The last time I saw my gynecologist, she glossed over the issue I’d come in for and gave me a test I didn’t want — without even discussing it with me first. In my previous visit, she ordered me a mammogram and brushed off my attempts to discuss the exam’s harms and benefits. It’s clear we have a communication problem, and frankly I’m ready to fire her — but how? Am I obligated to tell her I’m switching doctors? (I’d feel badly if she found out by reading it in this column.) And what obligations does she have to me?
It’s okay to just leave without notifying your doctor, says Michael Prameko, past president of the Colorado Medical Society and executive director at Primary Care Partners in Grand Junction, the city where I get my medical care. But he says it would be best to hold off on firing your doctor until you’re sure you have a new one. Most physician codes of ethics suggest 30 days as a reasonable amount of time to provide emergency care — but not appointments for routine care — while the patient finds another physician, says Reid B. Blackwelder, president of the American Academy of Family Physicians. After those 30 days, you’re on your own.
Before you move on, you should also consider speaking to the office manager. Many practices would want to know if one of their providers isn’t doing a good job, especially if the problem is severe enough to drive you elsewhere, Prameko says.
Doctors have added incentive to monitor patients’ opinions now that some insurers are using patient-satisfaction measures to help evaluate providers, Prameko says.
If you don’t feel comfortable giving feedback face to face, consider sending a letter that explains why you’re changing doctors, Blackwelder says. There’s no guarantee that your letter will change the doctor’s bedside manner, but “you never know, so it’s worth doing,” he says. If the problems with your physician include unprofessional or incompetent behavior, then the appropriate response is to report it directly to your state’s medical board, Blackwelder says.
Once you have decided to leave, be sure to request a copy of your medical records. You can have them sent either to you or directly to your new doctor. Ask that they include lab results and such things as MRIs, X-rays, EKGs and recent hospital records, Blackwelder says. If your doctor has sent you to a specialist, it’s a good idea to ask for copies of the consultation notes from these visits too, he says. Legally, the records belong to your doctor, but as a patient you have a right to a copy, says Rachel Seeger of the Office for Civil Rights at the Department of Health and Human Services.
In some cases, the best approach is to go to the front desk and request your records yourself. Under the Health Insurance Portability and Accountability Act, the doctor must comply with your request. You may have to pay for the copies and printouts, but HIPAA mandates that a practice may charge only “reasonable,” cost-based fees. Blackwelder says a fee of $20 is common, but the price can climb rapidly if you have an extensive medical record or if you have an electronic medical record that is not easily formatted for printing. You can ask for a digital copy, but some software doesn’t make this practical. Make sure you are charged only for the cost of copying the records. HIPAA states that health-care providers “may not charge fees for retrieving or handling the information or for processing the request,” Seeger says.
If you’re taking medications, you’ll want to renew your prescriptions before you leave your current doctor’s care and make sure you can see your new doctor before your drugs run out, Blackwelder says. Don’t let the old doctor bully you into staying. You have a right to move on. When you do, bring all of the prescription and nonprescription drugs and supplements to your first visit to the new doctor.
How do you find a new doctor that’s a good match? Start by seeking references, Pramenko says. While you can find physician ratings on sites such as the one run by Healthgrades, keep in mind that these tend to come from people who either really love or really hate their doctor, and they may not be representative or reflect what your experience will be, he says.
You can check a doctor’s credentials at the American Medical Association’s Doctor Finder Web site. The site lists physicians’ degrees, training, board certifications and hospital admitting privileges. But the best way to find a doctor you’ll like is by word of mouth, says Pramenko says. It’s okay to call the practice and ask some basic questions about the doctor’s policies, Blackwelder says, but it might be hard to determine in advanced more subtle things such as a physician’s communication style.
Since communication was the main problem with my previous doctor, I’m asking questions about philosophies and approaches to medical choices so I can find someone who is committed to shared decision-making. It’s a lot of work, but a worthy investment.