tired of bouncing from doctor to doctor
how does one find a good doctor? how do we find out, before submitting to their care and their judgment, that we actually approve of their judgment, that we can trust the advice they give us as complete?
i've made no secret about the fact that i've been failed by several practitioners in the medical profession, when their attitudes just didn't jive with my own. doesn't make them bad doctors, just not the right doctors for me. and of course i also had a couple who anyone would agree is simply a bad doctor.
we can all agree that finding the right fit is important, but i want to know how. facing a serious issue right now, bouncing from specialist to specialist, testing facilities and labs, i'm coming to a point where i need to get down to treatment. and, it turns out, that the problem could involve gynecology. and, as i've written about, i've learned that my gynecologist seems to believe that low income women should have hysterectomies to deal with gynecological problems, despite other treatments being available, because we can't afford to "mess around" with less invasive treatments. a surefire way to get rid of a tumor on your uterus or ovary, is to just "take everything out. if it were me, if i were in your situation, i would just take it out." between uncomfortable stammers, of course, about my "finances."
this isn't the first time. i was pregnant about 8 months when i found out my obstetrician was keynote speaker at pro life rallies. i had entered her care by word of mouth, from women who were well into menopause. it was too late, and i had too much to deal with at the time, to find a new obstetrician. my birth was dreadful. i labored for two days, while she performed c sections, rather than have someone else come and attend my birth. the hospital staff did a lousy job hiding their contempt for how she was handling her patients.
but what do you do? this hysterectomy-happy gyn, i picked from the phone book, because... what else is there? i asked around but my friends all used an internal medicine clinic for their gynecological shit and i didn't want to do that.
now, i need a gynecologist. my other doctors are telling me that the chances of me getting through this without going under the knife is slim to none. i can't really do what i've always done, which is just start going to a doctor, and when i see signs that they won't work for me, switch to another. i need one whose judgment i can trust. what do you do for that? interview them? should i call them and say "listen, my last gyn is toast because she was selling me hysterectomy before looking at a single test result. i need a doctor who believes in informed consent and will advise me on all medical options, despite their perception of whether i can afford them. what i can afford is my business, medicine is yours. can we work together?"
i don't see such a conversation going over well.
but what else is there? if you go to a tattoo artists web site, they will write volumes about their philosophy, how they treat their clients, and what they will and will not do. but doctors? we're supposed to just make the appointment, pay the fee, and hope for the best.
are there any directories of woman-friendly gynecologists? doctors who believe in informed consent? what prescreening is there available for patients?
anyone know?
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Sorry you are dealing with all this. I am very lucky to live in a city that is chock-full of responsible doctors with alternative approaches to western medicine. I guess I take it for granted. That said, I found our awesome family doc via my midwife. Are there any midwives in your area that could see you and perhaps provide a reference to a specialist?
I'm also looking for a new obgyn. I'm going to look for recs on a lesbian listserve, a parents rec website/listserve and I will also see if local midwives have ideas. I wonder if there's a midwifery association in NJ? You might ask if they have any sex positive/keepin girlie parts intact docs they like. Oh, how about any chiropractors, acupunturists or the like?
BTW, I think that the question you put forth is completely appropriate to ask.
"Mediocrity knows nothing higher than itself; but talent instantly recognizes genius"--Sir Arthur Conan Doyle
NJ has laws governing midwifery that lead me to believe that may not be a good angle to take. see below, i commented on it.
i don't know of any lesbian listservs... i bet i can find them if i look hard enough.
the trouble that i've found is that, with the exception of this one doctor who i just looked up in the phone book, i take personal recommendations from other people. i've come to learn that different people want different things from their doctors. like the pro life one. i can't tell you how many people gave her glowing reviews and she was horrible. i had a fibroid that she decided she didn't need to tell me about. i confronted her and she was like, "it was of no clinical consequence." she tested me for HIV without my consent of knowledge. she had a program that she expected all of her patients to follow and she was clearly the authority, not a partner or peer or advisor, but authority. and these women who love her? well i guess they like that approach.
i'm reading reviews on those web sites and i'm seeing shit (about other doctors, not her) "LOVE him, so caring and compassionate! made me feel very comfortable." and about the same doctor, "i had HELLP and he told me i was depressed and worried because it was my first baby."
same doctor, same attitude, different expectations, different outcomes.
my point being, recommendations only help if you're 100% certain that the person giving the recommendation has the same expectation as you do.
so, when i look around and ask around, i know that it's really a crapshoot. this is why i just said fuck it, i'll use the phone book because my chances are just as good there. but this time the stakes are higher because i already know i will need a procedure and i don't want to get pushed into anything unless it's the absolute right thing for me medically. and i also don't want to walk in there with a chip on my shoulder. but it looks like that's inevitable.
anyway, you get all that, i'm just streaming here.
I've always done the same thing, gone to ob-gyns based on recommendations. And then I went to this one ob-gyn who people just ADORED and who it was really hard to get in to see and I had to pay a fortune to park cos the office was downtown and they didn't validate...and I thought she was a total nightmare of a doctor- arrogant, brusque...and I thought, what the hell?! Did she just have a bad day? Why does everyone love her??? After that I was like, well, crap how am I going to find someone now??? And basically, I found a clinic near my house that was all about serving the Latin@ community and they had a midwife. So I just went there when I got pregnant. It turned out to be a perfect fit, I loved all the nurses and my midwife (although lots of women do not actually like her- she's very opinionated and straightforward & not lovey-dovey, earth mothery kind of midwife. Which I appreciate, but others not so much I guess!). So yeah, unless you can find a review or someone who agrees with YOUR expectations of what a doctor should be like, then relying on recommendations is going to be more or less a crapshoot, sounds like. Good luck! (I mean that sincerely, not trying to be snide!)
Kinda sucks about the midwifery laws in NJ...so much for that avenue....
Find ecstasy in life; the mere sense of living is joy enough. -- Emily Dickinson
You want to do what you think is right and what matters to you, and if other people don't like it, as my father would have said, they can go fuck themselves. -- Amy Bloom
The websites http://www.ratemds.com/ and http://www.vitals.com/ are sites that allow patients to post a review about the experience they have had with a particular doctor. I haven't had personal experience with this, but you may find it helpful in your prescreening journey.
Glamorous
Memory is a crazy woman that hoards colored rags and throws away food. ~Austin O'Malley
i looked up the doctors suggested by my family care guy and found bad reviews.
i'm a little leery of these sites. i think people are most inclined to go onto a site and write about their doctor while they are still fuming about something bad happening. despite my experiences, i still haven't written a review of any of my doctors, because i believe in accountability for my words. when i have an issue about a doctor, i will report it to the proper licensing boards. if anyone asks what this or that doctor is like, i tell them unabashedly. but leaving online comments in a setting where the doctor doesn't have the means to respond i think is asking for skewed results.
so, i still don't know about these docs that i just read bad reviews for.
i dont know if this has caught up to the medical field, but in almost every other practice of business, emails are quite common.
perhaps when booking an appointment with a new doctor you can request their email. before meeting them you can send a note about where you are coming from, and hope for a response that indicates a good match.
i believe that a doctor should respect that question and if they resist, then maybe that attitude carries over to their ideas on informed consent.
I recently found out that my favorite herbal/natural remedy writer & midwife - Aviva Jill Romm - is now also a medical doctor and has started an integrative medicine program at Yale (made me almost want to move to CT so I could see her as a doctor!). I think integrative medicine sounds like a much more patient-centered kind of practice and seems not as rigid as more traditional kinds of medical practices. Honestly, I don't know that much about it. I think there's someone on here or who was on here who might work with intergrative med practicioners? ascedarleaf? maybe you could PM her. I think she's in Wisconsin, which wouldn't help you, precisely, but maybe she's got access to a professional association or something? Just a thought.
I like the asking a midwife idea too. That's how I found my family practice doctor. In general, I like family practice doctors better than specialists..... seem more willing to actually talk to you as a person with a functioning mind. Leastways, MY doctor is that way. If she doesn't know the answer to something, she's not afraid to admit it and does her research and gets back to me. I don't expect my doctor's to have all the answers (and as far as I am concerned any doctor who thinks they DO have all the answers? that's a huge red flag for me). It seems to me that the conversation you describe is altogether appropriate and that doctors SHOULD be thrilled to have a patient who is so engaged and thoughtful etc etc etc. It's really pathetic that we have a medical culture in this country that does NOT foster that kind of interaction between doctor and patient. It's one of my pet peeves (esp. when it comes to pediatricians...but maybe that's just because that's the kind of doctor we deal with most often given T's age, etc etc...pediatricians are treated/seem to think of themselves as some kind of demi-gods, with the answers to all child-related things, regardless of whether the issue is medical or not. At least, some of them do, which gives the rest of them a bad reputation, in my opinion!).
This all reminds me a little bit of an article I read in the NYTimes mag that freaked the hell out of me. It was about an older couple- the husband had heart issues and dementia/stroke damage and because of the way our medical system is set up, piece-meal, fee for service, he ended up getting a pacemaker that he never would have wanted and if his regular doctor had been in the loop more he would have been able to help the man's family make a better decision, in the long run. The article mentioned that the Mayo Clinic has a very different model of care, with doctors on salary (rather than fee for service) and a single doctor oversees all the patient's treatment, even if there are other doctors involved. It seemed to me that this would result in a patient who knew who they could talk to about various issues and who would actually KNOW them, etc etc. I resolved that if I ever had serious medical issues I'd get my butt to the Mayo Clinic. But then again, that's fairly close to where I live, so easy for me to say!!!! Sorry, tangential.
It sucks that you are going through all this and that your ob/gyn is such a hysterectomy-happy nightmare. I hope you can figure out a solution to your issues without surgery. Or that at least you can feel like you've exhausted all the options before having to resort to surgery.
the RIGHT surgery. the least invasive, most appropriate procedure, or no procedure at all. not a hackjob to get the poor woman out of your face. that's how i felt about it anyway. i'm sure my doctor doesn't see it that way, but at this point i feel that the trust is breached and i live in a state that's lousy with doctors so i can just move on to the next one.
midwifry: alas, my state requires that midwives get licensed through a ob-gyn practice and the only one i've found in an hour of looking is in the practice that i've read bad reviews about. in any case, a local midwife is likely to recommend the doctor that got her licensed, and i'd have to call that doctor's office to reach her anyway. so, looks like that's a dead end. maybe i'll just go back to the one i moved away from. it's a haul, but at least i know her.
every time i go to new england i have to drive through connecticut, it always takes 5x as long as it should, and everyone there sucks. it's true. i'm homicidal within a half hour of being there, before ever leaving the highway. the people are rude, loud and boring, and you can't get a decent meal in the whole damn state. the whole place just does not need to exist. people who are unfortunate enough to live there go to either boston or ny to be amongst humans, but nothing exists within the confines of connecticut's borders.
I was being silly! I've lived in CT and in no way would ever live there again!!!! I don't want to live anywhere but where I already live. Well, okay, living in Rome would be nice or Portugal, but that's more the realm of fantasy..ha!
sorry you're dealing with all this, and I hope you find good care and support. I can't offer anything useful with the search, but I would say that *any* questions you ask are totally legitimate, and can be put to a doctor. They don't just spring into existence, pen poised, at the point of diagnosis - they've got an obligation to consider your queries and respond to you as part of their duty of care, from the get-go. Most of the doctors I've known would LOVE a person asking them questions, and taking some responsibility for their healthcare choices like that.
best wishes...
Did you make any headway? I hope whatever it is you are battling isn't causing discomfort...the last thing you need is to have to figure out how to work with this while feeling crappy.
sort of. narrowing down shit still. going for more tests. but the possibility of going under the knife is looking less likely, so that's good. in a way.
I have never really had to think about how to find a good doctor, first because I have always had an "in" to the medical system- my mom is a nurse and knew which doctors were asses. I did take a friend's opinion on an OB for my first pregnancy, and, had I known better, I would have, a)gone to a family doctor instead of an OB, and b) asked more questions at my first appointment. What questions, though? Some people end up having more trust in the patient-doctor relationship than in their marriage- how could you ever decide to marry someone on a first date?
I like this statement:
"listen, my last gyn is toast because she was selling me hysterectomy before looking at a single test result. i need a doctor who believes in informed consent and will advise me on all medical options, despite their perception of whether i can afford them. what i can afford is my business, medicine is yours. can we work together?"
Leave out the "what I can afford is my business, medicine is yours" part, and this is a perfectly reasonable thing to ask a doctor. (leaving that in is fine, it just makes it sound more confrontational than I think you intend.)
If a patient said that to me, I would immediately know that this was a well informed patient, and mutual decision making would be the basis of treatment. Not all doctors work well with that, and you should be able to tell from their reaction to that conversation whether they function best as a part of a decision making team, or as a paternalist. (Not that paternalists are bad doctors, but they're not the kind of doctor that you need.)
I saw some comments suggesting other specialties- family doctor, or nurse practitioner, or midwife- I agree and would strongly encourage you to have someone you can talk to about your general health as a whole person. OB-gyns (generalizing here) tend to be concerned with baby making parts, and may not have the most objective opinion. And once this problem is taken care of, the ob-gyn will likely not be involved in your care, so you'll still be stuck with trying to find someone you trust if anything else comes up.
Good luck, I hope you find someone that can help you through this and that you get some answers.
"listen, my last gyn is toast because she was selling me hysterectomy before looking at a single test result. i need a doctor who believes in informed consent and will advise me on all medical options, despite their perception of whether i can afford them. what i can afford is my business, medicine is yours. can we work together?"
Who the hell cares if it goes over well??? This is your body, that's what you are ultimately saying here, right? I don't think there's anything wrong with saying that for you a hysterectomy would be the last resort. Shouldn't it be? And if you can't be frank with an ob/gyn as to your needs, who can u be frank with? I would ask to speak to them via phone and ask exactly what you do above. Pfffft. I don't see any problem with that- sure, it might not go over well with some (although it's completely reasonable), but when you find someone it DOES go over well with, you'll know they won't be a waste of your time. RIGHT?!?
Love ya. 
by "go over well," i'm referring to gleaning honest, usable information. i foresee any gyn office saying hell yes we can work together. their practice is a business and a huge part of that business is convincing them that you need their services. they don't turn away customers. furthermore, i believe that any ob/gyn practice sees itself as "woman friendly" or "woman centric" because they see themselves treating women every day for serious as well as routine things. a lot of these women, i'm sure, respond positively to their approach, because it's what they like, otherwise they'd transfer to another practice. the question being, what DO they like? like it or not, a lot of women, if not most women, find the patronizing approach comforting and value comfort over competence. THAT is what i'd like to know. BEFORE getting into the examining room, investing half a day and $300.
i also think that question is totally reasonable. but getting an honest answer, i tend to doubt it.
In the library today I came across this book in the new releases section:
SURVIVING YOUR DOCTORS
Why the Medical System is Dangerous to Your Health and How to Get Through It Alive
by Richard S. Klein MD
I'm skeptical because the author is an MD, but it may have helpful information...anyway, I hope you have a chance to peek at it.
i have such mixed feelings about all of this. maybe i will read that book.
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i will start on that route today. thank you.