DOCTOR SHOPPING

If you have dealt with a serious illness of some kind and you have had to search for a doctor, or change doctors more than once, you have undoubtedly encountered somebody who accused you of doctor shopping.

I used to get very defensive about this. And then one day a lightbulb just went off. So the next time somebody, usually my spouse (now my former spouse) or a family member casually made this accusation, either directly or in an offhand indirect manner (otherwise known as passive aggressive) I was ready:

“How did you get the shoes you’re wearing?“

“Why does your purse match your pants?”

“Who gave you the ring on your finger? Is it stolen? Or did you or someone else pick it for you?”

“What kind of cereal do you keep in your house, and why? Do you have a favorite?”

“Your glasses seem to fit your face. Am I to assume you can get such a great pair of glasses off of Amazon? And they magically fit!? Wow.”

“That’s a nice car you have there. Who gave it to you?”

“Is that health insurance you have? Can you go to any doctor you want? That must be nice. How did you end up with that particular insurance? Have you ever wished you had a different one?”

“That’s lovely nail polish.”

“The highlights in your hair bring out the color in your eyes.”

“What kind of make up do you use?”

“How did you get the house or the apartment you’re in? Does it have enough rooms for all the people in your family? If it does, was that on purpose? Or did you just go out and buy the first house you saw on sale, and just decide to try to fit into it, whether or not it was too small or too big? Or affordable? Or accessible if you had a disability? Or close to a school that you need for your children? Did you just luck out by getting the things you wanted and needed?”

“Wait, what’s that? You mean YOU picked your own car, house, dishes, clothes, jewelry and accessories, toys for kids and adults, and in some cases, even schools? But why? You wanted to drive a quality car, wear quality clothes, live in a quality area in a suitable home, and have your clothes and accessories reflect YOUR lifestyle and personality? That’s okay with you? Isn’t that just like doctor shopping?”

What’s the Difference?

Why is it that you can shop for anything from your underwear to a gift for a colleague, from accessories to the home you will pass down for generations, from the food on your shelves to the school you will go to to get an education that will determine your caree; and you are even advised from early youth and going forward about the various factors you should take into consideration when making purchases? Why are these decisions considered so important and expected to be taken seriously as you enter the adult world and start learning the value and consequences of your choices?

In case you weren’t familiar with my particular brand of sarcasm, that was a rhetorical question. The answers are obvious. Every time you have the opportunity to make a purchase as a consumer of anything, whether it is a physical item or a service, you have both the opportunity and the responsibility of making an intelligent purchase. You also have the choice of making fun purchases sometimes, which is just fine, as long as you have your priorities taken care of. Why wouldn’t you shop for the best, or at least the most appropriate for you?

For reasons I can’t understand, this doesn’t translate to finding a medical professional for your health care. I have been a patient my entire life, and I’m now what I consider a “professional patient,“ meaning it is now my full time job, and the only one I have the time and ability to do, other than raise my kids. From the time I was a toddler, visiting the KinderCare Pediatric Hospital in Germany, or having allergy tests done in Philadelphia while we lived in New Jersey, or having urinary/kidney issues, in both of these places and in Alabama, during two of my dad’s tours, I’ve been a patient, so I was trained early.

Lately, however, I’ve become extremely disappointed and outright offended by people who accuse people with special medical needs or desires of “doctor shopping” if they go to a doctor who gives a different opinion from another one.

What is the alternative, exactly, that people expect us to do? Just take the first doctor that comes up when you flip open the list of doctors on your insurance and follow the kindergarten rule: “You get what you get, and you don’t have a fit!”? What if your doctor doesn’t have any experience with your rare medical condition? Tough luck?

First Doctor Shopping Episode

The first time this happened was when I was looking for an obstetrician to deliver my second child. My first child ended up being born by cesarean section. At the time, I was young. I didn’t know I had choices. I thought when the doctor said it was time, it was time. I didn’t think that meant it was 530 and time for him to go home and have dinner. And maybe that wasn’t the case. I was in labor for over 30 hours. But the point is, I was too young to even ask the right questions.

Later I found out this wasn’t uncommon. In fact, it’s more common in the United States than it is in other countries. I spent the better part of a decade angry because not only did I end up having the surgery, but I missed the first two hours of my first born child’s life while everyone else got to see her in the nursery, followed by my first moments with her being in front of EVERYONE who gathered into my room after they saw me rolled from recovery to my room, and then followed me as they brought me the baby. That was 21 years ago. I was mad. I’m still mad.

So when it was time to have another baby, I was 10 years older, and a lot more educated about the choices I had. One of those choices was the right to try a natural birth. However, the doctors I chose didn’t seem to even want to. I learned through a support group that most doctors would not do one after a cesarean birth. I set out on a mission to find one who would. I went through three obstetricians before I found the right one. It was my husband, who accused me of doctor shopping. Not to say he was the only one, because I know he wasn’t. But he was the most significant, because I was having our child.

The first doctor was a woman who flat out said she would only do a cesarean delivery. I moved on to a different doctor in her practice that I heard great things about. However, he said he would also only do cesarean, and convinced me that no doctor would do a natural (vaginal) birth after a cesarean (VBAC). I had grudgingly settled for this, until about the 35th week when I asked about watching the delivery, maybe in a mirror, even if it was a cesarean. Blood and guts are usually not an issue for me. Growing up with allergy shots and medical procedures, they fascinate me rather than disgust me. He didn’t know this. Even worse, his exact words to me were:

“You don’t want to see that. Just watch the discovery channel.” 🤔

I was so angry, it didn’t even take full effect until I had left the office and processed that he actually said what he said. I was around 35 weeks, so it was a problem. Luckily, I was able to find one more recommendation, and the doctor was willing to see me and take me on at 35 weeks.

Before I left, I went to the appointment I had already scheduled, and I told the doctor I had checked with a discovery channel, and as it turned out, they were not airing my delivery of my child after all. He was completely lost. I reminded him of what he had previously said. He didn’t even seem apologetic. It was one of the only times I have gotten up and walked out of the doctors office and left him sitting in the room rather than the other way around.

Like Night and Day

Not only did the new docto see me at 35 weeks, and offer to let me do a trial VBAC, but he was the FIRST doctor to look at my records and do a physical exam to determine my chances. In the end, it didn’t make much of a difference as far as a natural birth, because what he discovered was that an accident I had when I was young fractured my pelvic bone and it was at an angle that interfered with natural birth. Now this I could live with. At least I felt like I had tried. And he would continue impressing me.

Obviously, the issue was that I wanted to be involved in the birth of my child. I wanted a birth story. One that I could tell myself, instead of one that other people had to tell me about. He got it. After he opened me, he turned the mirror, pulled her out, but only halfway. He waved her little arm at us and said, “Hi, mommy! Hi daddy!” He then asked if we had seen her before he pulled her out completely and moved the mirror. They did have to give her oxygen for a minute, but then she came straight to me.

I suppose it’s difficult for anybody who hasn’t been there to really understand the significance of what this doctor did, and why it matters. But every doctor you choose should be chosen with the same care and consideration you use when purchasing a home or a vehicle. The same considerations you use when you pick a college. Those decisions are made based on needs/preference such as school districts when you buy a house, gas mileage and payment amounts when you buy a car, what kind of engagement ring you will stun your partner with, and going to a college that offers a degree in your chosen field of study. Even your clothes are picked out according to your style, according to your needs, and according to your body size and type.

To shop for your favorite lipstick, underwear, and clothing, as well as your college, your home, and your vehicle, and then to just take the luck of the draw when it comes to a physician, would just be irresponsible. It’s probably one of the most important choices you will make in your life, especially if you have health issues that make medicine a significant portion of your life.

I no longer have a problem when people ask me this question, or even insinuate that I am Dr. shopping. I simply ask them how they obtained what they are wearing, carrying, or driving. Then I ask why anybody would be dumb enough to not shop for a doctor knowledgeable about your medical condition, and qualified to take care of you. It’s arguably the most important shopping you should do, because if you don’t have the right doctor to keep you alive, nothing else you shop for really matters, does it?

Things to Consider While Doctor Shopping

To better understand why chronically ill patients shop for doctors, these are some of the considerations we have to take into account, not just because we like it, but because our lives may depend on it:

1. Has the doctor heard of my disease?

2. If he/she has not, or has only heard of it, but has no experience, is he/she willing to learn?

3. Does he/she take your insurance?

4. Is s/he willing to take me on as a patient, after learning about the multiple and complicated medical issues that come with me? (Yes I have had doctors say they cannot see me because they are not sure how to treat me.)

5. Is s/he willing to deal with the insurance company when they have ridiculous requests like prior authorizations, even though we both think it’s ridiculous? Because without it, I will NOT get my meds. Yes I actually did have a doctor who refused to do these. While I understood his point of view, it left me in a no-win situation.

6. Even if the doctor seems qualified, is his/her staff equally qualified and efficient? The best doctor it’s not worth a hill of beans if you can’t get to him or her unless his or her secretary, receptionist, or office manager deems your need worthy of even asking the doctor.

7. Is he/she a team player? Unlike cancer patients, who have oncologists who serve as a sort of “primary” doctors for purposes of treating cancer, and regularly deal with teams of various specialists for different parts of the body and different treatments, people with autoimmune conditions have no such specialist. Our treatment comes through other specialists, or sometimes, a rheumatologist. While rheumatologists are supposed to be able to deal with autoimmune issues, many of them are much more focused specifically on rheumatoid arthritis and/or other osteopathic/arthritic issues. This has resulted in having to travel two to three hours to get medical care from a specialist in my particular disease. It is critical that my doctors communicate with each other and are not battling with each other over ego problems.

8. Do they have privileges at the hospital I go to? Because of the issue raised in number eight, I have found this to be key in getting some kind of a “team” effort. My two most important specialists are both the heads of their departments or the entire hospital where they work. This means they can access each other‘s records, they know who each other are and respect each other, and they communicate with each other about my care. Just to be clear about how important this is, I spent 10 days in the hospital with other doctors trying to release me against my doctor’s orders, even when he was the medical director of the hospital I was in! Had I not been more vocal and a stronger advocate for myself, I would’ve probably checked out without getting what my doctor needed to get my diagnosis confirmed. Therefore, having doctors with privileges at the same hospital ensures that we are all on the same page. It also protects me as much as it does the doctors.

9. Is the doctor for or against something that is controversial, that will influence his or her ability and/or willingness to care for you? For example, if one doctor puts you on medical marijuana, and you have to find a specialist, is that specialist going to provide the same quality care if they do not support the use of medical marijuana and they know I use it?

10. Does the doctor recognize you as a qualified person to participate in your healthcare? Don’t laugh. This is probably the most important question. It is also probably the most difficult one to find in a doctor. Just like in my own career as an attorney, I have found that when it comes to professionals, there are two kinds. The kind who believe they are there to do their job, and your job is to fill in the blanks and say “ok” to every cookie cutter question and answer, or the kind who believe nobody knows more about your body than you do, and without your input, their knowledge is not often going to be enough. This is both practically true, and psychologically true. If you don’t feel heard and valued, it’s not the right doctor for you.

Do and Don’t

DO NOT be bullied into believing that you are not worth shopping for when it comes to your medical care.

DO NOT be silenced when you want to participate in your care.

DO NOT be afraid to ask questions. Be afraid to NOT ask questions. Be afraid if your doctor doesn’t like you asking them.

DO NOT be afraid to walk out and not look back. Whether you are insured or not, you are more than likely paying this professional for his or her services. If they don’t meet your expectations and standards, know your worth, and walk away. A degree is only a degree. It is not a certification about any professional’s humanity.

DO your research. Is the doctor board-certified? Where did here s/he go to school? Where did they do their residencies and fellowships? (Does that seem like an unnecessary question? Try telling a doctor about a bad experience you had at a tertiary care center, only to find out the doctor did her residency there.)

DO ask direct questions. Ask the uncomfortable questions.

DO offer information that should be helpful, and make sure the doctor is receptive to information you provide. (I’ve seen doctors glance at documents and stick them in the back of a file without even looking at them. I have also seen doctors review them and discuss them with me. These doctors are still my doctors. Such a significant difference. It can mean the difference between life and death.)

DO respectfully challenge things you are uncomfortable with, while also recognizing that just as a medical expertise is useless without the patient part of the equation, your own knowledge is simply that. Different patients have different levels of knowledge about medicine. While you are an expert on your body, the right specialist is an expert on how to use that information in conjunction with his or her medical expertise to obtain the best result for you.

Am I Asking Too Much?

Does it seem like I ask a lot? I do. Is it fair? Absolutely. My career choice is also a professional one. While I am currently medically retired, and don’t know if I will be able to go back to practicing law at all, I know that what I expect from my doctor is nothing less than the standards I held myself to as an attorney. I was good at my job. I was great at my job. Because it wasn’t just a job. It was a career, and it was my passion.

Therefore, I know what I brought to the table as a different kind of attorney than what people were used to. I surprised other attorneys and judges with my candor and professionalism. Because of that, I will not shy away from expecting the same level of professional responsibility from other professionals in my life. I am asking for nothing more than the same work ethic I put in for my clients. Additionally, I assure you, I often met with and represented clients who had previously interviewed or been represented by another attorney. I guess they were attorney shopping. Somehow, I never heard that term thrown around the way I hear, “doctor shopping.”

If that’s a problem, I’m afraid I will have to plead guilty as charged! I have always and will always shop for, and choose any medical professionals I deal with based on my needs and their qualifications. If you ask me why I am doctor shopping, don’t be surprised when I respond with, “Of course I’m doctor shopping; the real question is, why aren’t YOU?!”