Photo by Dan Saelinger
En español l Thirteen years ago, Kathleen O'Brien's mother, Dolly, passed out during a regular medical checkup. Her doctor shrugged it off. "This is what happens to people when they get older," Kathleen recalls the physician saying. "I thought to myself, 'Not to my mom.' "
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Dolly, then 79, had been a patient at her neighborhood practice in Minneapolis for more than 20 years, but Kathleen was concerned about the care she was getting, especially knowing that her family has a history of strokes and heart disease. She quickly found a new physician, who took her mom's symptoms seriously. That same doctor treated Dolly until she died late last year at the age of 91. "We had our mom for 12-plus more years because of him," says Kathleen, who credits him for her mother's good health until the end.
Dolly's original doctor was no quack, but even a good physician-patient relationship can turn dysfunctional over time. "Doctors may have the best of intentions, but their model of practice may no longer fit what you need," says Zaldy S. Tan, M.D., a geriatrician at the University of California, Los Angeles.
Medical musical chairs
In any given year about 10 percent of patients at least consider switching doctors, says Gerald Hickson, M.D., who directs Vanderbilt University's Center for Patient and Professional Advocacy. In one two-year study, 15 percent of patients moved to different practices because of dissatisfaction with the care they were receiving.
One reason may simply be that patients today have come to expect a higher level of care, says Sandy Reifsteck, director of the Office of Development and Quality Outcomes at the Institute for Healthcare Communication. Patients tend to be armed with more information about health care, either through news stories or after having researched their condition over the Internet. These more-savvy health care consumers also want physicians whose treatment philosophies are more in tune with their own lifestyles and choices.
More often than not, the reason for patient dissatisfaction comes down to poor communication, Reifsteck says. "Patients don't really know how to evaluate medical skills, but they do know if a physician interrupts them when they're listing their concerns."
Take Walter Wurfel, a retired journalist whose first encounter with a neurologist not long after being diagnosed with Parkinson's was less than ideal. Wurfel had brought along a list of books about Parkinson's that were available at his local Northern Virginia library, hoping the physician would recommend a few.
"At the end of the appointment I handed him the list, asking his advice. He looked at it for a minute and said, 'These books are not for doctors; they're for patients,' " remembers Wurfel, now 76. "I said, 'That's why I'm asking.' He looked at me and replied, 'Face up to it; you've been diagnosed with Parkinson's. Deal with it.' I decided I needed a doctor with a better bedside manner."
Too much talking, too little listening
Patient-physician communication can be further hampered by age, says geriatrics researcher Nancy Sin, Ph.D., of the University of California, San Francisco. Her dissertation focused on doctors' communication with patients over 60. She found that if a younger spouse or child accompanies an older patient, the doctor might ignore the patient entirely, discussing treatment in the third person.
"Doctors tend to be more egalitarian with younger patients, sharing the decision making with the patient," says Sin. Plus, many doctors may focus only on physical symptoms, without addressing psychological or social concerns, like whether the patient has the transportation to get to a medical test.
Substandard communication isn't just annoying, though. It also has serious implications for your health. "Research shows very clearly that when patients are actively involved in their decision making, and their opinions and perspectives are incorporated into a health care plan, there are much better outcomes," says Maysel Kemp White, Ph.D., of the American Academy on Communication in Healthcare.
Despite all this, even patients who are less than pleased with their doctors may be hesitant to leave them. First, there are logistical challenges, such as transferring a long medical history or finding a conveniently located physician who is covered by the patient's health plan. And boomers monitoring the health of their aging parents should know that Americans over 70 often resist changing doctors, mostly because they were raised with a profound respect for authority and don't want to offend, says Marilyn Gugliucci, Ph.D., who directs geriatrics education and research at the University of New England.
If you do decide to pink-slip your doctor, try to leave on the best possible terms, because your new doctor may need to consult your old one. Katharine Treadway, M.D., associate professor at Harvard Medical School, recommends sending the old physician a letter describing the specific reasons you decided to change. "It may be hard to write — and also hard to hear as a doctor," she says. "But we all learn things from what we've done wrong."
Caroline E. Mayer is a consumer reporter and lives in Arlington, Va.
So how do you know if your doctor isn't "the one"?
Your gut is often your best guide, experts say. But here are a few warning signs that you might need to give your doctor the boot, courtesy of geriatrician James Pacala, M.D., of the University of Minnesota.
Be wary of a physician who:
1. Dismisses every complaint, blaming age.
2. Insists that nothing can be done. There is always something to try.
3. Spends too little time with you, or interrupts you frequently, especially if you're a patient with complex, multiple issues.
4. Writes a prescription with minimum discussion.
5. Recommends treatments without considering your lifestyle.
6. Prescribes a variety of medications and procedures, or keeps referring you to more specialists without any improvement.
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