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  • How to Know it’s Time to Replace Part of Your Healthcare Team

    Stethoscope lying on schedule book

    How happy are you with each member of your healthcare team? Do you have a healthcare team? Do you even know who should/could be on your healthcare team?

    Who is on Your Healthcare Team?

    Your healthcare team consists of anyone who helps you with any aspect of your physical or mental health. Team members include:

    • Family or general physician
    • Specialty physicians – You usually have to be referred to these doctors by either your family doctor, another specialist, or the ER
    • Naturopathic physician
    • Chiropractor
    • Physical therapist
    • Occupational therapist
    • Speech therapist
    • Massage therapist
    • Acupuncturist
    • Psychologist
    • Master or clinical social worker (lmsw or lcsw)
    • Other counselor or talk therapist

    Two Real Life Examples

    I’ve heard stories of, and experienced firsthand, so many examples of providers that needed to be removed from someone’s healthcare team, that I could write a book. I won’t write it here, so don’t worry. I will, however, tell two of the tales, from my own life, to give you a couple real world examples to get us started.

    Switch to children’s medicine and call me on Monday

    When I was in my early 20s I had a crap HMO for insurance. One of it’s limitations was that I couldn’t go to an urgent care center without getting prior approval from my primary care doctor.

    So, when I found myself on a Friday night mouth-breathing and coughing so hard I almost vomited, I called my primary care doc for approval to go to urgent care. He said no. He told me to take a children’s cough medicine (that he mentioned by name) and to call his office on Monday for an appointment. I told him that I was already taking the strongest over-the-counter adult cough medicine and it wasn’t helping. He reiterated his denial and again directed me to switch to a children’s cough medicine.

    I sent my boyfriend out for the cough medicine (just so I could say I’d followed his instructions) and it didn’t help. No surprise there, so I took myself to the nearest urgent care center and paid out of pocket for the visit. (Egad! That was more than I had expected it to be!) They diagnosed me with one of the worst cases of bronchitis they’d ever seen. Great. They also gave me the strongest prescription expectorant and cough medicines available as well as an antibiotic.

    By Monday I was feeling a bit better and could say a few sentences at a time without triggering a coughing fit so I called my HMO to switch primary care doctors. Now, I knew this was not going to be easy task because the HMO had rules that 1) You needed a good reason for changing primary care docs and 2) They needed to approve your reasons. I explained what happened, assuring them that yes, I had followed his instructions. I had in backup, all the times he’d been condescending, dismissive, misogynistic, arrogant, and just an all around a-hole. To my shock, the only question they asked me was who I wanted to be my new primary care doctor. Had I been feeling better, I’d have done a happy dance then and there.

    I’m happy to report that the new doctor I chose is still my family doc to this day. It’s been close to 30 years since I made the switch, and I couldn’t be happier with the care I continue to get.

    Some Women Have Unexplained Pain

    A few years and one employer later, and I was commuting 45 miles each way to work. No problem, they had decent insurance and my doctor was a participating physician. Yea!!

    A couple years later, as a cost-saving measure, my employer changed to a hyper-local insurance company that only covered physicians and hospitals in a small area around the town I was working in. Crap. I had to change doctors if I wanted my doctor visits covered by insurance, so I took my best guess and chose one.

    Shortly after this switch I needed to see my new doc for some pretty serious pain on the right side of my lower abdomen. She did what I thought was a pretty thorough manual exam and then proceeded to tell me that sometimes women just have “unexplained right side pain.” I called BS. She doubled down. I decided to pay out of pocket to see my old doc for a second opinion.

    Turns out, I had ovarian cysts; an ultrasound showed them clear as day.

    I vowed to pay out of pocket to see my old doc for any future health issues. Thankfully, I switched employers before I needed to.

    When Should You Replace a Member of Your Team?

    How do you know when it’s time to make a change to your team? Here are a few examples of reasons you’ll want to find a new team member to give you the best healthcare team you can have. Note: some of these may seem kinda out there, but everything on this list comes from the real life experiences of either myself, a family member, or friend.

    • You don’t trust them
    • They don’t listen to you
    • They’re condescending
    • The belittle you, your complaints, or your condition
    • They’re dismissive of you, your pain, your goals, or the problem that you went to see them for (note: this is different than explaining a fact about your condition or treatment that you don’t want to hear)
    • They shame you in any way
    • They blame your complaint on your weight, gender, or age without doing an actual exam
    • They’re arrogant and rude
    • They brush off your complaints as normal without explanation of why it’s normal. Remember… just because it’s common, doesn’t mean it’s normal. Don’t let a member of your team conflate the two.
    • They don’t respect your time (or have very bad time management skills) and often keep you waiting well past your appointment time.
    • They have a horrible “bedside manner”
    • The use lots of fear mongering and scare tactics to pressure you into treatments or surgeries rather than calmly explaining your options
    • They get angry if you want a second opinion
    • They won’t believe that you’re doing all your home treatment as prescribed, no matter how much you assure them you are, simply because you’re not making the progress they want you to.
    • They have a one-size-fits-all treatment strategy and act as if it’s clearly your fault if for some reason you aren’t the automaton they expect you to be. (see reason immediately above)
    • When you tell them the treatment didn’t help or made you feel worse, they literally scream at you about their number of years in practice, how it’s all your fault, and how no one’s ever said that to them before. They never once inquire further about what made you say what you did, how your goals or expectations weren’t met, or how they can make it right (if you leave with worse pain than you came to them with).
    • They make assumptions.
    • They lie to you.
    • They act like you’re an imposition in their work day, rather than the reason they have a work day.

    What Traits Should You Look For?

    It’s important to know when to replace a member of your healthcare team, but it’s equally important to know what to look for in their replacement. Here are few suggestions:

    • They are interested in the issue that brings you in and ask questions to gain a better understanding of not just the problem, but how it impacts your life.
    • They ask about previous tests, procedures, meds, and treatments in regards to the issue that brought you in.
    • They not only ask to rate your pain is, they ask what number you’d consider too much to give them a sense of how you rate your pain. This is especially important if you’ve had trouble having anyone take your pain seriously or have had pain for a long time with little to no relief.
    • They are interested in you as a person. You’re not just the sore shoulder in exam room 3; you’re a whole person, and they treat you as such.
    • They believe you when you tell them about your symptoms.
    • They are genuinely interested in your goals – Do you want less pain, greater movement, both, something else entirely?
    • They don’t push their goals on you.
    • They stay within their scope of practice – If they’re not certified, registered, or licensed to give mental health, nutrition, fitness, or osteopathic advice or do certain procedures, they should willingly refer you out, even if you beg them to tell you or do the procedure and promise not to tell anyone.
    • You have a good rapport with them. Seriously. I cannot stress this one highly enough!
    • They are willing to answer even the most basic question without making you feel stupid for asking it.

    Your Options

    Obviously, if you live in a small town, your options are somewhat, or perhaps even very, limited. In which case, you may need to have some uncomfortable conversations, find a new practitioner in a neighboring town, or think outside the box. For instance, maybe a particular specialist who gets all the referrals in your town is a 90 minute drive away. They’re also the only specialist of their type in that town. Everyone from your town goes this specialist but they are not a good fit for your healthcare team. Are you stuck? Not necessarily. If you’re already going to have to drive 90 minutes, why not look at other towns that are a similar distance away, in a different direction and look for a specialist there. I know one person who did this at the behest of a couple family members and was not only saved from an unnecessary surgery, they were diagnosed with a rare disease that would have been made worse by surgery. Whew!

    It Really Does Matter!

    If the above example isn’t enough to convince you to weed out the members of your healthcare team who aren’t working for you, I don’t know what will. Your health is too important to not have a team of people who are 100% on your side. It’d be wonderful if all healthcare providers had your best interests at heart, were easy to talk to, etc. but they’re imperfect people, just like you and I. That means you have to be your own advocate. And sometimes being your own advocate means firing the team members who aren’t responsive to your needs.