new PCP

Why does it seem that a patient is supposed to assume all doctors are not only equally qualified but equally a good fit with them? I don't think this is just me, although I'd be hard pressed to put my finger right on what (other than my own experiences) has informed this opinion. I'll have to think about that. For now, here are my thoughts on this implicit and possibly overly subjective impression.

I realize there are institutions and agencies in place to ensure that all licensed physicians meet a minimum standard of quality and ability. That addresses the qualification issue somewhat, but what about the second - the issue of a good fit between patient and doctor? I don't assume a doctor's certifications, license, and other professional qualifications means that we will be able to communicate and work effectively together. This perspective seems quite reasonable to me. And yet you can't make an appointment to interview a doctor. At least you can't with my health plan.

These things are on my mind because I find myself in the very unpleasant position of needing to find a new primary care doctor.

From January of 2004 until April of this year, I had a great primary care doctor, Dr. C. I found Dr. C in 2003 when she was my (ex)boyfriend's attending while he was inpatient for a quite unexpected attack of pancreatitis (though I guess few people actually expect pancreatitis). The consulting GI who saw my boyfriend at the hospital had ruled out cholelithiasis on the basis of a low but within normal limits ejection fraction on the HIDA scan. However, the bloodwork, history, and symptoms all sort of kept pointing to that. When my boyfriend was discharged with no real diagnosis, Dr. C suggested a second GI appointment with a different doctor. One outpatient GI doctor visit and an MRI later, the gallstone was confirmed.

After this, my boyfriend and I both went to Dr. C as our primary care. Her refusal to accept a write off by the first GI doctor was not the only basis for my decision to see her as my primary care doctor but it did factor in significantly. To me it meant she was willing to consider other evidence rather than sign off on one somewhat equivocal test result in the face of still unexplained symptoms.

Dr. C was not super warm. No one would call her effusive. She was direct and respectful, no nonsense (as in taking or giving none), and as I got to know her I realized she had a nice slow burn sense of humor. She listened and she took note of the things you said outside the official answers to the official questions. She remembered things like my brother being HIV positive, my family history of autoimmune disease, and that I had mentioned my sister had found a lump in her breast around the same time a good friend was diagnosed with breast cancer.

But she moved out of state in April and now I must find a new PCP. She gave me the option of transitioning to the people who took over her practice - a married couple, both family or internal medicine (I haven't looked them up, yet). I was uncertain about committing to this since the office is a little far away from where I now live. The only reason I kept going there since I moved was Dr. C.

I put off looking for someone but then I had surgery and you know, it sort of reminds you "hey I probably ought to find myself a new primary care doctor". So a few weeks ago, after doing some research online, I made an appointment to check out a potential new PCP, a woman who practices a few towns over. Let's call her Dr. Y.

Unfortunately, I had reason to see a doctor this week, well before my appointment with Dr. Y. This brings me to today. Today I saw the husband of the couple who took over for Dr. C.

At one point he said "You use medical terminology...why?" He said it quite neutrally but I felt like I had to defend something. I hadn't recalled saying anything overtly medical except that I had recently had a laparoscopy. I wondered if that was it. And I wondered do most people say "I had a tummy operation" or "They done dug into my lady junk"?

When he noted my low blood pressure, I didn't declare "Indeed, I am usually rather hypotensive". I just said "yeah it's usually kind of low". My point is that I don't aim for pretension.

Since today's appointment wasn't in a "getting to know you" context, I hadn't had a chance to give my "why I know medical terminology so please don't think I'm a freak" speech. It's not like I have nothing better to do than sit down and memorize this stuff, and I think it's important to mention this because otherwise people will assume. When he asked why I used medical terminology, I figured I needed to make sure I gave him enough info to dispell those potential assumptions.

I explained quickly "I was married to an ER doctor for 5 years and my mother was a nurse and I worked as a unit secretary to pay for college..." I said it all really fast, like a kid who was caught by his parents skateboarding without a helmet or holding a pack of cigarettes - "I swear they aren't mine, it was Josh's idea 'cause he took them from his older brother Mike and I didn't even know he put them in my bag!"

New doctor had a minimal response.

I sort of feel like we didn't hit it off. This impression was reinforced when he went to push on my "belly" although my reason for being there had little to do with that part of my anatomy. I reflexively moved my arm to block him, saying "please no, not unless you really must." At this point, I should mention I had already told him I was still having cramps even on 400 mg of celebrex a day and that I hadn't stopped bleeding since the surgery (I had a Mirena IUD placed during the operation - otherwise a month of blood and pain post lap would probably be more alarming). A little warning maybe, some kind of "hey I know you're in pain but I need to poke around a bit.." would have been good, respectful, and a sign that he had actually heard what I said when I was talking.

So I kind of came away thinking I'm definitely not cancelling that appointment with Dr. Y.

I know I'm a kind of patient who can be a pain in the ass. I know it can be difficult to have a patient who had a recent case of somewhat hard to treat Lyme disease, who has endometriosis on her bowel making for confounded GI and GYN symptoms, who has autoimmune disease lurking in her family, bloodwork, and physical presentation, and who watched way too up close and personal a group of people go from being little doctorlings to full blown attendings.

I know how I'm seen as a patient to some doctors. I know because they've told me. But I don't think because some people I didn't like or feel comfortable with didn't like me in return means I am a bad patient. My sense is that sometimes there is just what they call "a failure to communicate" brought on by an unfortunate intersection of incompatible personalities and personnas. All these doctors are people, regular normal people who also happen to practice medicine. And I'm the kind of person who people either really like or really dislike. I'm the kind of person who can seriously rub people the wrong way. Makes sense I'm that kind of patient too.

All the more reason why I shouldn't burden this poor fellow with someone he's quite likely just not quite up to dealing with, right? His taking me on as a patient is a lose lose situation, the way I see it.