Deal with Doctors Show Segment

Linda Mondoux, Administrator of Nursing at Botsford Continuing Care Corporation speaks about choosing a Doctor.

Q: Linda, I've kind of been in this situation myself and I wonder if a number of other people have been too and that is, how can we select a physician without, you know, we don't have an opportunity to go look at all of his degrees before we select them and things like that and really know much about them. So are there some ways that, you know, that we can determine who would be a good health care provider for ourselves?

A: There certainly, you can certainly check through your medical societies and American Osteopathic Association or the American Medical Association and get some information on credentials. You can check on Board Certification of the physicians. You can, one of the things that actually I've done in the past when I was looking for a new health care provider, I actually, in this instance it was a dentist, and I actually went and interviewed the dentist. Now, what I found was that some dentists didn't have time to even have you come in and shake hands and, and meet them and that immediately took that person off my list. It was the one who was willing to have, have me come in. I think it's appropriate to call ahead of time and say, "Does," you know, "does this physician have time to meet a potential consumer?' Because that's what we are. We're a patient, we're a client, we're a consumer.

Q: Right. That's a good way. I mean, just go for like a little 15 minute interview and see if that person has the listening ability that you're looking for or the understanding of your situation and things like that, not to be afraid to do that.

A: Right and you get a feel. You get a feel for the office too when you do that. You know, not that environment is, you know, a reason to choose your health care provider, it doesn't have to be posh or anything like that, but you get a sense of the, of the, of whether, whether people are listening, what kind of office staff is there, whether, whether you will have access to that physician. Just in a very short time you can get a sense for that. You can hear if somebody's complaining about having to wait long and so I would say that and then also certainly word of mouth, that if you trust somebody and you trust that their values would be similar to yours and their criteria would be similar, you might be able to make a decision on that. Whether somebody is affiliated with that particular school, particular, an institution that seems very credible than that, that probably makes a difference.

Q: This hospital or that.

A: That's right. Whether you have students, whether you have a residency program like in our facility we have a residency program and a lot of times that makes a difference too.

Q: Right. Sometimes, I know, people go to the doctor and, and they have some symptoms that they haven't really tracked, you know, when was the onset or what's happening to them, you know, as it's progressed, and I, I think that that'd probably be pretty important information for a doctor to know. Are there some things really, you know, before a person goes to the doctor, besides that, that they should kind of, have in their mind to talk to the doctor about?

A: One of the things that I'll frequently suggest is that if, first of all, when you decide to go, say your knee hurts, and you decide to go to the doctor. Usually it's hurting pretty badly at this point. You've ignored it. Most of us have busy lives, it's hard to set up the appointment, you decide, "Well it's probably going to go away." You come up with reasons for why it probably occurred and so what I suggest is that you just, you stop and sit for a minute and take a pen and paper and you start to jot down, "Now when did I first notice this." and you start to think back and as you think about it, you say, "Well you know, my knee's been hurting for three months now. Because I remember it hurt, you know, it hurt at this point, it got a little bit better, it hurt again." and then as you start to do some, it's almost like detective work. As you start to do it, you start to think about what had occurred around that time and you might be able to come to a very specific instance. You might be able to link it to possibly starting a particular medication, not, not taking a particular medication. You might relate it to a ski trip you took and you didn't really injure yourself but as you think of it, there was a little twist that you weren't even aware of but as you thought about it, you remembered the fall that you'd taken and so if you write all that down, it's very helpful to the physician also to know when does it occur. Is it an ongoing thing, is it intermittent, does it occur certain times of the day and night. Is, is there anything that helps it? Is there anything that makes it worse. And if you really write that down and take it to your physician, I believe that the physician one, statistics say about 80% of the diagnosis is actually made on what the patient comes and says to the physician or the health care provider and that if, if you really take the time to do that, you might all, almost have the diagnosis at the time you go to the physician and most physicians will take time to read what you've written. You know, it's very helpful for them.

Q: As, as people age, do you think that they attribute little aches or pains, say, "Oh well, I'm just getting older." Is that something that they should think or, or should they take these little concerns to the doctor all the time you know, as they come up. You know, not just discredit them and say, "Oh, I'm getting older."

A: Well, I think it's probably the same, sort of, throughout your life, whatever your style has been. There are certainly people that have gone to their doctor throughout their life every time there was a little ache or pain and probably as we get older, usually our habits don't change that much. As long as we're healthy with regard to our psychological status anyway, usually our habits stay pretty much the same. Sometimes they get a little more entrenched as we get older but they stay about the same. So that, I guess my suggestion would be that if it were a little ache and pain, that no, not every single one needs to go to the physician but as you start to see a pattern or trending, if it's something that really has never happened before, then that's something that you, that you would certainly, if it's something more than just a little ache, if it's a chest pain, then it probably is something that needs to be investigated. It might not be a, it might not be a heart attack, they certainly are the reasons for chest pain but it's something that, depending on the severity, you might need to see a physician right away for.

Q: If it should happen that you weren't satisfied or for some reason, something happened in your health care that you feel you were not treated properly or something. Is there recourse? What should a ordinary citizen do about that?

A: Well certainly if you're talking about a relationship with your individual health care provider, if that's a physician, then you could call the state board for that. If it's, if it's a nurse, you could call the Nursing Board, you know, they're very, Boards are under the Department of Commerce here in Michigan and so they're various boards that you could certainly report that you had a concern whether it was about the care you received, the direct care. Whether it was about behaviors that you noticed. Maybe, you know, if there's a, if you felt that there was a problem with alcohol or anything like that, then that's something that you would want to, to at least report and then it would be followed up. If you're talking about a particular institution, your recourse would be always to go, you would be always to go, you could go to Administration in a hospital to talk about it. Sometimes if you're, if you're actually a patient in the hospital, you might, you know, it's always best to start where the problem is. It depends on how big the problem is. But I always advise that you start where the problem is and if you start with your staff nurse, the one who's taking care of you, and you find that, that it doesn't get resolved there, then you go to the nurse manager and then proceed up through Administration. In most hospitals there's a, there's somebody who acts as a patient advocate. An Ombudsman or a patient advocate, and many times they, once, once you've talked with them, they can help to, to sort of navigate the system and sometimes it's something that can be very readily taken care of and sometimes it can be a major problem.

Q: That's true and really the patient doesn't know, you know, all the network operations, you know, and so I think, you know, they know that there is somebody in every situation like a hospital or someplace that they can just find out how to navigate this, you know...

A: And if you're in an office setting, then there's usually an office manager you could ask to speak with the Office Manager. A lot of times because, by title, they're managing the office, they, they know what it is if you're talking about a concern, a financial concern and bills that, you know, maybe you think are inappropriate or if you're talking about a care concern then they can, they can find out what the real problem is and help you.

Q: What about when we're in the hospital and none of us like to go there, and we want our stay to be as short as possible but while we're there, are there some things that we should know that could help us to get through that period a little easier?

A: OK, there certainly, you know, there're rights that go both ways in a hospital setting or any, any care setting really. There're rights that go both ways and one is that, that you certainly have the right, as the consumer, as the patient, to say that you want something to be done or don't want something to be done. Now there's a point where you can't dictate medical practice. You can indicate that, that you want a procedure to be done and maybe based on a number of reasons, that procedure wouldn't be done. But you can refuse treatment that has been suggested. Now it's up to your health care provider to explain why, why that person thinks it's important to have the treatment. But the bottom line is, it's your decision to refuse that treatment and you're assured of confidentiality in that setting and that means people shouldn't be talking about your condition in elevators etceteras. Not just in elevators....

Q: Right, wherever.

A: But anywhere that's inappropriate and you also have, as, as a consumer, as a client, it's expected that for, for the therapy to work, it has to be a two way street and so that, that you have to buy in to that treatment and, and be involved in it in some way because just to have, have a treatment plan dictated to you isn't going to work. You have to, if it's a special diet, if it's taking your medication at certain times, if you don't do it, then the treatment plan isn't going to work. One of the things that you can do when you're, when you're in the hospital, one of the things that I often recommend is that, that for you to be totally involved in that care, that one of the ways to do it is to make sure that you're very in control at the time that, that your physician comes to visit and a lot of times, physicians, because they have office hours, are making rounds rather early in the morning. I don't know if you've been in the hospital but usually they come fairly early in the morning and so in the morning you, as a woman, you might not have your face on yet. You might not, you know, the teeth might not be in, the glasses might not be on and so I suggest to people when we're talking about this that they want to roll their bed up, to be, you know, to look like they're ready for a meeting and sometimes if you want to think about, again, the notes that I indicated that you take, that maybe the night before, you put your questions down that you want to ask the physician and so you just reach over to the bedside table and, and start to ask the questions. I don't know if this has worked but I have suggested it to people that they might even suggest that their physician pull up a chair and sit down. On busy rounds, I don't know if that's happening or not but, to me it seems like a good strategy because as a patient, you don't feel like standing up and talking with the physician but that puts you on, on an eye level. So at least if you get your bed up so that you can be somewhat closer to eye level then that might make a difference.

Q: Well those are some really good ideas and things for us to think about when we're thinking about our health and that's so important to us and we want to feel like we're in control of what's happening to our bodies and not just hand over the job of, of our health care to someone else. We have to be involved in it. Well thanks so much for spending time with us today.

A: Well thank you. Thank you.

Q: You know, Linda, sometimes it happens that we're not completely satisfied or we don't feel that we're making progress with a certain physician but we have this great awe and respect and, for, for just the physician themselves and we're afraid to say that we're not satisfied or we're afraid to make a change or we're afraid to really voice any dissatisfaction. Is there some advice you can give us on that?

A: I, I think first of all, you need to try to make yourself voice the, the dissatisfaction. You know, if you, I know a lot of older people have had relationships with physicians for many many years and maybe they were the ones that, they had, they had babies and maybe this was the person that delivered their baby and so they, they really feel like they don't want to hurt this physician's feelings to leave the practice and, and in that case it might be that it's time to switch practices. Maybe they need a physician who is more, has kept more up to date. That certainly doesn't say that an older physician has not kept up to date because many have and, and so age is certainly not a criteria to identify that but, if for whatever reason they feel that trust isn't there, if they have a physician that, that no matter how excellent the care is, the, if they don't trust that physician or if there's not good communication with that physician, they're probably not going to comply with the therapy and, and, you know, take the medication as prescribed or, or do the exercise that's prescribed or follow the diet, whatever is needed and but I do think that the physician at least if there is a, has been a relationship, that probably the patient needs to talk with the physician about concerns and sort of give a chance to see if it's just that it hasn't been voiced and, and see if that makes a difference. If it doesn't make a difference, then they need to, to consider changing. Right now I know there are a lot of people that are in managed care, HMO kinds of insurance coverage and so they feel they've been assigned a particular physician and they can't change it and that's not true. You can always change. The choices might not be as great but you can change and you have to go through a certain system to do that. You have to talk, as I mentioned earlier about the sort of a patient advocate, they have the same kind of patient representative in most HMO, in all HMO's and so that you could go and talk about what your needs were or and why you wanted to change and certainly a change could be affected. If you, if you have, if you're living in a small town, I know my parents were in a small town in Delaware and my mother just wanted a different physician and she went through this of not knowing. She didn't want to hurt this physician's feelings but we knew that, that she just wasn't getting the care that she should be getting. And as a nurse, certainly I, I was aware of that and so I, I probably pushed it a bit but she was able to go to another physician. In small towns though, there is a problem because you don't have as many physicians. But it is, you can certainly just, you have to be strong though. You have to say, "I'm going to take control of my health. This is my body and I'm not satisfied with what's being done and I'm going to go to another physician.

Q: That's true.

A: And some people have gone through great maneuvers of even going to another town so that, and just sort of drop off the Earth with that physician. I would not, I wouldn't agree with that in that, you really need to close the relationship with the other physician out of courtesy if for no other reason. But there are also medical reasons for that. You know, that, the physician needs to know that he or she is no longer the one that's providing your medical care and it also gives you a chance to get your files and to make sure that their baseline information, there is baseline information there that can be covered with the new physician and sometimes if you go to a new physician and you don't want to do that, you just don't want to hurt this other persons feelings, then, then you're starting at ground zero which isn't fair to you and to your health.

Q: Exactly. And, once again, it comes down to being in control. We like to be in control of everything else so why not our health.

A: That's right. Very important.