Living Well: Shopping for a Doctor

Reprinted from PN October 2000
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Times have changed. Gone are the days of those Marcus Welby-like physicians who delivered you at birth, treated your tonsillitis, set your broken bones when you were growing up, and cared for you as an adult. Now the odds of finding a physician like old Doc Welby are pretty slim?and even Welby himself was fairly clueless when it came to managing spinal-cord injuries (SCIs). That?s why you need to know what you can expect of a physician, how to choose one wisely, and what?s expected of you. In short, you need to take an active role in your care.

Reasonable Expectations

If you understand what you can reasonably expect of a doctor, it will be easier to select one who can meet your individual needs. Here are a few pointers. You should expect:

????? To receive information you can use and understand. Your doctor should discuss with you?in a nontechnical way?diagnoses, tests, and treatments. He or she should also be able to explain the likely short- and long-term outcomes for any treatment or intervention you choose (or do not choose).

????? To participate in decisions related to your care. Your disability should not prevent your doctor from talking with you as an equal or from treating you as a responsible adult. You have a right to express your concerns, doubts, and fears and to ask questions until you understand what?s going on and what you?re being told. Your physician should allow you a role to determine when to ask for a second opinion and should give you the option to change doctors if you feel your own best interests are not being served.

????? To have adequate access to your doctor. You should be able to get an appointment within a reasonable amount of time. You should know whom to contact if your doctor is unavailable. As a person with a disability, you will find the word ?access? also has some added meanings?not only the typical ramps and wide doorways but also that diagnostic equipment and other machines and services can accommodate you, and that staff is trained to lift, transfer, examine, and treat you with safety and dignity.

????? A physician who will commit to the long haul. You need someone willing to learn about SCI and how it affects?and is affected by?other health issues.

????? To be comfortable with your physician. In his book Healing Words, Larry Dossey says to ask yourself, Does my doctor make me feel better or worse when I am around him or her?

Choosing Wisely

Use the above information when you visit and talk with potential physicians. It?s not likely that any physician will be everything that you want. This is why you need to decide what you?ll compromise on.

Realistically, it may not be possible to find a physician who is an expert in SCI, especially if you live outside a large urban area. However, you should be able to find one who will learn, work with you, and, most importantly, consult with other physicians who may have the experience your prospective doctor lacks.

Your Role

The doctor-patient relationship is key to making things work, but it?s not just the doctor who?s going to do the healing. The doctor, you, your family, and other healthcare professionals all share in the responsibility.

You are the best judge of what?s going on in your body, so you must actively participate in the process. You cannot afford to be passive and unsharing; you must make sure your doctor hears you. You need to:

????? Share your full medical history, information about other doctors you may be seeing, medications you use or have used, and your smoking, alcohol, or drug history. If there is anything about your lifestyle that may impact your doctor?s efforts to treat you safely and effectively, you need to share that also.

????? Tell your doc everything you know about your injury and disability, its possible long-term effects, and complications. Be thorough and accurate in describing your symptoms and any complications.

????? Follow your doctor?s directions closely, or make sure your doctor knows and understands why you cannot do so.

????? Keep scheduled appointments, pay bills on time, and limit calls unless they are vital to your well-being. Remember: If you don?t do these things, your physician has the right to refuse to treat you.

Getting the Most out of Doctor Visits

Doctors are busy. You can do several things to decrease your chances of leaving frustrated and disappointed.

First, before you even arrive for your appointment, think about the purpose of your visit. Have your questions already written out. Try to ask specific ones, and don?t be embarrassed if you don?t understand something.

For example: What is the purpose of a particular treatment or medication? Does your SCI put you at risk for other-than-normal side effects? Will short or long-term effects?like weakness or fatigue?cause you to need more help at home? Do you need to worry about drug interactions? Will your bowel or bladder be affected? If your physician doesn?t know the answers, ask him or her to find out.

Are alternative treatments or medications available? If so, what are their advantages or disadvantages? If you choose not to treat your problem, what could happen?

If tests are involved, how will they help diagnosis or therapy? Does your SCI make any planned procedures or surgeries riskier? What about safer or easier ways to accomplish the same things? Will anesthesia be used and what may be the complications? How will your skin be protected? Will you need to be lifted? Will you need extra help at home for the prep or afterward?

What is the recovery process? Will you need additional help during that time? Will your bowel or bladder management need to be changed during that time?

What are the costs? What will health insurance cover?

A common thread runs through all these points: You need to help your doctor understand the unique SCI angle and how his or her recommendations, tests, and interventions might affect you differently from an able-bodied person. For example, ?no lifting for six weeks? is a common post-surgical restriction. You will need to explain to the doctor what this means to you. You can?t transfer, can?t do shifts, can?t push up hills, etc. Will your doctor recommend that your insurance company cover a paid helper? Or help you rent a power chair or custom mattress?

And, if the problem, diagnostic test, or procedure you?re facing is not urgent, you may want to ask about consulting another physician. Your best bet may be to get that second opinion from a rehabilitation doctor or a physician who has had a history of treating SCI survivors.

Remember, you and your doctor should see your relationship as a partnership. You both have rights and responsibilities. This should be key to making things work for you.

If we had to reduce the advice in this column to two words, they would be: Ask questions!


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Living Well: Shopping for a Doctor


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