by: Bri McCormick, DPT, PT – Master Jedi PT
I recently had a patient come to our clinic for treatment of low back pain. She was diagnosed with a severe herniated disc and was told by her orthopedic surgeon that she needed to have surgery and she had very few treatment options. Despite her asking the doctor about those other options, the surgeon was adamant that the only thing that would help her was surgery and she should not bother with conservative treatments.
I worked with this particular patient for 8 weeks and she was able to return to a workout routine absolutely unrestricted. She did not need surgery.
What would have happened to this person had she fully trusted her doctor? She would have had lifelong changes to her spine, no guarantee of any change in symptoms, and have to recover for another 4-6 months after a costly surgery.
Should you trust your doctor or provider? Not yet. In fact, I tell all clients to question what their health care providers are prescribing or recommending for a treatment plan. This will empower you to be your own healthcare advocate, give you better quality treatments, and improve your relationships with those you do find you trust in healthcare. Only after you have become your own healthcare advocate will you start to find trust in the providers you choose.
The healthcare system is hard to navigate. There are laws, insurance guidelines, referrals needed, in-network vs. out of network, good reviews vs. bad reviews. How do you pick a provider who is right for you?
I want to summarize a few things to look out for and what I have learned both practicing and being a patient.
Doctors want to help people
The vast majority of providers were drawn to the medical profession to help people get better. A good general rule of thumb is to assume your doctor is a good person just because of this fact! They did not get into the profession to take out enormous student loans, do years and years of training, to become someone who is giving bad treatments and building a bad reputation. What does this mean for you? This is good news; at the very least, you know you are being treated by a person who wants to help you and you can look for other signs to see if your provider is a good fit for you.
Qualifications and Bias
Are you talking to the right person for what is going on with your health? The medical system has many different fields, specialists, trainings, experience, etc. This is a tough one because of the vast differences between specialties. Most know you don’t see an optometrist if you are experiencing back pain; however, how do you choose between all of those who do treat back pain? For example, do you choose a Chiropractor? Physical Therapist? Orthopedist? Neurologist?
This is where it can get confusing. You may be told of one treatment option at a doctors office; however, there are typically different options to treat a certain condition.
Keep in mind, every clinician will treat with bias- this is to be expected. For example, a surgeon will most likely recommend surgery, a chiropractor will recommend chiropractic medicine, a physical therapist will recommend therapy. This is normal, but you should be aware of this when you choose your treatment. Most providers will recommend only one to which they think is the best option for you. If you want to know if there are other options, they should be willing to discuss this with you!
I have had 2 patients in the last 5 years ask me the following question. “What makes you qualified to treat me?” I LOVE this question! Why don’t more people ask this question?! If you want to know what business your provider has in treating you, ask! This will give you a great idea on how open they are to meeting your needs, a history of their experience, as well as their level of confidence in treating you the way you want to be treated.
Something to look out for, does your doctor say they have training in the specialty you are seeing them for? I see many doctors practicing outside of their field. For example, I recently saw a vascular surgeon was performing joint injections for pain management and then providing rehabilitation for these patients. Is the best person for someone experiencing joint pain a vascular doctor who specializes in arteries and veins, or an orthopedic doctor who specializes in bone, muscle, and joint dysfunction? Should this person have experience and training for giving injections? Are they the best person to provide rehabilitation services?
Lastly, let’s say you have decided on the right specialty for you. Please be aware there are different levels of qualifications in each specialty and you may be subject to different quality of treatments depending on the scenario. Physical therapy, for example, has many different levels of treatment: a physical therapist, then a physical therapist assistant, and then an aide that may all play a role in treating you. This may mean different qualities of treatment or it may not, but you need to be aware and ask these questions to choose what is best for you. A good provider in this example will address your concerns and be available to you during the course of treatment. These are the types of questions to ask yourself before choosing a doctor or therapist to treat you.
Does your doctor list his or her degree on their website or in their office? If not, they may be limiting that information for a reason. You should be able to look for someone’s qualifications easily and find how it easily and DIRECTLY relates to what you are being treated for.
Trends of Medicine: Upper management, and Patient Volumes
Unfortunately, insurance companies and healthcare trends have caused a bad shift in most medical offices. Doctors are trying to see more patients and spending less time with them. This is a big reason to choose your provider carefully. Does your doctor take the time to listen to your problem? What about your goals or concerns?
Be aware that many offices, especially large ones, will have productivity standards or are contracted with other companies to only use certain products or medicines. What does this mean? At the end of the day, healthcare is a business and management in the business is going to try to make money. This should NOT affect the quality of care you receive; however, unfortunately, it can. Does your provider only recommend one treatment option? Are they skipping discussing options with you or spending a very minimal amount of time with you? Are they handing you off to a lesser qualified individual? You may not want to trust they are giving you all options and discussing the best one. Look for those doctors who give you one-on-one time to discuss all the best treatments and options for your care.
Does your doctor’s office only refer to other doctors within the same practice or hospital system? This can limit your options in finding the best care. Sometimes, the best care is outside of that system, sometimes it is not.
Research-based Medicine and “I Don’t Know”
A clinician who doesn’t say, “I don’t know,” is a dangerous one. Nobody is an expert on everything and a good provider will always refer you to a better option if they believe it is out there.
I recently went to a doctors office to discuss a treatment option I had been researching. I read up on the treatment and when I got to the office, I asked the doctor a few questions regarding it; this doctor told me the wrong information. I was livid, to say the least. When I questioned her further about this information, she handed me a pamphlet and said, “read this and we can discuss this on a follow-up visit.” I never went back.
Someone I would have trusted with my healthcare, in my opinion, should have admitted they were not an expert in this treatment and referred me to someone who was. Even more importantly, a trustworthy clinician will research for you! One who states, “let me do some research and get back to you on the most up to date findings” is invaluable to me because it shows they care enough about me and are willing to find relevant information to apply to my individual case as opposed to treating everyone the same way with the same treatments.
So what is evidence-based medicine? This is medicine practiced based on peer-reviewed research and studies. It is also based on professional clinical experience. How do you know your doctor is up to date on research? This is a tough one, sometimes it is not very apparent. The easiest way to find this out is to ask! I frequently ask doctors I see to tell me the latest trends in research for a treatment or diagnosis. Those you can trust can generally give a conversational answer and clearly explain this to you in non-medical terms so you can understand.
Lastly, from personal experience and as cliche as it sounds, I try to find those practitioners who are “trying to be the change they want to see” in medicine. The ones who think outside the box, those who are not dictated by insurance, and those who are willing to go out of their way to find you the best treatment even if that means it is not with them. The ones who give you dedicated time and individualized treatments based on their best experience and up to date research. Hopefully, this leads you to find the provider you trust and thus leading you to be your best self.