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A Tale of Two Docs: Part I.

The Hunt for Better Doctor ... in October."So you are here for ..."  the nurse asked, tapping the keys on the computer keyboard and not making eye contact with me.

"I'm here to see if I'd like Dr. NoWay to be my primary care physician.  I'm here to see if I like her, and this office."  I said, already annoyed.  

From the moment I walked into this doctor's office, I was uncomfortable.  The people in the waiting room looked exhausted, like they had been there since birth and had slowly aged and melted into the seats.  The walls looked like they hadn't been painted since 1985, and everything had this damp, dingy undertone to it.  It seemed sad.  Hopeless.  But I had hope that I was judging a book by its cover, and that I could find my new primary care physician here.

"Yeah?" said the receptionist.  "You need to fill out these forms and then sit over there until we call you."  She handed me a clipboard - still without even looking at me - and dug a pen out from underneath a pile of papers.  "And I need your license and insurance card.  Like now."

Oh boy.  I gave her my license and insurance card, and sat to fill out the forms.  Even though I had barely walked through the door of this place, I knew it wasn't the right fit.  

I'm an empowered, engaged patient, but I'm also a picky patient.  Since taking my health into my own hands (namely, once my mom stopped coming on my doctor's appointments with me), I definitely have a choice in who is part of my health care team.  Just because they're covered by my insurance or recommended by another doctor doesn't mean they'll be a good fit in my life. I need to be able to talk to this person.  I need to feel comfortable being a little vulnerable.  I need to feel like they care, even just a little bit, about more than just billing codes.

Initial doctor visits are like first dates - you go on them to see if you want to see them again.

And this doctor's office wasn't getting a second date.  Because the following statements were uttered during the course of my visit (by the doctor, the nurse, and the receptionists):

  • "You have diabetes?  Maybe after you lose the baby weight, you'll be off insulin?"
  • "For your wrist pain, you can take Advil three times a day."  (Never mind the whole diabetes/kidney thing, right?)
  • "Your license photo looks new."  (How is this relevant?)
  • "You test your blood sugar?  Like once or twice a week?"
  • "You were diagnosed with diabetes as a kid?  But you went on insulin only for your pregnancy, right?"
  • "An insulin pump?  That's when your sugar gets really, really bad.  It must hurt a lot to wear that."
  • "You're here to interview me?  Are you a reporter?"   ("No, I'm a potential patient.  Stress on the potential part.")
  • "I can't find your name on your insurance card."  (My response:  "It's there on the card?  Next to where it says "Name?")

Dr. NoWay herself was very nice, and I think she had her head on straight.  But honestly, it was the staff who worked in her office who put me over the edge.  They were rude, uninvolved, and uninterested, across the board.  And I mentioned this to Dr. NoWay.

"I have to admit - I'm on the fence about whether or not I want to have this office handle my primary care.  You seem like a good doctor, and I feel comfortable with you, but - and I'm wicked embarrassed to say this - your staff seems like they are on the moon.  They can't find my name on my insurance card?  Come on!  How can I feel confident that they'll take your medical direction and process it properly for me?  Their inattentiveness could result in a screw up for me.  And I'm not willing to take that risk."

Dr. NoWay explained that the office had recently experienced a shift in staffing, and that everything was a work in progress.  And I understand that.  I have empathy for that.  But I fear that, too.  I'm fortunately accustomed to clinics like Joslin and Beth Israel, where people have their ducks in a row.  I don't worry about the competency of the people answering the phone or scheduling appointments.  I don't feel weird giving them my home address or my social security number (which is something I felt odd sharing with this PCP office - can't explain why).  This new PCP place wasn't cutting it.  I definitely can't manage my health at a place where I feel uncomfortable and insecure about the care I'll receive. 

And it's not just the Joslin Clinic that's been awesome - my medical team in Connecticut was new to me, but ended up being awesome.  Dr. CT was fantastic, and so was her staff.  But I did have my fair share of Dr. Idiots.  It's part of the health care management process - weeding through the mess of doctors to find one that fits with both your personality and your medical needs. Every medical relationship has ups and downs, but it has to have more ups to be effective in improving my health.

As a chronic illness patient, and someone who doesn't feel shy about requesting competent care, I think interviewing doctors is essential.  We spend a lot of time managing our medical conditions - we shouldn't have to waste any time wishing we were seeing a different doctor. 

The search for a local PCP continues.  But I did see a Physical Therapist that was a very different experience ... more on that Monday.

Comments

When I go to my endo (don't see my PCP very often) I am always excited to see the staff there too....love them! It's interesting how much of a difference it makes in the full doctor experience. Good luck in your search!

While it makes my skin crawl that people, in the medical profession to boot, can be do out there in their thinking and lack of understanding of diabetes...this post made me smile.
Just like many of us, I too have had similar experiences with stupidity and rudeness in the dr's office.
People don't realize just how important those front staff & nurses are and if they mess it up and make a patient feel uncomfortable/misunderstood it's pretty likely the doctor has a limited chance to change the patient's viewpoint, no matter how great they are at what they do.

I love the interview.

The staff at an office can make or break it for me too. Hope you find the right fit. :)

I think staff can be an issue anywhere. Lauren just had her very first appointment at Joslin (moving to adult endo from all our really wonderful years with Boston Children's. Cannot say enough good about every single person there). So the endo is awesome, but Lauren said the nursing staff and check in people seemed clueless -- like they ONLY understand Type 2. one asked her for her most recent blood sugar and lauren said "201" and she said "So is this an emergency visit?" WHAT?????

My favorite one was "You have diabetes? Maybe after you lose the baby weight, you'll be off insulin?" and "You test your blood sugar? Like once or twice a week?" I just cracked up when I read those because I hear those a lot from normal people too.

I haven't found a PCP yet either since my diagnosis (6 yrs ago). I have an endo that I can trust, he's old, but he's very knowledgeable about all the latest treatments, and is willing to accommodate my needs. He started the diabetes center and his endocrine practice. I just fear the day he retires or dies. I don't know if I could trust anyone else with my health even though type 1 diabetes and a non-existent thyroid are my only problems.

Good luck finding Dr. Right!

Eeks, those are a bunch of red flags! I don't expect a PCP's office to know the intricate ins and outs of diabetes, but at least know the basics. Added to the ridiculous comments you got, I'm not surprised you won't be back.

Kerri:
GREAT post- love the imagery of pts melting into their seats!! LOL...An ob/gyn once shared her S.P.E theory: surrogate perception of excellence- If the staff was stellar, the pts assumed the doc was equally competent, whereas a bumbling, rude staff made pts immediately UNcomfortable, even if the doc was terrific...No matter what the illness, pts NEED a receptive "reception"...Bravo for empowered/engaged pts like you...

After my daughter's most recent endo visit where the endo graced my girl with a mere 30 seconds (maybe 45?) of her time, our search for a new endo began. The 'first date' analogy is perfect and an empowering thought.

I'm still on the hunt for a good PCP. I went to a new one a couple months ago because I was having some pain in my knee (being a softball catcher was bound to catch up with me).

After I filled out their little overall health form, she asked me what was my last A1c. When I told her 6.5 (it's 6.3 now!), she actually said, "That's good, but it could be better." I was so livid, and all I could see was red!

It's so hard to find a PCP that 1) understands diabetes and 2) understands that I'm here for stuff OTHER than diabetes. Leave that to my endo, kthx!

Ugh, sounds like this one I had once. Swore that Diet Coke also had sugar in it and it would spike my blood sugar. Ummmmmm, no. And then there was the one that forgot which patient was next and so we waited in the exam room for an hour and a half before she saw us. Thankfully I really like the endo and PCP I have now.

Kerri,

This is an excellent post, describing a problem that is (sadly) all too common these days. Good for you for speaking up. I've had doctors with great office staffs, and others with staffs whose attitude is some variation on the theme of "we can't be bothered."

I once went to an Ob/Gyn whose policy was, "if you don't hear from us, then assume your tests came back normal." After one annual exam, I didn't hear back from the office, and assumed my test results were normal. Until six months later, when I called the office for a routine prescription renewal. A few hours later, I got an alarmed call from Dr. BadStaff, who said that in reviewing my files for the prescription information, she noticed that no one had informed me about my abnormal test results!!! When I came in for a followup test, she actually said to me, "Well, didn't you think it was strange that no one from our office got back to you about your test results? Why didn't you call us??" I reminded her that, per her office "policy," I was told to assume all was well unless someone from her office called to tell me otherwise. Suffice it to say, that was my last visit to that doctor.

Doctors are overworked - I understand that. I understand that even the good ones can't always keep close tabs on staff members who aren't doing the job. On the other hand, a stupid clerical error in a doctor's office can have grave consequences.

Great post, Kerri. I had a PCP (quickly dropped) once say: "whoa, you check your blood sugar 5+ times per day?! We recommend that our diabetes patients test once per week." Oy.

Good luck finding Dr. Right!

This is what scares the crap out of me about moving away from Chicago. I *loved* my PCP and her staff (especially her charge nurse). For now I'm still adrift, but I would definitely avoid this one if it were me--! It's interesting how being engaged and involved as a patient makes us the "picky" ones...shouldn't everyone care about this stuff?

Good luck in your search!

I had the same experience with an Endocrinologist. Wonderful doctor, very well respected, horrible office staff. I put up with it for a while, because I liked the doctor, but I ended up changing. Makes me question the doctor that we would not hire competent people. Good luck! My current endocrinologist recommended my current primary care physician and I've been happy so far...

My endo's office is great as is my PCPs. The gyn, on the other hand... the office staff is not so hot. I put up with it for now because the dr is awesome. She isn't afraid of diabetes or me being pregnant. So we'll see what the next few months bring.

Wow! When I first moved here, I had to wait 3 months to see a new endo. Meanwhile I needed a new scrip for Lantus, so I called my new PCP's office. He called back and told me he couldn't give me a prescription for Lantus, because I was already taking NovoLog, and you can't take two insulins at once. Needless to say, I fired that guy.

Which of those statements were made by the doctor?

Eeeeesh. Good office staff is essential. Honestly, I have never bothered with a PCP since my diagnosis because I don't want to deal with explaining 1,001 aspects of my Type 1 diabetes. I just go to an urgent care facility or a Minute Clinic type of place when I need to address something that isn't related to diabetes. Otherwise I've got a regularly scheduled 3-month "check up" with a doctor and staff who really understand my body. I should probably suck it up and look for a PCP but...blah. It's experiences like yours that make me feel like I can't be bothered.

I have to agree that it is very disappointing that people in the medical field seem to be clueless about diabetes especially Type 1. When my husband was in the hospital we had one nurse who asked us if he had the good kind or the bad kind of diabetes and another nurse actually asked if she could catch diabetes!!!!

When I went to see my ex-PCP last year with unexplained weight-loss, frequent trips to the bathroom, and excessive thirst, she told me that I "had to have type 2 because you're older than 18." Didn't make a difference that I was fit, had just run a 10K a few weeks prior, and was trying to get pregnant. The screw-up could have cost me an ICU admission and a miscarriage if I had taken her advice and not sought a second opinion. It pays to stand up for yourself as a patient, and to see a Dr. you trust (which includes their office staff)! Best of luck as you continue your search...

Dude, I am experiencing serious HULKSMASH feelings after reading the litany of WRONG COMMENTS you heard while there. EEK!

Did you move to California? I swear I have been in that office. YIKES

Good luck Doc Hunting.

"I'm an empowered, engaged patient, but I'm also a picky patient"

That statement made me feel like I was looking in the mirror. And I have quit a doctor over the office staff.

However, I don't have a PCP. Either I'm at the endo or I have a cold and so I just go to urgent care. I know I should get one but it just feels like a hassle.

The diabetes comments made during the visit...ARGHH is all I can say. AND. Yet, I get it. When Joe was diagnosed, I was a Critical Care nurse in a Surgical and Pediatric ICU at a Level 1 Trauma Center. Can I just tell you...my co-workers and I took care of ALL children admitted in DKA...and yet, my co-workers had no idea that Joe would need to inject insulin for the rest of his life. I am not saying this to take away from my ex-co-workers...I am saying this b/c once again it becomes so blatently obvious that we have our work cut out for us...to keep talking, writing, supporting, educating...it is crucial.

Happy Halloween to BSparl! Her first!!! YAY.

This makes me glad that I'm still able to be with the PCP office that dx'd me with diabetes! The staff there is great, and so is the NP, the doctors, and the phlebotomist (which is also very important!)
Good luck in you search!

Man I wish the rest of us were as smart as you all. Good post though. I didn't think the post sounded as arrogant as the comments.

And yes, I'm remaining anonymous.

Fun! But it's the same here in France. I told my new doc that I have diabetes since 1967 when I was a child, and that I took insulin, that I have type 1. And he asked me " what was your last blood sugar number?" so I asked what did he call my last bs ? My A1C? no he answered, maybe you have a glucometer and you test your blood sugar sometimes, when you wake up? Oh! I said, I made 7 or 10 tests by day. He looked at me with a strange face and I'm sure he never saw a type 1!!!!!! these docs are crazy. I laugh but how couldn't they know.
Just want to ask you what do you mean about wrist and diabetes and kidney? thank you for any answer.

The Barbara Davis Center for Juvenile diabetes in Denver is another great center with fabulous doctors. I worry too if we ever have to leave. How will we find anyone as knowledgeable. Good luck in your search for a doctor!

I completely understand what you mean about how the people in the office - your first impression of the doctor's practice - can make or break your experience. I LOVE my PCP, but she got some new people in her office and even though they're temporary, my dealings with them have been so frustrating it's made me look at my doctor differently. I actually considered switching to someone else until I remembered that finding another PCP I work well with is about as likely as seeing Snuffleupagus.

That's exactly why we didn't go back to my mother's gynecologist once she had her hysterectomy. If she needs further gynecological care, we will find someone else. He was fine but his staff was infuriating.

Kerri,
I have to tell you this brought me to tears, I know you think "what this posting? I have other really good tear jerkers." I recently had to find a new endo, my last one during my pregnancy was not so great and she was having major personal problems that she was taking out on me.
So I I went to another Endo on my medical plan. I should have run out of the office when I saw them using a typewriter, yes I said a typewriter. He looked a me and said "you really need to lose a lot of weight now" My new born son was sitting next to me in his car seat. I told him was losing it slowly since I had just given birth. He then said we can get you off insulin... I have had diabetes for 23 years, type 1. He said he could cure me, with diet and exercise, and that I should seriously consider surgery. He then went to draw blood from my wrist, he missed the vein, slipped and hit the bone, my hand went numb. I got up grabbed my son and walked out of there crying. One of the worst experiences of my life. Thank you for sharing, you have made me feel very normal to know that I am not the only one who goes thru all this, after having a baby, who is the same age as your daughter. Your blog helped me stay sane thru out my entire pregnancy.

I'm anxious to hear about your physical therapy appointment. I am going to make a prediction. I am guessing that you visited this therapist for the wrist pain you mention, and that their diagnosis was DeQuervain's tendonitis. I had it two years ago, and my wrist was very painful. It was awful. Ultimately I got a shot of some steroid right into the tendon, and was cured. I was told that the number one candidate for DeQuervain's is the mother of a newborn who has to repeatedly pick it up. My endocrinologist later pointed out (since I am too old to be a mother!) that we diabetics are prone to connective tissue disorders, of which tendonitis is one. Good luck, whatever it is that ails you!

Kerri,
Great post. New Dr appointments are like an interview. Dr. and Staff need to show there best.

One of my recent frustrations has been the "computer interview-medical history thing". I understand that it is much more efficient than a chart that may not be yours or lost. But I do feel that conversation should be face to face, not face to monitor. I sometimes feel that I can just say blah blah...blah and they will continue to type in the computer and never look up.

We have daily conversations with many people on the internet and texting messages A major change on how we communicate. I find it unacceptable during a Dr appointment.

Good luck on your continued interviews.

Happy Halloween to your little Goblin

I know just what you mean! I switched pediatricians for my T1 son shortly after his diagnosis for this exact reason. Office staff is the biggest investment a doctor can make in their practice, after getting the expertise!

:O)

So I go to Joslin's and BI as well. And yes, I agree that they have great doctors and staff. But they have still made some major mistakes with my care - one that financially could have cost me hundreds of dollars and one recently where they didn't inform me of an abnormal test result for 3 months. The fact remains that doctors and nurses are human, errors do occur, and you MUST be your own advocate no matter how comfortable you are in a soecific office!

I left my last new PCP appointment in TEARS while equally RAGING MAD. There for my ankle, she lectured me about my T1 the whole time, even after I explained I was treated regularly by a wonderful Endo who has done amazing things to get my A1C down... She was awful and my search continues too...

Yes, been there done that!!

It's funny that we like/hate sharing the worse of our medical experiences. In Seattle, the care from Evergreen Medical Group and UW Medicine is generally spectacular. There are the scary exceptions though...

Wow. Good stuff.

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