I’ve been in Sarasota, FL, the last week tending to my mother, who is 84, trying to help her decide whether or not she needs to move from her apartment in a senior citizen community into an assisted living facility. She’s had what seems to be a rapidly accumulating number of health problems, primary among them dizziness and edema in her legs that renders her nearly unable to walk. Still, she is understandably resisting the move.
Part of my intention in coming down to Sarasota, aside from helping my mom assess a specific assisted living facility, was to help her explore switching doctors. Her existing physician of twenty years has told her that he can find no cause of her dizziness (which has sent her to the hospital a couple of times after actual fainting), and that her edema really isn’t getting worse, that it’s just something that can’t be treated and that she needs to learn to live with. I actually was with her on one visit to this doctor a couple years back, so I knew my mother’s reports of his detached approach haven’t been an exaggeration He’s had her on three or four different prescription medications designed to thin her blood and help correct possible heart beat irregularities.
My feeling has been that there may be some non-drug tactics she can apply to her problems (perhaps herbs or supplements) and that she may benefit from the insights of another physician. So, with help from my sister, who lives in the Sarasota area, I checked around and found a doctor trained in so-called functional medicine, which emphasizes prevention and comprehensive management of complex and chronic conditions. I arranged an appointment about a month before coming down, and last week my mother and I went in to visit the doctor.
We were both impressed. In listening to my mother’s heart, she thought she detected problems with her aorta. In examining her legs, she found fluid in her knees, and in her questioning figured out that there is likely a genetic factor contributing to the edema. None of these matters had ever been explored or raised by her previous doctor.
It turns out the new doctor has what’s known as a “concierge” practice—a new trend among doctors who want to increase the amount of time they can devote to each patient, and reduce their overall patient load by charging an annual fee above and beyond regular office charges. I had known about this in advance, and encouraged my mother to consider it, since it seemed as if she needed additional care, assuming the doctor was knowledgeable and appropriate to her. The $1,500 annual “membership” fee, as this new doctor called it, seemed okay—perhaps beneficial, since my mother tends not to take great care of herself in terms of diet, and she resists exercise. So if she’s paying, I thought, she might be incentivized to follow through on this doctor’s recommendations.
Before leaving the office, my mother signed a form requesting that her previous doctor send along her medical records to the new doctor.
An hour-and-a-half later, a call came in to my mother’s apartment from the old physician’s office. I answered the phone, since my mother was lying down, and the physician’s office manager said it was his practice to call any patients who were leaving his practice to find out why they were leaving.
I explained that my mother was concerned that some of her conditions continued to deteriorate, and Dr. XX had said there was nothing he could do. She wanted to get another physician’s input.
“If she wants to consult with another physician, Dr. XX can send her to a specialist—maybe a vascular specialist for her legs,” she said
I explained that my mother wanted to avoid being sent to specialists—that she wanted her primary-care physician to do as much as possible to oversee any treatment.
In that case, the assistant told me, if she leaves his practice, “she can never come back.”
I said she hadn’t made the decision to leave, but in any event, that sounded like a strange approach. Just because she was consulting with another physician, she was being kicked out of his practice forever?
. “Yes, since she is going to another internist, he won’t take her back.”
“Why is that?” I asked.
“It says to him that she has lost faith in him.”
“Hmmm, “ I said. I then explained that my mother hadn’t made any final decisions (since she hadn’t and, even though the decision seemed clear to me at this point, she had the final say). The office manager she she’d call back the next day to speak with my mother.
When I explained the situation to my mother, she was upset. She had heard stories that a number of doctors in the Sarasota area had closed their practices to new patients. “What if I don’t like the new doctor. Then I won’t have a doctor.”
The intimidation was working. I tried to reassure my mother that she would always be able to find a new doctor. In any event, any doctor who was using such scare tactics probably wasn’t worth being with. While I thought the new doctor offered some possibilities for more effectively understanding and treating her conditions, the final decision was hers, I said.
She was troubled, and rightfully so.
The next day, when I called her at mid-day, I asked her if her old doctor had telephoned. Yes, the office manager had called at 9 a.m., and confirmed my report that if she left his practice, she was out for good.
So what did you say, I asked.
“I told her I was changing doctors,” she said, with more force than I’ve heard her say anything of late.
P.S. I spoke further with my mother’s new doctor today and told her about the old doctor’s reaction. “It’s partly about ego,” she explained. “Also, some of the doctors around here want to get rid of Medicare patients” because of its low reimbursement. The wonders of our healthcare system!
After 10 years with the same PCP, I switched primary care physicians twice in the last year trying to find a good "fit", and it isn’t easy, even without the intimidation. It kept me up nights at one point. You know the saying about the devil you know vs. the devil you don’t know. I’m still not 100% satisfied, but so far, my current one is the most holistic and open-minded I think I will find in our HMO plan. Plus I am more assertive, a squeaky wheel, I guess.
Your mom is lucky to have you as an advocate. But it probably can’t be easy for either of you if you aren’t in the same area. But it’s good she isn’t willing to settle for less than she deserves. Seniors are some of the "frequent flyers" of the health care system, yet they often unknowingly get less than adequate care.
I have never, ever heard of a holistic practitioner (of any modality) say something like this, and to me it is a reflection of the same thing you experienced, Dave, at the dinner recently when you had a conversation with the pediatrician. The conventional medical model is eroding, and it’s practitioners are quite scared. That is from where the defensiveness originates.
There is so much more. It is a very interesting article.
Twenty years of "healthcare" resulting in unexplainable dizziness, untreatable edema, and multiple medicines, all chased with a bullying threat. Seems to me that lost faith is the only reasonable response to this doctor.
No one can say how common such browbeating is, but we do know that such medical/health results are becoming more the rule than the exception.
We all hope and pray for a happier turn for your mother, David.
David’s mother’s doctor, these past twenty years, has probably been providing care according to generally accepted standards of practice. That is to say, by the medical system’s standards of clinical competency, he is in all likelihood a good doctor. I am sorry if I did not afford him this benefit in my last posting.
I prefer to disparage the system itself rather than those suctioned to it by educational or cultural circumstance. Needless to say I am not attempting to excuse any doctor’s uncompassionate bedside manner nor attempted intimidation, but the real crime here is bigger than a single doctor-patient episode. The corker is that we’ve allowed this hugely expensive, pathology-focused, interventionist-minded medical system to take charge of our health.
The sad results of that are demonstrated in David’s story, and millions of others like it.
It’s strange how we speak of authoritarian systems, which after all are just mental abstractions/concepts, as though they are living beings which have a self defense and preservation response. How can an abstract concept be concerned with self preservation? And why do we spend so much energy fighting a concept("systems") unless it’s because we don’t really see that it is only a concept and not a living\feeling entity at all. I can’t figure this one out; why do we assign the qualities of living beings to concepts? Maybe we are living in the Matrix after all. I know that sounds far out and off topic, but I think it does relate and has really changed the way I(and I suspect many others) relate to the experience of the great cultural shift that’s happening. I guess that’s enough philosophising for one day!