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When it's time to fire your doctor

What to do when it's time to move on—and how to make a clean break

Consumer Reports on Health: July 2009

I fired two doctors in the past year. In each case I asked for my medical records and never returned. Both doctors were part of a large, multispecialty group that seemed to have an assembly-line philosophy of care; my appointments seemed to take less time than a drive-through car wash.

Although I was merely annoyed with my doctors, my friend Sally, a 41-year-old medical-office manager, experienced an incident that could have killed her. A few days after a flight home to New York from Arizona, she developed shortness of breath so severe that she made an emergency appointment with her regular physician. Although she requested a chest X-ray, her physician ignored her, diagnosing a panic attack instead. When she returned to work the next day, her physician employer stepped in and arranged an immediate visit to a pulmonary specialist, who diagnosed a blood clot in her leg. It had broken off and traveled to her lung. That condition, called a pulmonary embolism, is a hazard of sitting for long hours in a cramped airline seat, and generally shows up a few days later. It is a life-threatening emergency that requires hospitalization for treatment with a blood thinner. Fortunately, Sally's problem was caught in time and she made a full recovery.

Though the consequences for Sally were clearly more serious than they were for me, the underlying problem for both of us was that we had doctors who didn't take the time to listen. The end result can range from inadequate evaluation and treatment to a waste of time and money, not to mention increased risks, from unnecessary tests and procedures. If your doctor never seems to have enough time for you or ignores what you say, it's time to move on.

Other signs that it's time for a change

A poor bedside manner. If your doctor is rude, brusque, insensitive or condescending, find another one. Granted, anyone can have a bad day, but if you find a consistently unsympathetic attitude, it probably won't improve. Besides being downright rude, disrespectful or arrogant behavior may make you hesitant to freely discuss your concerns.

Not answering your questions. Your doctor may not always be able to give you an immediate diagnosis, but you should expect answers to your questions and a discussion about all tests and treatment options.

Difficulty making appointments. No matter how good your doctor is or how much you like him or her, if you can't get an appointment, you can't get care.

Unreturned phone calls. Office staff should call you back about insurance or scheduling questions. If they don't, raise the issue with your doctor at your next appointment. And your doctor should promptly respond to medical concerns. If problems continue, consider leaving.

Keeping you waiting. Sometimes waiting-room backups can't be helped. Doctors have to squeeze in urgent patients, arrange for hospitalizations, or run to the emergency room. But if you routinely have to wait more than an hour for a scheduled appointment, wreaking havoc with your own schedule, you may want to seek out a practice with better time-management skills.

A rude office staff. Office staff members play an important part in your care. They answer the phone, schedule your appointments, take messages, work on your referrals and prior authorizations, call in medications, and handle billing problems. If they are ill-mannered or unhelpful—and continue to be so after you've discussed the matter with your physician—it may not matter how much you like him or her.

Unreturned phone calls

Making the break

Before you leave the care of a physician, especially one you've been seeing for some time, you may want to have a discussion about why you're dissatisfied. Most doctors appreciate the courtesy and often find the feedback helpful. If you do decide that it's time to make a change, make sure you've found a new physician to assume your care before parting with your old one. You have the legal right to get a copy of your medical records, and they will help your new doctor in treating you. State laws vary, but you will probably need to make the request for a transfer of records in writing.

Orly Avitzur, M.D.

Medical Adviser

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