Doctor Shopping Shouldn't Happen Inside a Medical Practice
Doctor Shopping Shouldn't Happen Inside a Medical Practice
When I finished my fellowship and joined a practice, I was seen, rightfully so, as the new kid on the block. The senior doc had been solo for over 10 years, and was “the man.” Everybody knew of him, all the other physicians referred to him. He got lots of patients through word of mouth.
After all that, his schedule was pretty full — which is why he hired me. So the plan was for me to get all the new patients. Except patients didn’t want to see me, they wanted “the man.” Since they needed to be seen, they settled for me. Most of them were perfectly happy to continue seeing me, but there were others who saw me just to get their foot in the door, then asked to switch to my partner. He didn’t want that any more than I did, so it became our policy that patients couldn’t switch within the practice. With the exception of the emergency visit, or a physician illness, once a patient saw one of us, they could not switch.
Fast forward nine years to when I hired my new associate after having gone solo for a year. Same thing: patients wanted to see me (hmmm, I guess that makes me “the man”), but since the wait to see me was three months, as opposed to two weeks, they would ask if they could see Dr. X and then follow up with me. The answer is no. For many reasons.
First of all, while it is flattering that they want to see me and not her, that request is arbitrary. Secondly, most patients who want to switch after they’ve seen one of us, want to do so because they don’t want to hear what we’ve had to say. The thing is, I trained Dr. X through three years of residency and two years of fellowship. She practices medicine the same way I do. We discuss cases from time to time, and ask each other for opinions, and invariably, we end up hearing the same answers that are already playing in our heads. Third, I already have a very full schedule with my own follow up patients — I can’t add more. Fourth, even though they are not considered new patients, if they switch docs, it’s as if they are new. OK, sure, the history is already in the chart, but seeing someone for the first time always takes more time. Heck, follow-up patients that don’t come back for eight months take longer than ones that come every three months.
Now, I have a patient that would like to switch to Dr. X. It is clear that she doesn’t like me. She doesn’t trust what I say, she doesn’t adhere to my recommendations. She cries at her visits, she argues with me. And she doesn’t understand why I get frustrated. I told her that unfortunately it’s because I actually care. Nonetheless, she still wants to come to this practice, but wants to see Dr. X. Let me point out, she was seeing another endocrinologist before and left him to see me because, as she put it, “he’s an a**hole.” I’m sure she has equally pleasant words for me. Suffice it to say, I personally don’t care if she sees anybody but me, however, I don’t want to set a precedent, and Dr. X doesn’t want her.
My husband doesn’t understand why we don’t let patients switch back and forth, but I think it is a bad idea. I see no good coming of it. Patients will derive no real benefit, and the two of will be pulling our hair out.
In our psychiatry practice, we often have the same problem. We have a similar policy about not switching providers. However, there are times when there is not a good "fit" between a physician and a particular patient. We do not allow the patient to call or ask office staff for a switch, but instead ask them to meet with their current physician and have a discussion about a transfer. The physician can also offer a transfer if they think it is necessary. In other words, one physician can REFER a patient within the practice to another physician (and the new one has an opportunity to accept or decline). If all agree, then the transfer can take place. This usually weeds out the patients who are just "doctor shopping" and provides for appropriate care when there is a personality conflict.
Is a medical practice patient centered or provider centered? If it's mission is to meet the patients needs, they will be responsive to a patients requests.
From the provider perspective "doctor shopping" is not beneficial. For the patient, searching for, interviewing, researching, and comparing physicians is not only a critical right and responsibility, but can be the difference between life and death.
The days when doctors are believed to be gods are over. Patients need to understand that doctors offer opinions. When their lives or those of their loved ones are in jeopardy, the patient better work very hard to make sure they have chosen a physician and/or a team of healthcare providers that will work hardest for them.
A medical practice that has a policy disallowing me to see another physician in their practice would be the first red flag that I could not expect to get team members who are really on my side. My advice if your physician informs you they have a policy disallowing you to see another doctor within their practice is to run to more enlightened, less self serving and less insecure doctors.
I understand that it must make things uncomfortable for doctors within a practice when a patient doesn't like one doctor and requests to see someone else. However, honestly, screw doctors and their ego where my money and LIFE are concerned. I have a laundry list of neurological symptoms that have pretty much put my life on hold. I'm 23 years old, just got out of college, and am now basically homebound afraid to leave my house most of the time due to severe cognitive difficulties and a combination of dizziness and balance problems. I don't even want to wake up anymore because just being conscious is miserable for me. There is one major neurology group in my area with probably over a dozen doctors within the practice. I've been seeing one of their doctors over the course of about a year, and he has done NOTHING for me. I explain my concerns to him, and he nonchalantly responds as if I just told him my only symptom is sneezing. Then he sends me out the door with a followup appointment some 5-6 months later, so I go home and continue to suffer for months. The other day, a technician at the hospital told me that I should request to see another doctor within the same practice because, as far as she knows, he's really competent. I requested to see him, and now I'm waiting to hear back on whether they're "willing" to let me see who I want to see. If they won't let me see him, then I guess I just accept that there's no help available for me seeing how there pretty much are no other practices with neurologists around here. It's not my fault all of these doctors work together. I'm not trying to make things awkward for anybody. I'm just trying to get my life back so I can do something with myself. I think it's really freaking unethical to tell me I can't see if someone else has better solutions to offer me (or ANY solutions really since this guy has offered me none) because such and such doctor's feelings will be hurt.
While I understand your point, and agree that it is a good policy for the reasons stated, sometimes it is just a personality conflict. I have a neuro group to whom I refer that has that policy. It is frustrating to me that I then have to send the patient to another group that is not as good when the patient "didn't like that doctor, " and refuses to give them a second chance. Usually, it's a choice between that or not have them see any neurologist.