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Follow up pharma & Finding a doctor, for doctors

May 23, 2009

After blogging about the ethics of interacting with Big Pharma, someone sent along a good article about medical students and how they are swayed by pharma freebies; check it out at The Globe and Mail.

I’ve been assigned my Family Practice clinic for the next 2 years. I don’t know yet what their policy is on interacting with drug reps, doling out free samples, or attending pharma-sponsored events, but I’ll probably do whatever my preceptors do, and see how it works for me.

It seems I wound up with a few of the best docs in the city. So good, in fact, that they were on my list of “new doctor for me” candidates. I’ll admit, I read their “rate my doctor” profiles to find out more, made my list, and put stars beside the ones that I would probably beg to be looked after by. That site obviously shows the worst and the best of people, and I dread to imagine what it might one day say about me, but where else could I start? I’ve doctor shopped before in a sense; I don’t advocate switching often, but if the fit isn’t right, the therapeutic relationship suffers. I got a doc about a year after I moved to Vancouver. He was a fine clinician, but he kept treating me like a medical student instead of as a patient. That didn’t work for me, because I felt like I could never get across the reason I came in. So I found another fellow who worked out of a combo walk-in/regular practice; I saw him on a semi-urgent walk-in appointment, liked him a lot, and managed to have him take me as a regular patient. He’s hardly ever there, but everyone in the group have been excellent to deal with, including all the Residents they have. They each have their own style, and I tried my best to be nice to the Residents since I’ll be in their shoes soon enough!

Health Care Providers are lucky in that, at least anecdotally, doctors are more willing to take us on as patients, even when their practice is full. But we can also be the absolute worst patients; we are know-it-alls, demanding new and crazy treatments, taking up time yakking about politics, and causing the doctor to fear that we are critiquing his every step. As awful as we can be, we can also speak the same language, understand why doctors have to balance listening exhaustively with being on time, struggle with ordering enough tests but not too many, etc. To be a “doctor’s doctor” is a very tricky thing.

For  the average patient to find a doctor, it may be even a trickier thing. Usually, I recommend the College directory to patients looking for doctors accepting new patients, and sometimes I can even provide them with a list of ‘open’ physicians (some Emergency Rooms have these handouts ready). However, this doesn’t always work. The list may be out of date, the doctor may be taking only obstetrical patients, or no obstetrical patients, or they may not like you. Yep! “Physician Interviews” are a topic I’m not ready to touch on, but Dr. Couz describes the challenge of “Making the Cut,” and how it is especially challenging for patients with illnesses that are chronic and difficult to manage.

Well, some of the great docs that I would have liked to are now outta bounds, since they’ll be my colleagues. It can be a very awkward situation for small town docs, who know everyone in the whole area and would have to entrust all of their personal details to one of their work ‘buddies.’ Working in a Montreal Emergency Room, a physician from a small town in another province introduced himself. He was my patient. He collected for himself urinary retention, gastoesphageal reflux, various musculoskeletal complaints, and a list of other problems before making the trek to our hospital. In his own town, he was the doctor. No one else. But he knew all the nearby GPs and was simply not comfortable with the idea of having them palpate his prostate. Fair enough!

Some resort to taking “physician, heal thyself” in a very literal way (as opposed to the meaning that encourages us to self-care in all but non-medical ways). But self-medicating or even caring for one’s own family is really not how that’s meant to go. It leads to dangerous things. Patients, including doctors, their spouses or kids, need to have someone they can go to, to talk about their sore knee, their STD, how sad they are, how much they drink, or that headache. No matter the problem – medical, social, or otherwise – a patient should feel okay discussing it with their GP.

Speaking of “heal thyself” it’s time for some fun outside in the sunshine. Ciao!

5 Comments leave one →
  1. May 29, 2009 5:54 pm

    Couple of thoughts. One day, 10 years from now, it will be Saturday at 7:30pm and your child will have a big bulging TM and you’ll call the pharmacy for some Amox. Would I phone in Dilaudid suppositories? Not on your life. Would I sit in an urgent care for 2 hours for Amox? Not on your life.

    Second, the cat is out of the bag! You’re never going to just be a patient, for worse, but mostly for better. You’re going to negotiate care with somebody you’ll be vaguely suspicious isn’t quite as smart as you are. You won’t wait as long as other patients for services, and you’ll get a private room at the hospital.

    Last (geesh, shut me up), doctors make THE WORST patients. WORST. They never do what you say. They see through your tricks. They’ll all think they’re smarter. Best appointments, though. You trade stories, yuck it up, talk seriously about the pluses and minuses of a given treatment or guideline, recognizing that there’s a 90% chance your advice will be soundly ignored. But you can laugh about it together over dinner later and talk more shop.

  2. June 1, 2009 3:29 pm

    yeah, there are a lot of fuzzy grey areas and every ethical question will see me stumbling through; as far as finding a doc, well, it will be hard to do what they say but I try to be honest when it comes to those things. I kept telling my dentist that I do not and will not floss. She tried for a while to convince me, realized it was futile, and then offered mouth wash as a workable solution. And handed me a big bottle of mouthwash. No excuses now!

  3. June 6, 2009 3:54 pm

    Thanks for writing,I really enjoyed your newest post.I think you should post more frequently,you obviously have talent for blogging!

    • June 6, 2009 9:40 pm

      thanks that’s very kind
      probably once I begin my residency, July 2nd, I’ll write more; right now, I’m in vacation mode and trying to enjoy the last of my freedom (and the good weather).

      J.

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