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In Practice

Doctors can be fired, and taught too

October 18, 2010|By Anna B. Reisman, Special to the Los Angeles Times

Last year, I fired a doctor.

I was at his office to get the result of a mammogram, which I'd had about two weeks earlier. He flipped through my chart and found the document. A frown flickered across his face.

"Anybody call you about this?" he said.

"No." My mouth felt dry. Why was I just hearing about this now?

He told me that there was an abnormality on the left side that would require a biopsy.

"Why don't you take a feel?" he said to the other doctor with him. Without asking my permission or cleaning her hands, the second doctor pressed her fingers into my left breast.

"Whoops," my doctor said, still studying the report. "It's actually on the right."

When I got home, I made some calls, found another doctor to do the biopsy (which turned out fine) and told my husband I was never going back to that doctor again.

So, yes, I fired him. Of course, he probably hasn't realized it. Maybe he thinks I decided to put off the biopsy, or moved. Maybe he hasn't even noticed that I never came back.

And that is the problem. When we make the decision to never set foot in a certain doctor's office again, we usually keep it to ourselves.

We don't fire doctors loudly enough.

I'm not saying that we should barrel into the office, waggle a finger and shout, Trump-style, "You're fired!" But a sotto voce firing can be a missed opportunity to teach our doctors how to do their jobs more effectively.

My doctor might have learned something if I had let him know how I felt. Maybe I should have sent him a letter and told him that I wished he'd taken two minutes to read the report carefully before he saw me. That he should have reminded the other doctor to wash her hands. That he should have called me when he got the report instead of letting me wait two weeks to hear potentially bad news. I could have told him all these things, but I didn't. I just grumbled about it to my husband.

Being a physician doesn't make it any easier to give doctors constructive criticism. A doctor I know was angry that her son's pediatrician not only belittled her concerns that her child had a serious digestion problem but never apologized when it turned out that he did. She wrote a polite letter informing him that they had decided to leave the practice. The pediatrician probably thought she left because he missed the diagnosis; the real reason was his arrogance.

In my own primary care practice, it's been easy at times to figure out that a patient has fired me. One woman chewed me out on the phone for taking too long to call her about her blood test results. Despite my apology, that was the last I saw of her. A man who was hooked on oxycodone for his headaches wasn't pleased that I had insisted on tapering off his pills. He simply stopped coming to appointments.

A few years ago, my office manager told me that one of my patients had asked her to switch him to a different doctor in the group. I was baffled. I'd always thought we had a great doctor-patient relationship. Since there were no openings for several months, she asked him if he would see me one more time.

When it came time for his appointment, I paced around my office for a couple of minutes, taking deep breaths and telling myself to apologize for whatever it was that I had done — or not done. After an incredibly awkward few moments, we started talking about what had happened. It turned out that he'd felt I hadn't taken one of his symptoms seriously. I was able to reassure him that I had not blown it off and apologized for giving the impression that I had. Thanks to the office manager, we had another chance. The results were good: Our relationship was mended, and he stuck with me.

So how can we let our doctors know what we think? We can vent on websites that rate doctors, but we can't be sure that our doctors will read our comments. It's better to be direct. In hospital-based settings, patients can share their opinions with patient advocates. Hospitals or day surgery centers often send a feedback form to patients a few weeks after procedures, and patients can make their comments anonymously.

There are fewer opportunities for this in outpatient settings. Practices might consider sending such forms twice a year to their patients (along with a postage-paid envelope), with an option at the top of the page stating "I no longer go to this practice because …" And there's always e-mail, or the old-fashioned letter, which allows for anonymity. If you don't like a doctor, figure out a way to tell him why — even if you're not going to see him again.

An occasional serving of humble pie is good medicine for all doctors.

Reisman is a general internist in Connecticut. She can be reached at anna.reisman@yale.edu.

Are you a doctor, nurse or someone else in a healthcare profession? Do you have a personal story to tell about your work and lessons it has taught you? Send "In Practice" submissions to health@latimes.com. Offerings will be edited for space and content.

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