I always liked my primary care doctor personally. He routinely welcomed me to his office with a cheery hello and a smile. We asked about each other’s children. We often discussed our respective exercise regimens, running in his case and pickup basketball in mine. For more than 20 years, we even confided about our ambitions as writers.
But I often questioned his judgment in medical matters.
Take, for example, the time my neck bothered me. I complained to him about frequent soreness and stiffness — probably a result of spending hours planted in front of a computer. He suggested I obtain a neck brace to wear while working. “Is that necessary?” I asked him. No, he said.
At no point did he ask me where my neck hurt, or how much, or how often. He never physically examined my neck, nor instructed me to turn my head to observe my range of motion. He neglected to propose I do specific exercises to rehabilitate my neck or get a new chair or just take frequent breaks from sitting at a keyboard.
Rather, he advised me to see an orthopedist or physiatrist. He also printed out some medical journal articles about neck problems for me to read, all well over my head.
Some time later, my annual physical revealed my overall cholesterol level to be borderline high. “I should probably put you on a statin,” my doctor said. “I could prescribe Lipitor.” “Would that be necessary?” I asked him. No, he said.
“It’s a trend that reflects the state of medicine today,” Dr. Danielle Ofri, associate professor of medicine at NYU Langone Medical Center and author of “What Patients Say, What Doctors Hear,” told me. “Physicians are so risk-averse they prescribe medications as a default and reflexively refer patients to specialists. It’s systemic.”
What to do? After all, this was my health here. As a lifelong recreational athlete and fitness enthusiast, I’d entered my 60s healthy, but eventually — inevitably — my age would catch up with me. Was I going to risk my longevity to avoid hurting my doctor’s feelings? I needed a physician I respected and trusted. Should I stick with the status quo or take a hike?
“Your experience is more common than was the case even 20 years ago,” Dr. Michael Fleming, former president of the American Academy of Family Physicians, told me. “It can be very frustrating to be a patient nowadays. That’s why they’re more inclined to switch doctors than ever before.”
A 2001 study in the Journal of Family Practice showed that one-fifth of patients left their primary care doctors voluntarily over a three-year period. Patient satisfaction with the relationship often predicted loyalty, the research revealed. Indeed, patients with the poorest physician relationship were three times more likely to leave than those with high-quality relationships. Today, those figures might be even higher: With the upheavals in insurance coverage and physicians increasingly available at a pharmacy, urgent care center or via telemedicine, some people no longer even visit their own primary care doctors.
My most recent appointment with my doctor made reaching a decision much easier. For years, he discussed my health with me in his office while typing his observations into an electronic health record on his computer. He would turn sideways to talk with me, then look back at his screen. He typically looked at the computer more than at me, but at least I could see his face.
In my latest visit, that arrangement was no more. Instead, he sat at a computer in his examining room with his back to me. Yes, he literally turned his back on me. I could still hear his voice but now without seeing his face.
“The electronic medical record has turned physicians into data entry technicians,” Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School, told me. “It inserts an interference between doctor and patient.” A study last year in the Annals of Internal Medicine painted a picture of this predicament. It showed that while physicians are in the examination room with patients, they spent only 53 percent of their time on face-to-face contact and 37 percent on medical records and other administrative chores.
Clearly I now had to turn my back on my doctor, too. The big question was, how? How do you go about firing your longtime doctor? Does the American Medical Association recommend a protocol? Do you just say, “Your services are no longer required?” Or “I’m sorry, but I’ve decided to take my health in a different direction?” Or “Forgive me, but I need to start seeing someone else?”
“So many patients have no idea about how to approach this struggle, and they feel bad about the idea,” George Blackall, associate professor at Pennsylvania State University College of Medicine and co-author of “Breaking the Cycle: How to Turn Conflict Into Collaboration When You and Your Patients Disagree,” told me. “You should reach out to talk to your doctor. That’s the key. Make clear how you feel. Say what you need.”
How physicians feel about themselves may actually translate into how patients feel about them. The more satisfaction internists take in practicing medicine the more satisfied their patients are likely to be, a study in the Journal of General Internal Medicine concluded. And the reverse also appears to be true. “Burnout and caregiver fatigue among physicians is a real and growing problem that impacts patients,” a spokesman for the American Medical Association told me.
In Mayo Clinic Proceedings last year, Dr. Tait Shanafelt, then the director of the Mayo Clinic’s program on physician well-being, said, “Research has shown that more than half of U.S. physicians are experiencing symptoms of burnout, and the rate is increasing.”
As I agonized over my decision, a Facebook friend who also goes to my doctor delivered a surprise: She posted a message saying that he would be retiring soon. So I called his office to verify. Yes, the receptionist told me, he would be retiring next month.
So I was spared having to tell him I was defecting, and I’ll soon be seeing another doctor anyway. Mine quit his job before my health went on me (and possibly before his did, too). As it turns out, he’s done me a big favor. Ending his career just might have saved my life.