Diagnoising Your Doctor’s Office

How to Diagnosis Your Doctor and Medical Office

When it comes to figuring out where to go for medical care, nothing is more difficult to gauge then if you have the right doctor for, you. From bedside manners, to ease in contacting your doctor’s nurse, there are varied indicators to what level of care you can get. If you are in a medically fragile home, this one diagnosis is very impactful and important.

Once again a new year has started. You have selected your insurance carrier, your pharmacy, and perhaps a new primary care provider if new insurance has forced you too. Considering influenza is at a seasonal peak, you probably have visited your new physician by now. But what happens when you get to that appointment and feel very unsettled at the entire feel of the medical office? Or that after you leave realize it was stressful from check-in to check-out, not because of an out of control anxiety disorder, but because nothing felt personable? It’s easy to feel blindsided by a provider when you go in expecting a concerned invested doctor to care for you, but get emotionally punched in the gut by a rude nurse, or a physician who seems 5 years late to retirement. It happens all the time and more than you would expect.

We go to a doctor, their assistant or a nurse practitioner to feel better and get answers. Not necessarily to leave with quadruple the number of questions you came with. Trying to figure out if you made a mistake selecting someone is rough. Last week, I talked about trusting my gut. This week is more about what to do once your gut has said run like hell. The last thing you want is to run smack dab into another provider who may be more problematic than the last.

This is where diagnosing your doctor comes in. Very much like getting out of a romantic relationship, it’s important to know what went wrong, so you can determine what should happen or not happen the next time. Sometimes your gut has the right instinct but not all the information to help in the next round. Well, thanks, gut, now what, a little help here?

This is a very watered down and simplified answer, but typically when you feel unhappy at a doctors office the basic needs are the best place to start. I am careful to ask myself the following list of questions:

  1. Did the check-in desk behave professionally and respectfully?
  2. Did medical staff explain and communicate delays, changes in schedule and complications interfering with my appointment?
  3. Did the nurse ask common relating questions? How are you? How’s your day going? Are you a Carolina Panther’s Fan? Anything that creates a patient-provider bond.
  4. Did the nurse use a respectful tone of voice or be more militant and only give basic commands? “You can have a seat here.” as opposed to “Sit here please.” Very subtle but has a completely different manner to it.
  5. Did I get eye contact or did nurse take report face down at chart or computer?
  6. Did the doctor walk in with a smile already or more blank expression?
  7. Did the doctor introduce himself? If the 1st visit.
  8. Did the doctor take time to listen and answer questions?
  9. Was he/she have a gentle touch during a physical exam, or was the handling too gruff and disconnected?
  10. Was anyone seemingly under the influence of substances, or overall work capacity affected by their own health? I had a nurse once who had a really bad nose bleed. Not her fault, but I didn’t want her taking my medical history while wiping her bloody nose. I left that practice after hitting a wall communicating my concern. I was there myself with pregnancy complications, so it was no time to be taking chances.
  11. Were you comfortable with the explanations given during visit, this includes entire visit process?
  12. Did you/Do you, agree with your provider’s direction of medical treatment? If not were your concerns openly discussed?
  13. Did the medical practice offer you contact information should any issues arise for you as a client to practice?
  14. Was there sufficient parking and security at medical facility or building?

These are 14 initial questions I ask myself when selecting and evaluating a new provider to use. When I have been there awhile and begin to see issues arise and feel things sliding south the questions get more specific based on the circumstances.

I tend to break problems into separate areas to help diagnose where and how to resolve them. The following information may be helpful in doing the same for you. Keep in mind this is a very general discussion and may not be completely relatable to what you experience. But I do think much of this has carryover to many people.

  • Billing

Any type of accounting obviously needs to go to that area. Depending on how your provider’s practice or medical facility is organized, billing representatives are often off-site. This means gathering your account information and calling the billing office. Should your medical provider have on-site billing, it may be necessary to speak with a supervisor. I have had many billers/coders/claims processors etc, get very rude and indifferent. Many medical practices now will refuse to see you if you arrive and a balance is due. You must pay up or leave. I get enraged when no one bothers to call and lazily waits for me to show up unprepared. So pay very close attention to the billing contract you sign as a new patient. If you see fraud or suspect it, make sure to report that to your insurance agency. They have big dogs, with huge teeth and are not scared of your provider’s health system. If it’s your portion of balance then do your best to make payment arrangments. Sometimes, no matter what, you may have to leave if overly aggressive collections endanger your care.

  • HIPPA

I have a zero-tolerance policy. So should you. Not a single slip is acceptable. If you have not read the updated HIPPA laws do it right now (or when you have a few hours because it’s ridiculously long). But do make a point to get familiar with it. Its rare for a medical system to be compliant in the way they should. It really is up to you to enforce it. Sad to say that, but the law is more about empowerment than enforcement. I say that because its violation reports that drive future compliance. I never sign a release of information that is blank. Dr offices love to hand you a form and tell you we will fill the rest out. They say that because they know the information of where to send forms, but it can be grossly abused. You sign a blank form grateful they will look up the addresses. But now they have a form with your signature they can duplicate and send wherever they want without your knowledge. I had a school pull that once and a physician office called me to let me know the school was asking for copies of everything. Once I got to the bottom of it, it was an out of control social worker, unfamiliar with IEP eligibility processes breaking the law. She was removed from IEP responsibilities and my child’s records were locked. Always make sure forms are completely filled out by you, or in your sight and only sign for a short time period. If your doctor needs an x-ray report, only release that. Not the entire record for a calendar year. It is not about trust all the time, it’s about protection.

  • Ethics

Another zero tolerance area. I will not stay with a provider of any level who violates any ethical code. It matters not if it happens to me, my neighbor or my family. If a verifiable violation has occurred I am leaving. Primarily I focus on my family. Cursing at patients, touching improperly (not always sexual, it can be too familiar as well), trash-talking patients behind their back, oh man that makes me mad and I hear it too often. You understand this most likely. Demand proper ethical treatment. Reporting failures are harder. If it is the doctor, depending on nature it should be the state ethics board, a chief medical administrator or a practice manager. All carry the risk of you being forcefully discharged to keep you quiet. Be prepared, most of all, be safe and advocate your rights. Sometimes leaving is best.

  • Physician Behavior

This kind of goes with ethics, but some behavior is just in bad taste, not necessarily a wrongdoing. If a Dr has a baseline of rude, you do not have to remain in their care. If you feel as though some feedback to the physician is possible to do so. I have said, “man, if I didn’t know better I would think your angry or your dog died. Everything ok?” Now that is actually part of diagnosis my doctor. If they say, sorry my mother is really sick, or my newborn was up crying all night. I will be quite forgiving. If that person is an ass, well, not much I can do for them. Maybe offer some Charmin wipes? Honestly, your doctor is human, has bad days, get stressed, hardships of their own and compassion that is deserved should not be withheld. But if most days that physician is rude…get away, write a letter to his superiors, but only after you are with a new medical provider.

  • Nurse Behavior

For me, this is easier. I have had so much interaction with nurses I am quite comfortable giving feedback. I have on several occasions requested a particular nurse be removed from my son’s care during hospital admissions. As recent as last year I told a nurse she was being very unreceptive to needs being communicated and to please leave the room. She was scolding my son who was crying because a bandage was burning his skin. She had been a problem before and actually ripped my son’s skin not being educated in adhesive allergies. I tried once to instruct her, even had handouts (sad I have to do that), but when she disregarded, I had her dismissed. It was very uncomfortable to engage in that near confrontation, but my child’s well-being is all I care about. So if you are the patient or the family of a patient you can ask for a different nurse to attend to you. In a hospital that is easier. At a physician practice, you may have to see a different doctor there as specific nurse-physician teams are matched together.

  • Non-clinical Staff Behavior

This is the easiest to address. I am verbal to those I interact with. Generally, people respond when I mention a concern. Much of that has to do with the way I approach it. I don’t like being judgmental, so giving some space for error is really important. I mess up and make errors. But unprofessional behavior opens the door for a stronger response. But I have my limits and refuse to allow someone else’s behavior dictate my own. Directing concerns to a supervisor or practice manager is best.

  • Communications & Scheduling(administrative)

Oh, I could write a book on this. Administrative Medical Negligence is a term I coined. It’s a simple thing, a common problem and one of the most dangerous complications in the medical world. A typo can kill your child. On the other side are the more mundane. Poor office to patient communications in schedule changes for example. If your office is constantly changing your appointment without telling you, go to the manager. What I have found, both professionally and as a patient, is that those are breakdowns in specific peoples work performance. Lazy attitude, frustrated or overworked employees needing more resources, and poorly established procedures can all contribute to this. But if it is systemic and not ever addressed, you will waste lots of hours going to appointments they have moved. In the end, you miss work or pay for a sitter, and still not get your needs met medically. But also keep in mind writing communications such as lab results. My personal PCP only calls with abnormal labs. Normal results are mailed only. I get frustrated when those letters are not mailed and I have to call to figure out what happened. If everything ok or not?

Following some basic personal guidelines will keep your patient to doctor relationship in health. Being an empowered patient keeps you in the best health. Having the information and knowledge when to get away from bad relationships is life saving. Whether that is an abusive relationship or an abusive medical provider. In general, however, your doctor and medical office do want to provide you great care. Getting there takes teamwork and you can be part of that. In fact, you need to be a part of that.

If you have questions, curious what other families have done, or have a story of your own doctor diagnosing tools, feel free to shout out. We learn from each other and by doing so, build a stronger patient community.

Come back to ensure your up-to-date on all Help Haven topics, don’t forget to sign-up for email notifications or follow the blog. Be healthy and be an empowered patient.


 

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