How to deal with a doctor when you can't choose

All the discussion about how to choose a doctor revolves around outpatient care. Outpatient care means you are well enough to get into a car and go to a doctor.

When you are at your absolute sickest, you probably won’t have a choice of your doctors.

In a hospital, doctors are assigned based on specialty, volume of current patients, and random assignments. Perhaps you have lupus and the lupus specialist happens to be on call for rheumatology when you arrive in the hospital - you got lucky! Or perhaps she is on vacation, and her colleague who specializes in fibromyalgia is on call. The colleague will be able to treat your lupus, but you aren’t getting the expert, purely due to random chance.

What’s more, there is very little flexibility in whom you see. If you despise the cardiologist who is assigned to you, for example, it is extremely difficult to get a new one. If you love the hospitalist who is caring for you, the chance that person will still be taking care of you the following week is fairly low.

And it’s very difficult to move to a different hospital. To do so, you either have to have a condition that requires more specialized care, in which case your insurance will pay for medical transportation, or you have to pay several thousand dollars out of your own pocket for that same transport. The doctors at the other hospital would have to formally “accept” you and agree that you can come, which is not the case if you come through the emergency room.

This paints a fairly dire picture of care in the hospital. In general, it works out and patients get the care they need. But here are a few tips for how to get the best possible care when you have no choice in your physicians:

  • Have someone else with you when the doctors come by. This may be very early in the morning for many specialists, but it’s usually in the morning. If you can have someone with you between 6:30-12:30 every day, that is ideal. I realize in an ideal world the physician would always call your support person daily, but there’s really no substitute for everyone being in the room together. Having someone else there serves a few purposes:

  • There is someone who is not ill who can take notes, ask questions about the big picture or next steps, and remind you of those things when you forget later

  • The doctor can interact with someone who is thinking clearly. It’s often - predictably! - difficult for patients to discuss complex medical issues while they are sick and often medicated. These conversations can be frustrating for everyone involved.

  • The support person can provide objective information that the doctor is likely to trust

  • Be straightforward. Tell the doctor what you wish s/he were doing differently. Doctors are usually pressed for time, and if they’re doing something that is bothering you, just tell them. If there’s information you’re not getting or a diagnosis that you think is wrong, tell them your concerns.

And try to really listen to their responses.

Maybe the information you’re looking for doesn’t exist, or the diagnosis is right. If the situation escalates, say something like “Look, I think we got off on the wrong foot. I want to work together to solve this problem.”

  • As with anyone who works with a wide swath of the public, a small amount of kindness goes a long way. Saying “I know you’re busy and you may not be able to go into this now, but I’d really like to discuss X. When would be a good time?” Realize that most doctors, like most people, don’t go to work planning to do a bad job.

  • The above suggestions assume that you had some personality differences or minor disagreements with a physician. If you feel a doctor is mistreating you, being negligent, or isn’t addressing your concerns, you need to escalate:

  • Discuss your concerns with one of the other physicians whom you trust. Honestly, most physicians want their patients to get great care and be satisfied, and will do what they can to help you solve an issue with another physician.

  • Call the hospital ombudsperson. This is a really under-utilized resource. This person’s main job is to help advocate for the patients in these exact scenarios. Call them while you’re in the hospital if you’re not getting the care you want so they can try to solve the problem then. They have access to administrators and physician leaders who can help evaluate a situation and intervene if necessary.

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