“It is more important to know the patient who has the disease, than the disease that has the patient”
Sir William Osler
Lately I’ve been concerned about the “doctor hopping” that has been going on. Years ago people picked a family doctor and stuck with them, sometimes for generations. In addition to the bond that developed, this type of long term medical relationship had other tremendous benefits. The doctor knew you, not only your medical history but also your individual response to injury, illness, medications and ailments. Things that we now know are as unique as your fingerprint.
This was a part of “mind-body medicine” (before it had a name)-the appreciation that your personality and mindset could impact your response and recovery from illness as well as what might be the best treatment for you as an individual. That knowledge is true healing power. It’s interesting that two patients with exactly the same diagnosis can be best served by different treatments. Your doctor really getting to know you has other distinct advantages. It is important to know who can’t afford and won’t buy their much needed medications. Who is a chronic complainer and should not be over treated unnecessarily. Who is so stoic that when then do show up in your office with even mild aches and pains, you’d better listen. Equally important, your patient gets to know and trust you, a critical element of success in the physician-patient relationship. These things do not occur when you play “musical chairs” medicine, getting a new doc for each new ailment.
Times have changed in that regard. I believe it all started when HMOs and insurers started telling patients (“members” to them) who they could and could not see. Directories of “Participating Providers” emerged and the movement started. Today, individuals are being forced into “narrow networks” in efforts to supposedly control costs. “If you like your doctor, you can keep your doctor…” well, not really. In some instances you are cared for by a large group practice and you see the doctor du jour. Sometimes you don’t even see your physician, with care being rendered more and more by physician “extenders” like nurse practitioners and physician assistants (note- this can be very reasonable at times). Others seek far too much routine care in the local emergency rooms where one really is just a number, and care is impersonal and fragmented since your past history and records are rarely available. Also, in non-emergent situations, it truly is a waste of limited precious healthcare resources. Not too long ago, in certain parts of the country, like my region in Pennsylvania, we suddenly lost doctors (especially surgeons) who were forced to pack up and leave because of out of control malpractice insurance rates. More recently I’ve seen really high quality physicians, with long-standing established practices, fired (with little or no notice) by their new employers (hospital and/or hospital system) because they are not “making their numbers” (i.e. not seeing enough patients or meeting their quotas). So whatever the reason, physicians can be forced out of Dodge, leaving their patients in the lurch to find a new doc.
All this leaves you the patient to fend for yourself without the oversight of a Marcus Welby type figure. I believe that ideal care involves a solid relationship with a family doctor who knows you literally inside and out, but also knows when to refer you to top specialists when needed (hopefully sooner rather than later). They are your medical manager that communicates not only with you but also assure proper flow of information to and from others involved in your care. I do not feel, however, that you must always stay with the one who has cared for you especially if there are quality concerns or if they are just not right for you. Get another opinion and give someone else a try.
Years ago a high ranking executive in one of the largest HMOs in the country shared with me his vision for the future of medicine. In his mind, physicians were readily exchangeable. He made the analogy to individuals choosing an airline for travel. They willingly put their lives in the hands of the pilot that they really don’t know. They do know the pilot is “qualified” and that is enough for them. He predicted the same for patients going to the doctor- that they would happily choose anyone on the HMO list. Like most HMO executives, he would have accepted this approach for you but not for him or his family. Pilots are indeed highly qualified and I don’t need to know the ones flying the plane that I board, but I can’t say the same in any way applies to the physician-patient relationship, which I hold close to sacred, as should you-fighting to preserve it.
FitTip
Find a great doctor, one who wants to know more about you the person, and stick with him or her- grow old healthy together.
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