Should I Fire My Doctor?

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox.

One of the gripes I hear from patients with some regularity is that they are not thrilled with their current physician.  How do I know this?  No, I’m not a mind reader.   I query every patient on our first meeting if they are pleased with their primary care professional (PCP).  Surprisingly, many offer lackluster or even negative commentary on their PCPs whom they have been seeing for years.  Why would patients who are unsatisfied not seek care elsewhere?  Puzzling!

Typical complaints include waiting times in the office, rushed appointments, missed diagnoses, unreturned phone calls or portal messages, refusal to order diagnostic tests and tepid bedside manners.

Obviously, these are patients’ perceptions and I offer no judgment on their merit.  It is likely that the physicians and their staffs might have differing viewpoints on these patients’ experiences. 

Sometimes, the patient has no tangible specific complaint, but simply feels that his doctor is just adequate. These patients may have lower-level medical needs and expectations and are not motivated to change horses.

Other patients confide to me that they intend to seek a new PCP.   While it’s not my task to dissuade a patient from making a personnel change, I do point out that it may be much easier to fire a doctor than it is to find a new one.  This is not analogous to crossing a restaurant off your list when there are abundant alternatives that can seamlessly step right in.  The overall patient demand to see doctors is higher than I’ve ever seen in my long career.  Many patients must wait months or longer to be seen by PCPs.  This is one reason why there are so many urgent care offices, nurse practitioners and medical clinics housed within pharmacies to decompress this demand.  Patients accept these alternative levels of service in exchange for timely access. Yes, this venue may be appropriate for certain medical concerns, but this is not a place to discuss diabetes management or months of back pain. 

How long would it take to find a new doctor and would this one meet the patient's needs and expectations?

Doctors are Carrying a Very Heavy Load

This reality is not a criticism on my fellow PCP colleagues.  They are working harder than ever.  They don’t want to be booked out for months with ill patients calling every day asking to be seen. Doctors have so much more to do than just practice medicine, which is burning out many practitioners.  The rising administrative and compliance requirements are staggering.  The electronic portals are bursting hourly with messages from patients that must be attended to.  Nearly every day, a patient or two will arrive late, which throws the rest of the day off the rails.  (No, we can’t just reschedule these late patients who might be elderly or impaired.)

We have insufficient PCPs to meet the demand.  And we likely have too many specialists like me.  The profession needs to triple down on an effort to incentivize medical students to choose primary care.  How could we do this?  Here are a couple of hints.  Pay them more and make the job more fun.