Friday, June 11, 2010

Looking For Doctors, Psychiatrists and other Highly Paid, Highly Educated Helping Professionals: Questions and Concerns

I make a habit of interviewing highly paid medical people, just one or two questions, before I make a first appointment with them. If they will not answer these questions and insist that I make an appointment first, or answer in a way that makes me doubt their ability to treat me as a partner in my care as opposed to a subject of their care, then I go on shopping for someone else

The last time I switched doctors my first question was to the receptionist/intake person: Can Dr. Smith (not the real name) talk to me briefly on the phone prior to making an appointment so I can ask him/her a few questions to see if I think it would work out? If the receptionist said I had to make an appointment first, I went on to the next choice of “candidates”. If they said “yes” and the doctor actually called, then I asked my follow-up questions about my own particular circumstance: the thing/s that are most important to me related to the ways I prefer I be engaged in a relationship with a professional helper or health care provider.

One of my questions that time had to do with sharing confidential information.

I am in a thirty-year-old unmarried relationship with my life-partner and want to be assured that, when necessary, my written power-of-attorney (DPOA) wishes, that my partner be kept informed and an important part of decision making, be honored without fail and without question. This is more important to me because of a potentially catastrophic situation that arose with a doctor who was my partner’s and my primary physician. My well-documented and routinely reinforced power of attorney status was summarily revoked while my partner suffered a rather terrifying reaction to a medication the doctor prescribed. During a number of phone calls to their office during this crisis (Susan’s skin had turned bright scarlet, she was projectile vomiting and I found her semi-delirious after one dose of a powerful antibiotic), because I asked too many questions and expressed fear and was upset, I was told the office staff would no longer speak to me about the situation! Of course, when we went looking for a new doctor, questions about the integrity of how our DPOA status would be honored within the prospective office were paramount.

Each person will, of course, tailor their own questions to fit their own situations and concerns. This is a brief initial “employment” interview. Your prospective “helper” will be able to bill you or your insurance company for substantial amounts and make their living (often at a much greater rate of income than you or anyone else they serve) through the services they deliver to you. They are being hired by you. It is important to keep that in mind, in spite of the powerful position these people can occupy in our lives..

As an aside on this subject, and as a kind of unabashed advertising for Professional Coaching I want to say that one thing that attracted me to practicing as a Life, Family and Business Systems Coach is that the coaching process usually includes a free initial session to help determine if the “fit” will be good, from both the client's and the professional’s standpoint.

Other questions that might reflect your own concerns are as follows:

1. What is the average amount of time I will have to wait in your office before I am seen for an appointment?

2. How much time do you usually allot in your schedule for each appointment?

3. What is you experience treating people of my racial [gender, sex preference, cultural, occupation etc.] background.

4. Tell me your philosophy of your relationship to your patients.

5. Can I expect that you will routinely let me know what a procedure/medicine/assessment/service will cost, and if my insurance will cover it (or how much of it my insurance will cover) prior to ordering it?

6. What is your philosophy about non-traditional or non-western approaches to your area and scope of practice?

There could be many others.

There are good people out there, but also too many who think that book smarts and the number of letters after their name equals excellent clinical acumen.

I would be especially careful of any clinician if you get any inkling from them, through this interview process, that they have not been able to master the skills of non-judgment. Do they strike you as being so blind to their own value paradigms and prejudices that they will not be able to put them aside in the treatment of those they serve? Questions to get a quick picture of this dynamic might be important to you.

Knowledge, insight and applicable skill related to race, socio-economic, cultural and gender/sexuality related differences are especially common unlearned skill areas in highly paid, highly educated, people who generally have little-to-no intimate, equality based, experience with people outside their own cultural sub-categories. This is aided and abetted by the nature of segregation, especially in higher education in the US.
To close, here is another bit of input especially about psychiatry:

Remember that psychiatry has changed a lot from its early days of being the founding profession of "The Talking Cure". Now the profession is largely about medication prescription and administration and any talking is to those ends, especially if you are dealing with publicly-funded psychiatric services.

Once more, psychiatrists may be excellent at what they do but are not very good at supportive and insight developing/non-medication related behavior change via talking/listening strategies and techniques. If you are looking for someone adept in those skills you might look elsewhere.

It is, however, often productive to have a counselor and psychiatrist working together with you... especially if there is some inevitability about medications being a part of what you will require in their care. If that is the case, make sure your helpers talk to each other and do not have too much inter-professional hubris about who is best at what part of the work that is being done. If you hear one blame the other for perceived misapplication of practice or judgment, it might be wise to go elsewhere… or at least to be quite direct about the inappropriate nature of sharing such professional dissonance with you perched in the middle.

It is also important to decide, when choosing a helper, whether you think confrontation will be a useful tool in helping you with your plan to move forward in your life.

Regardless of the proof that confrontation is at best a last resort technique and generally ineffective in producing change, it remains a technique used widely by ineffective clinicians who bring too many of their own unexamined value judgments into the therapeutic relationship, whether it concerns a medical issue or a “talking cure”.

Confrontation, over-used, is akin to emotional and verbal abuse, and though it may be a normal and even preferable direct communication device used between family members, it is out-of-place in professional relations and really only serves the needs and wants of the practitioner. Often a clinician resorts to such techniques when they have been unable to come to terms with the needs of their clients related to rates of change and autonomy of choice. They want something different, and in a different way, than their client wants.

Confrontation feels good to them, but rarely is productive to the goals of the professional relationship. It can actually be damaging and serve only to produce or repel dependency and transference. Take care if you find yourself feeling like a child or too much like a bad student in your relationship with those you hire to help you.

Here are some other questions for you as you go forward in developing your own pre-hiring interview.:

1. How much control can you exercise and how much do you want as your "treatment" goes forward?

2. How and when will you know when the professional you hire to partner with you in your care has stepped over any lines you do not want stepped over (i.e.: are they assuming too much control? Are they dictatorial as opposed to supportive?)

3. How much control do you want/need to give to your care professionals?

4. How will you communicate these kinds of needs in the relationship and when will that conversation start?


Iris Arenson-Fuller said...

I have nothing but praise for this very helpful article. I have had my own run-ins with the medical establishment and believe me, Bob knows what he is talking about. Be an advocate for yourself and your loved ones. Don't back down. These questions are excellent.

Bob Vance said...

Thanks Iris.