Work With Your Doctor

By Dr. Kenny Handelman

As a doctor who works every day with kids and teens with ADD/ADHD, I come across many issues in my office which I can blog about. Sometimes I take certain experiences, and turn them into articles, and other times I don’t.

Yesterday, I had an experience which was so difficult and frustrating for me, that I wanted to share it with you…

I do this for two reasons:
1) To let this out (i.e. catharsis)
2) I hope that this experience will help you to work more effectively with your doctor.

In our hospital based clinic – generally it is up to our patients to rebook with us. People will sometimes cancel – and our secretaries will definitely call them to reschedule. However, if someone doesn’t come back, and doesn’t call to book a new appointment – we do not chase people down to get them to come back. In Canadian healthcare – if it is a dentist’s office – they will send a reminder post card after 6 months, but that’s generally not done for medical doctors. I don’t know how that works in the US system (please share your experiences in the comments section below).

Yesterday, I saw a young man who I had seen only once before – 9 months ago. I saw him once, and I suggested a medication change, and I asked him to come back in 4 weeks. He didn’t come back. I also asked him to see our therapist. He came for about 3 appointments, and then stopped. When he came in yesterday, he was angry that he was feeling so badly, that he needed a solution NOW. In other words – I had to fix his crisis. Part of my problem was that I hardly knew him. Seeing someone once 9 months ago doesn’t equip me well to know what’s going on in his life, and what can be done to get him out of his current crisis. If he had been coming approximately monthly, I would know him well, have an understanding of his strengths, and his supports, we would have found a medication which worked well for him (hopefully), and then we would be much better equipped to handle this crisis.

To top it off – he is now over 18 years old – and once that happens, in our clinic, he needs to get referred to the adult side of the clinic.

While discussing the situation together yesterday, he told me that he didn’t come back because he had concerns about medication side effects, and concerns about Psychiatry as a whole. I explained that I’m fine with people questioning these things – and I’d rather he came, and kept me in the loop, and that we worked together to avoid the crisis he is in right now. I was really focusing on this point to help to use this scenario to teach him how to handle working with a doctor – so that when he meets his next doctor soon, he can work with him to get the right care that he needs, even if he doesn’t agree with everything the doctor is saying.

It is OK to disagree with, and challenge your doctor. It’s important to do that with the doctor directly, so that you can work something out. Not doing this, and then coming months later when there is a crisis creates a very unworkable situation.

If you’re reading this post – you know that doctor’s aren’t perfect. We make mistakes and we do our best.

When can we make our best decisions?
When we know you really well, and we have a good working relationship, because we’ve worked out any differences in opinion, reviewed options, and created a treatment plan. In my experience, the best treatment plans are created when they can be personalized because I know my patient very well.

The case that I’m referring to – there’s a lot of complexity to it, and I’m not going to reveal one tenth of it – for the sake of privacy. And although many bloggers just rant a lot on their blogs – I have to show some restraint, as a practicing and licensed physician.

Now, there will be times that your doctor is not the right match for you, and you may have the option of switching doctors. Or, it may be that in your community, or with your insurance, this doctor is the only one that you can access. Whatever the situation is, I recommend that you work with your doctor. Work with him or her, explain your concerns, and challenge them as well. You need to advocate for yourself, because if you don’t – who will?

In my experience, the vast majority of doctors will respond well to a well thought out objection. Most doctors don’t respond well to angry, hateful and rude comments. And as I write this, I’m thinking, I don’t really respond well to people who refuse to take any responsibility for their own decisions and healthcare. In other words – when this young man made this situation MY crisis, even though they haven’t seen me for 9 months and didn’t book again, and are now too old for our clinic. I do respond well to people who completely disagree with my treatment recommendations, yet explain it clearly, logically and thoughtfully. I keep seeing them if I think (and they think) that it is still of benefit.

I just want to emphasize how important it is to keep working with your doctor – even if you don’t always agree with him or her. Also – take responsibility for your own decisions and actions. I know this can be an issue for kids and teens with ADHD, though it’s still very important nonetheless.

Now, I did work with this young man, and his father who was present, to create the best possible solution to help with this crisis. We created a plan, and a back up plan. The appointment went way over time, and I know that if I had been seeing him regularly, that we would have had a much better crisis plan (but we still would have gone way overtime in our appointment ).