4 ms·

Random aside - I wish I had a tough love doctor that would tell it to me like it is, and pay close enough attention to refuse to let me do things. I don’t even

by cactus2093 6y ago

Random aside - I wish I had a tough love doctor that would tell it to me like it is, and pay close enough attention to refuse to let me do things. I don’t even really use the term “my doctor”, I just see a doctor when I need to. I’m 30 and live in a large city, and I’ve rarely seen the same doctor more than a couple times in a row. I go in for a physical roughly once a year, and the doctor will sit and talk with me for 10 minutes or so. But otherwise if I need something checked out in between I often get seen by a PA or whatever doctor in the practice is free. I’ve never really felt encouraged by the same doctor to see them repeatedly, or to email them personally if I have a medical question like I know some people do. So when I move to a different neighborhood or something, I just end up seeing a different doctor next time. Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have.

whateveracct 6y ago
I think you get it by going to the same doctor over many years. Continuity of care is important!
- jonlucc 6y ago
  That can be very difficult. Increasingly, physicians employ a staff of PAs and/or nurse practitioners who handle cases. Those staff seem to move around more frequently than physicians, so even if I keep going to the same office, the staff may have almost entirely changed.
  - zucked 6y ago
    This, coupled with the fact that, as an American, my ability to see a particular doctor (or even supporting staff) is highly dependent on whom I am employed with at any given time. If you switch jobs regularly, you will likely end up on multiple insurance plans, each with their own set of participating medical professionals. Sometimes there is overlap, often there is not.
    - michaelmrose 6y ago
      For those that can get insurance via their state or federal health care exchange you can pick your insurance based on doctors covered.
war1025 6y ago
That's been my experience with doctors. Even our kids doctor, who we see multiple times a year. My mom has a fairly good relationship with her doctor, but she worked in the same hospital with him for 30 years.
arkades 6y ago
> Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have. Doc here: Stay in one place, go to the same guy repeatedly over time, and ideally, be really candid with them, and send them your family members. When I see half (or more) of a household, it's an entirely different dynamic. You can't buy the sort of relationship that comes of seeing someone's kids grow up, and then treating that kid. That kid is like... 5% blood relative to the doc at that point. He will never be "just a patient." Or when you treat someone and their mother - that's a different level of candor right there, because that person trusts me with their mother - that right there suggests I can be more open with them, because they won't immediately blame/hate me for news they don't like. Time is the key, though. A lot of patients, if they get "tough love", turn around and go to a different doc. Especially the ones that say they just want to hear it straight - they are trying to convince themselves, I think. So getting to "tough love" is something that's built up over time, in both directions. (Also, studies suggest that it's somewhere between "not effective" and "actively harmful" when it comes to positively changing patient's health-related behavior, so it's not a super high priority.) Bonus points if you go to someone that only takes cash. For a once or twice a year visit, it's not that much money (compared to, say, one month of most prescription meds), but it means they don't have to hustle you through an 8-minute visit to keep their lights on. You can only get so much of a connection with someone that's forced to hustle you out of the door - it's jarring and kind of upsetting to everyone involved, on both sides of the interaction. (When I was in training I was told pretty candidly I'd make a fantastic attending one day, if I learned to actually hustle patients fast enough to be able to afford keeping an office open. ... You can imagine, I structured my career towards cash patients only. I don't like being inaccessible to folk, but I hate it less than I hate giving people half-assed help when they're in need.) Another good element is going to a physician that you're community-bound to in some way other than a strict transaction. Your kid's little league coach will have an entirely different relationship to you than "random doctor." That's becoming less common these days, unfortunately - with the way reimbursement is swinging, I don't know of many docs that still have time for much in the way of community activities. They exist, but they're a lot rarer than they used to be.
brianpan 6y ago
I'm going to disagree with all the other commenters so far. You are only going to find a tough love doctor if you're really, really lucky. Having a long relationship with a doctor might help with continuity of care, but the truth is there is no doctor that is going to be more invested in you than YOU. In fact, I would recommend going to MORE doctors if you have concerns. That's why you get second and third opinions for important medical decisions. I have high cholesterol. My father had a heart attack around 40. His father died of a heart attack. I told all my past doctors this and I have never gotten "tough love". Maybe because I have a young looking face and I'm rail thin. Maybe because I know my family history so they assume I know the risks. I put off statins in favor of trying diet and exercise unsuccessfully until I met a doctor that finally DID more forcefully suggest a statin. I should have started taking them way sooner. A doctor is not where to find tough love or to find a friend. A doctor is where you go for expert opinions and recommendations. Inform yourself and be responsible for your own health.
aerostable_slug 6y ago
It is critical to get a primary care physician you bond with, or at least can build some rapport with. My late father was a cardiovascular and thoracic surgeon, but then decided to go back to school (while teaching) to get his boards in internal medicine. He had two motivations: one was not to be the Old Surgeon that has to have his privileges revoked, and the other was his evolving relationship with the world, largely facilitated by SSRIs. His journey from surgery to internist over many years gave him what I think was a pretty good insight into the human condition. As an internist and primary care physician, he had one patient who presented with back pain and was loaded on opiates, wanting refills plus more dope. He talked with her for almost an hour (a unique privilege most don't have in today's healthcare system, and likely none will going forward) and ended up sending her home with an SSRI and a note to check back in a little while. A few weeks later she was calling the clinic's owner raving about how she felt so much better, her back didn't hurt anymore, etc. I'm not writing that to say SSRIs > opiates, just to say in her situation he correctly identified her pain was due to depression. You don't get there unless you have rapport with your doc and the time to talk with them. The point is that you have to find a doc you like and one that can spend time with you. Unfortunately I don't know of a good way of doing that. I'd hook you up but my dad passed some years ago. I'd love to hear people's ideas on finding someone like him — I need a doc, too.

whateveracct 6y ago

I think you get it by going to the same doctor over many years. Continuity of care is important!

jonlucc 6y ago
That can be very difficult. Increasingly, physicians employ a staff of PAs and/or nurse practitioners who handle cases. Those staff seem to move around more frequently than physicians, so even if I keep going to the same office, the staff may have almost entirely changed.
- zucked 6y ago
  This, coupled with the fact that, as an American, my ability to see a particular doctor (or even supporting staff) is highly dependent on whom I am employed with at any given time. If you switch jobs regularly, you will likely end up on multiple insurance plans, each with their own set of participating medical professionals. Sometimes there is overlap, often there is not.
  - michaelmrose 6y ago
    For those that can get insurance via their state or federal health care exchange you can pick your insurance based on doctors covered.

war1025 6y ago

That's been my experience with doctors. Even our kids doctor, who we see multiple times a year. My mom has a fairly good relationship with her doctor, but she worked in the same hospital with him for 30 years.

arkades 6y ago

> Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have. Doc here: Stay in one place, go to the same guy repeatedly over time, and ideally, be really candid with them, and send them your family members. When I see half (or more) of a household, it's an entirely different dynamic. You can't buy the sort of relationship that comes of seeing someone's kids grow up, and then treating that kid. That kid is like... 5% blood relative to the doc at that point. He will never be "just a patient." Or when you treat someone and their mother - that's a different level of candor right there, because that person trusts me with their mother - that right there suggests I can be more open with them, because they won't immediately blame/hate me for news they don't like. Time is the key, though. A lot of patients, if they get "tough love", turn around and go to a different doc. Especially the ones that say they just want to hear it straight - they are trying to convince themselves, I think. So getting to "tough love" is something that's built up over time, in both directions. (Also, studies suggest that it's somewhere between "not effective" and "actively harmful" when it comes to positively changing patient's health-related behavior, so it's not a super high priority.) Bonus points if you go to someone that only takes cash. For a once or twice a year visit, it's not that much money (compared to, say, one month of most prescription meds), but it means they don't have to hustle you through an 8-minute visit to keep their lights on. You can only get so much of a connection with someone that's forced to hustle you out of the door - it's jarring and kind of upsetting to everyone involved, on both sides of the interaction. (When I was in training I was told pretty candidly I'd make a fantastic attending one day, if I learned to actually hustle patients fast enough to be able to afford keeping an office open. ... You can imagine, I structured my career towards cash patients only. I don't like being inaccessible to folk, but I hate it less than I hate giving people half-assed help when they're in need.) Another good element is going to a physician that you're community-bound to in some way other than a strict transaction. Your kid's little league coach will have an entirely different relationship to you than "random doctor." That's becoming less common these days, unfortunately - with the way reimbursement is swinging, I don't know of many docs that still have time for much in the way of community activities. They exist, but they're a lot rarer than they used to be.

brianpan 6y ago

I'm going to disagree with all the other commenters so far. You are only going to find a tough love doctor if you're really, really lucky. Having a long relationship with a doctor might help with continuity of care, but the truth is there is no doctor that is going to be more invested in you than YOU. In fact, I would recommend going to MORE doctors if you have concerns. That's why you get second and third opinions for important medical decisions. I have high cholesterol. My father had a heart attack around 40. His father died of a heart attack. I told all my past doctors this and I have never gotten "tough love". Maybe because I have a young looking face and I'm rail thin. Maybe because I know my family history so they assume I know the risks. I put off statins in favor of trying diet and exercise unsuccessfully until I met a doctor that finally DID more forcefully suggest a statin. I should have started taking them way sooner. A doctor is not where to find tough love or to find a friend. A doctor is where you go for expert opinions and recommendations. Inform yourself and be responsible for your own health.

aerostable_slug 6y ago

It is critical to get a primary care physician you bond with, or at least can build some rapport with. My late father was a cardiovascular and thoracic surgeon, but then decided to go back to school (while teaching) to get his boards in internal medicine. He had two motivations: one was not to be the Old Surgeon that has to have his privileges revoked, and the other was his evolving relationship with the world, largely facilitated by SSRIs. His journey from surgery to internist over many years gave him what I think was a pretty good insight into the human condition. As an internist and primary care physician, he had one patient who presented with back pain and was loaded on opiates, wanting refills plus more dope. He talked with her for almost an hour (a unique privilege most don't have in today's healthcare system, and likely none will going forward) and ended up sending her home with an SSRI and a note to check back in a little while. A few weeks later she was calling the clinic's owner raving about how she felt so much better, her back didn't hurt anymore, etc. I'm not writing that to say SSRIs > opiates, just to say in her situation he correctly identified her pain was due to depression. You don't get there unless you have rapport with your doc and the time to talk with them. The point is that you have to find a doc you like and one that can spend time with you. Unfortunately I don't know of a good way of doing that. I'd hook you up but my dad passed some years ago. I'd love to hear people's ideas on finding someone like him — I need a doc, too.