Ending a Patient-Provider Relationship Well vs Committing Medical Adultery

Another Day Another Eye Exam - Nomadic LassBlog post by Colin Hung

Last week, I did something that I am now feeling very guilty about. On Monday, I decided to start seeing a new ophthalmologist without telling my previous doctor that I had decided to move on. At first I thought this wouldn’t be a big deal. I haven’t been seeing my regular ophthalmologist as regularly as I should have and over the past few years it had become very inconvenient to arrange time to see each other. This entire week I’ve been feeling awful about my decision. I feel like I’ve just committed the medical equivalent of adultery.

In a Wall Street Journal article, Kristen Gerencher offered five reasons for leaving your doctor:

  1. Your leave with more questions than answers
  2. Your doctor dismisses your input and questions
  3. Your doctor has misdiagnosed you
  4. Your doctor balks at a second opinion
  5. Your doctor isn’t certified

Gerencher’s reasons all seem very logical, especially #2 and #5, but her third reason “misdiagnosis” caused a bit of controversy. In a follow-up blog, Dr. Kevin Campbell, posted his take on #3:

Medicine is not a perfect science.  Consider if your physician has carefully considered your problem and has provided a well thought out differential diagnosis before leaving due to a misdiagnosis.  It is important that communication continues during the process of misdiagnosis.  If there is no good communication at this stage, it may be time to choose another provider.

In his KevinMD blog, Dominic Carone offers ten ways that doctors can lose patients. My favourites are #5 Disrespectful Staff and #4 Drab/Dreary Office Space (the subject of a recent #hcldr chat).

In my particular case, however, none of the reasons cited by Gerencher or Carone applied. My ophthalmologist provided me excellent care. He was always on time, answered all my questions (of which there were many), provided good advice and was pleasant to talk to. His staff were friendly and his office was always up to date.

My reason was simply a problem of logistics. When I started seeing my regular ophthalmologist, his office was conveniently located between my home and work. I was living downtown at the time so going to his office was a pleasant 15min walk. Several years ago, however, I moved far outside the city and now his office is about an hour’s drive away.

In addition, my doctor had become much more involved with teaching as well as other endeavours and had been gradually decreasing his office hours. As one of his long-time patients, I was not shifted to a different doctor within his practice. But the days and times he was “in” kept decreasing to the point where his hours were just too difficult for me to accommodate.

For a long time, I shrugged off the distance and the inconvenient office hours because of the excellent care I was receiving. Then about 3 years ago, I had a bit of an “eye emergency” and had to go to the ophthalmologist that my children go to see (thank you Canadian universal healthcare!). This new doc was very nice, took his time with me, answered all my questions and gave me a prescription that worked wonders. This alone ranked him as “excellent” in my books, but it was something he said at the end of my appointment with him that put him into the “stellar” category. As we were wrapping up he asked me how my son was reacting to his new prescription and whether the glasses were still “too powerful” (something my son had said during his last visit).

I never forgot how much this doctor cared and three years later I decided to switch. I need to see an ophthalmologist regularly and my new doc is very conveniently located and has hours that are easier for me to accommodate. According to Jessie Gruman, this is exactly what we, as patients, should be doing – be more active in seeking harmony with our clinicians:

Patient-physician incompatibility is a barrier to our participation in our health and health care that has no direct policy solutions…The bulk of the change will probably have to originate with us.  And it is likely that we will only take this task on when we learn how much more effectively we are able to care for ourselves when our efforts are in harmony with clinicians we like and trust and whom we feel are working with us to live as long and as well as we can.

I haven’t, however, told my regular ophthalmologist about my decision and I feel horribly guilty about that. I think I will write a nice letter, thank him for years of great care, explain how difficult it is to match schedules and wish him well. Better late than not at all right? I hope he’ll understand that I needed to move on.

This week with the help of the wonderful #hcldr community, I thought we could discuss this aspect of patient-physician relationships – how they end and how it impacts both patients and providers.

Join us Tuesday August 12th 2014 at 8:30pm Eastern Time (for your local time click here) for the weekly #hcldr tweetchat where we will be discussing:

  • T1 What can patients/physicians do if they feel they are incompatible or unable to continue?
  • T2 Should patients let docs know they are ending relationship? Would docs appreciate knowing?
  • T3 How do you feel patients & providers are impacted by decisions to end the relationship?
  • CT One thing you learned tonight that you can take back & use to help a patient or your organization tomorrow?

Resources

“When Should You Fire Your Doctor?”, Kristen Gerencher, The Wall Street Journal, June 29 2013, http://online.wsj.com/news/articles/SB10001424127887324328204578571640215952804, accessed August 10 2014

“Considering A Divorce From Your Doctor? Here’s What You Need to Know”, Kevin Campbell MD, July 5 2013, http://drkevincampbellmd.wordpress.com/2013/07/05/considering-a-divorce-from-your-doctor-heres-what-you-need-to-know/, accessed August 10 2014

“When patients ‘divorce’ their doctors”, Dr. Suzanne Koven, Boston Globe, December 24 2012, http://www.bostonglobe.com/lifestyle/health-wellness/2012/12/24/the-doctor-patient-divorce/uWTiX8CQ2zB21OhN6rMHBP/story.html, accessed August 10 2014

“10 Reasons Why You Need To Change Doctors”, Dominic Carone, KevinMD.com, October 1 2011, http://www.kevinmd.com/blog/2011/10/10-reasons-change-doctors.html, accessed August 10 2014

“10 Ways Doctors Can Lose Their Patients”, Dominic Carone, KevinMD.com, November 28 2011, http://www.kevinmd.com/blog/2011/11/10-ways-doctors-lose-patients.html, accessed August 10 2014

“Why patients should change their doctor”, Steve Wilkins, KevinMD.com, July 19 2011, http://www.kevinmd.com/blog/2011/07/patients-change-doctor.html, accessed August 10 2014

“Firing Your Doctor Carries Emotional Weight”, Jessie Gruman, KevinMD.com, July 10 2013, http://www.kevinmd.com/blog/2013/07/firing-doctor-carries-emotional-weight.html, accessed August 10 2014

“Say goodbye to your patients the right way”, Jill of all Trades MD, KevinMD.com, December 23 2010, http://www.kevinmd.com/blog/2010/12/goodbye-patients-2.html, accessed August 10 2014

Image Credit

Another Day, Another Eye Exam – Nomadic Lass

https://www.flickr.com/photos/nomadic_lass/8358691955/in/photolist-dJCtUx-aVSoUP-7AHzTH-Bnb7F-5So6ss-kyzJtn-36zGRq-8H4rGT-aVShxn-36v4DM-aVSneP-66DDfN-e8qGxb-aCiZVg-6vSKWP-5coA6y-9BH9qP-2yCN8-nXevD-4cCSVW-nXevT-uhRvE-6eCG9c-5Xm58e-6HcHV3-9v6KFE-9v3KiB-AuZtB-6NEQ9Q-55qvtm-4y1NZa-55miPM-5p8h6t-6Zp4vx-cHgszd-dcFivQ-AvScX-4JQqBa-7ZdycS-7m3EcD-2sjMuD-7HPnaf-7fXCZJ-98tkFW-a1VTko-qrZmc-qVjGr-82jBJ1-4NTL6g-2TSkiU

 

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One comment

  1. […] Choosing a new provider, August 2014 […]

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