The bond between doctor and patient is particularly important with a chronic disease. Unfortunately, the patient-physician relationship is a human one and sometimes things just don’t work out. In a January 14, 2014 article in the Washington Post, Christie Aschwanden provides some sound advice about how to proceed when it is time to end that relationship.
The experts Ms. Aschwanden consulted made it clear that the decision about whether to tell your doctor you are moving on is up to you. They do advise that it is best not to fire your current doctor until you have a replacement and an appointment booked. You should have a copy of your medical records sent to the new physician and you should make sure that you are current on all your medications. If you find yourself between physicians without a valid prescription, you could be in for some unnecessary distress.
The question as to whether to tell your doctor she is being fired is entirely up to you. You should never be bullied by a physician into staying with the practice. On the other hand, it may be helpful for you to let the practice manager know that you are leaving and why. A medical practice is a business and any quality business will want to know how they are doing in the eyes of their customers. This can be done by a letter or phone call. Quality assessment is a trend in health care delivery and many insurance plans contact you about your impressions of service delivery. I always participate because the aggregated data can tell a plan or practice a lot about the quality of its contracted providers. Negative feedback can and does lead to change. Ms. Aschwanden suggests that you report unprofessional or incompetent behavior directly to your state medical board.
The Post article’s information is all well and good when it comes to medical specialties with an abundant coverage by practitioners. However, movement disorders experts are a rare breed, typically flocking together in larger population centers. A person with PD would be wise to approach this matter strategically.
First, ask around about the quality of care and patient satisfaction with the neurologists that are in your region. You can do this via direct contact with folks at support groups and conferences. Not only might this provide you an opportunity to talk with people who have PD, physicians are often presenters who may be available for brief conversations. A lot of aspects of a person’s personality become apparent when they are on stage. Social media like Facebook and the many PD-focused chatrooms are good places to obtain recommendations. However, be wary of online rating systems such as Yelp, Angie’s List, or Healthgrades.com as a physicians ability is far more difficult to assess than a restaurant or carpenter and the motives for a given rating are rarely transparent. Whereas such reviews can be interesting, be aware that the disenchanted are more likely to take the time to rate a service than are those who thought the doctor was outstanding.
Secondly, if there are not two or more practices in your area, decide whether it might make sense to try someone else within your current doctor’s practice. Although physicians band together to share office costs, it is almost impossible that they would all share the same attributes that are leading to a search for new care. It would also make sense to think about how far you are willing to travel for better care. Long drives or plane rides may make it more reasonable to try to modify the current circumstances than to venture out in search of a new medical team.
Never lose sight that even when the disease is PD, you are a consumer paying for a service from a trained team. You should always be an active member of that team and when it is not functioning, you need to let the coach know. Whether or not you should fire your physician is a question you should consider carefully but it is never one to be acted on in the heat of the moment. Many with PD are reluctant to confront providers with their dissatisfaction. If this is true for you, bring a family member or trusted friend with you to the appointment. This is not a bad time to have an advocate with you.
You might have to change your doctor some day. The when and whys are somewhat complex but it might help to read http://www.washingtonpost.com/national/health-science/how-to-fire-your-doctor-rule-one-make-sure-you-have-another-one-lined-up-first/2014/01/13/44778c2e-76fb-11e3-af7f-13bf0e9965f6_story.html and consider the modifications to her advice that Parkinson disease demands.