Getting to know each other
I went to see my new primary care physician last week.
She’s my fifth PCP in eight years because of ever-changing provider networks, or doctors leaving primary care.
I asked friends for recommendations, read online bios and Yelp reviews, and looked for any history of malpractice suits.
Related post: Need a new doctor?
I went to the visit prepared with a short, organized list of concerns and questions; I knew I had only 10-15 minutes max for us to get to know each other.
I’m pretty experienced at talking to doctors, and have read lots of books (see below) on the subject.
But I still ended up having a conflict and some communication problems that I’m trying to resolve.
Talking to a new doctor can be tricky
Having an appointment with a new doctor is kind of like speed dating: you have a very short period of time to learn a little about each other.
Keeping the same primary care doctor for years is ideal. Your doctor knows a lot about not only your health history, but about you personally. And over time you learn to trust your doctor.
But with health insurance policies and provider networks changing every year, many people find themselves always looking for a new doctor.
It’s very frustrating.
During the visit I explained that I take good care of myself because I don’t want to take prescription medications for high blood pressure, diabetes or osteoporosis. It’s important to me to have a healthy lifestyle and limit medical intervention.
I’m also afraid of too much medicine. Read my About page and you’ll understand why.
She seemed to understand, and I left after having some basic lab work done.
Then the lab results came back.
Everything was perfect, expect for one test result: my bilirubin level was a little bit above the normal range.
Bilirubin is one of the liver function tests (LFTs) that are part of a comprehensive blood chemistry panel. Bilirubin is a waste product that is broken down in the liver and then excreted. A high bilirubin may indicate some problem with the liver, or a blocked bile duct.
But I’ve had high bilirubin levels for more than 20 years due to a genetic condition called Gilbert’s Syndrome. I lack an enzyme that helps break down bilirubin, so it’s always slightly elevated. Gilbert’s syndrome is, as the Mayo Clinic website states, “…a common, harmless liver condition…”
There is no test for Gilbert’s Syndrome; it’s diagnosed by elimination. If the bilirubin is mildly elevated but all the other LFTs are normal, the presumed diagnosis is Gilbert’s. I’ve had at least two doctors tell me this.
Being my own advocate
My new PCP sent me a MyChart message with all my test results. She noted that the bilirubin was above normal and said she wanted to get an abdominal ultrasound to look at my liver and gall bladder.
I replied and told her about my presumed Gilbert’s Syndrome and gave her the results of my past 20 years of bilirubins, some normal, some high.
She wrote back: that’s interesting, and Gilbert’s is a good bet, but I still want an ultrasound to make sure everything’s okay.
I chewed on this for a couple of days. I really didn’t think an ultrasound was medically necessary. All my lab tests were fine, and I wasn’t having any abdominal problems.
I could either:
- just get the ultrasound because it was the easiest thing to do and would make her happy; or
- be my own advocate and make a case for why I thought I didn’t need an ultrasound.
I chose the latter. It’s not my job to make her happy. I am paying her for her advice; whether I choose to follow it or not is my choice.
An ultrasound is relatively harmless, so why don’t I want it?
One, it isn’t free (approximate cost $350) and I have a crazy-high deductible. I don’t want to spend my healthcare dollars unwisely.
Two, even relatively harmless tests can have risks. A big problem in healthcare now is finding something abnormal but probably benign on a routine test. Something doctors aren’t sure what to do with other than perform more tests or even biopsies. This results in more treatment, more risk of harm, more anxiety, and more expense.
Three, having a test just to confirm everything is normal seems unnecessary to me.
I replied again on MyChart (not the best way to communicate, for sure) and told her I wasn’t concerned about the bilirubin and it seemed very normal for me. I didn’t want the ultrasound, and was comfortable with that decision.
I also said I understood and appreciated her wanting to be thorough, but I have a less-is-more attitude towards my health.
I suggested a compromise: repeat the test in 3-6 months and if the bilirubin is higher, I would reconsider the ultrasound.
I hoped she would reply “Sure, sounds like a plan.” Or insist on the ultrasound and give me her reasons for it, as I gave my reasons for not having it.
But I haven’t heard back, so I’m not sure if I’ve offended her or made her see me as a difficult patient. I’m not! I just know what’s right for ME.
Time will tell. Perhaps she’s just super busy and hasn’t had time to reply, or she doesn’t think the matter is worth further discussion. Or she’s mad. I don’t know, and I’m not sure what to do now.
I will probably reach out to her in 3 months and see if she wants the LFTs repeated or not.
And I’ll probably pick up one of the books below and read it again for more advice on talking to a new doctor.
Has anyone else had problems talking to their doctor? I’d be interested knowing how you resolved them.