they are brilliant. I find these type of Drs. tend to fall into the Diagnostic Medicine world- they are happiest hunting down the issues and giving you to someone else for treatment and follow up- this works for me. Sometimes though, they despite having no personality want to continue to treat or follow up(usually from an academic perspective)and usually that triggers Dr. shopping for me! :-)

8) There a few reasons that Dr. Shopping is universally bad. If you are shopping to find a dr. to give you drugs that you have an addiction to or are not healthy for your body. If you are needing attention and actually enjoy the medical drama(yep, I know people who go for every little bit of snot)...

9) I also understand that some diseases are hard to diagnose and sometimes a Dr. has to see a pattern. It would not matter who you saw, they would all need multiple appointments to get enough clinical data to make a diagnosis-again another good reason not to Dr. Shop.

10) At the end of the day, you are the one living with an illness or disease. You are paying for the time spent with Dr. If you are not getting the care you are paying for- find a new Dr. I think you are doing the Dr. a favor too- they probably are well aware that you don't trust them or are not happy with their style,method etc- leaving their practice opens a slot for a patient who would benefit more from his or her time.

11) I wish there were better directories for patients looking for the "right" fit. Specialists need to have their sub speciality posted right next to their speciality instead of buried in their bio's. Insurance companies need to post Specialists sub specialities- it would save them a lot of money if we did not have to try a few different specialists to get to the 1 that can actually help us. All Drs. should have a bio posted that we don't have to dig the internet to find. I would also love to see average times for how long it takes to get in for the first appointment(Texas Children's can take in excess of 6 months if they do not feel you are an emergency)even if you are urgent it can still take 2 months. There are a lot of things Drs. could do to make sure they get the patients they are best trained to see- and it would save me and my insurance company a lot of time and money.


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