Shomon* * *
The nature of the relationship between you and your doctor can have a profound effect on your health, and can play a part -- good or bad -- in your effort to successfully cope with a chronic condition like thyroid disease. An important part of understanding that relationship is to have a better sense of how you and your doctor relate to each other. Does your doctor see him or herself as an expert whose advice should be unquestionably followed, or does your doctor work as a partner or teacher? Does your doctor view the role of a physician as teacher, or perhaps even as your "employee?" Is the doctor's allegiance to you -- the patient -- or to an HMO employer who signs the paycheck?
No relationship is necessarily good or bad. It depends on your personality, the nature of your illness, and the skills you bring to the relationship with your doctor.
Let's take a look at some of the different styles you may encounter in physicians, and what they mean for you.
The Father Figure
The Father Figure may tend to be older, and probably skew more towards men (although, there are definitely women physicians who fit into this category). These are doctors who tend to feel that being a doctor is a prestigious profession, and that patients should be respectful of the doctor's position. These types of doctors expect that patients will "obey" the instructions and follow the directions, without undue questions or challenging the recommendations of the physician. You'll find this type of doctor both in private practice and in HMOs, where many older physicians have found themselves due to rising costs of private practice and insurance.
Pros: Some people, in particular older patients, find themselves more comfortable with this traditional style of doctor. The formality and air of authority in some of these physicians can also inspire patients to feel "in good hands." That confidence and trust can be a positive factor in recovery and wellness for some patients. If your thyroid problem is fairly straightforward, and your idea of the perfect doctor is a "Marcus Welby" type, then this could be the right kind of doctor for you.
Cons: Father Figure doctors don't usually respond well to being second-guessed, or being asked about alternatives to their diagnosis or recommended course of action, and often don't respond well to answering many questions. If you are the type of patient who likes to be involved in the decision-making process, this may not be the ideal type of doctor for you.
There are not many Dictators out there, but when you find one, you will know it. This sort of doctor is authoritarian, and may even use fear or intimidation to get you to follow his or her instructions. Think of the "Dr. Romano" surgeon character from the hit TV series "ER." (Surgeons are frequently known to fall into this category.) One self-proclaimed thyroidologist and dictatorial type actually wrote an angry e-mail to a thyroid patient who inquired about taking Armour Thyroid, saying that she would soon discover that her "bones would dissolve" if she didn't immediately cease taking Armour right away. Other patients have been told unequivocally by doctors that "in their expertise, the problem was clearly and absolutely not a thyroid problem," and therefore, not even worth testing for, and
that the patient should "get over it, stop eating so much, and quit whining," only to find a sympathetic doctor who tests for and diagnoses a thyroid problem easily.
Pros: You might think there are no positives to this type of doctor, but in some cases, the "geniuses" in surgery or treating particular forms of rare thyroid cancer, for example, may fall into this category. It may be well worth putting up with an authoritarian personality if this doctor is considered particularly expert or talented in treating your specific thyroid problem. Just make sure you confirm the doctor's expertise or fame with patients and others, besides the doctor and his or her immediate colleagues.
Cons: Some of these doctors are covering up their lack of knowledge with bravado and egotism. And personality wise, smart or not, these types of doctors may be difficult for patients to deal with, and may in fact not be conducive to recovery. Unless the doctor is considered a renowned expert in treating your particular thyroid problem, and offers such great technical ability or medical skill that the negative personality traits are worth putting up with, it may be better to move on.
If you are one of the new breed of informed/empowered patients, you may have found yourself with a Partner/Colleague/Consultant style of doctor. This type of physician believes that he or she is your partner in the process of diagnosis, treatment, and follow-up. This style has evolved in response to patients who wish to take part in their own health care. Likely to be younger, these physicians tend to feel less like the final authority, but rather as consultants with expertise to help you in your health care decisions. Many alternative physicians tend to fall into this category, and women physicians also seem more likely to adopt this style than men.
Pros: If you want a doctor who is willing to explore alternatives, and who may trust that your own judgment of your situation is an important an input as lab tests, or his or her own opinion, then this type of doctor could be ideal for you.
Cons: Sometimes, these doctors leave too many decisions up to you. You may wish to fully explore the ramifications of, for example, trying antithyroid drugs versus radioactive iodine for Graves' disease, and wish your doctor would suggest which option to choose, but the doctor will say "It's up to you to decide what you want." The doctor may even end up expecting you to decide on what treatments you should have, or even look to you to research more about the situation. If you want this type of physician, you must be willing to delve in, research, read, and educate yourself and the doctor.
The Revolving Door
Whether you're part of an American Health Maintenance Organization (HMO), or are part of the military medical system, or in the national health systems of Canada or the UK, the doctor you see this week may not be the same doctor you see next week. HMO systems frequently offer primary care clinics or practices made up of several doctors, and you're assigned a physician for each visit on a first-come first-served basis.
Pros: Let's face it, having medical coverage and access to a physician is better than not having it at all. So if you have to make the best of a revolving door situation, your best strategy is to plan ahead. Write up a one-page bulleted summary of your entire health history, so the doctor can quickly review your situation. Few will have the time to review your chart or medical history, and having to explain it verbally can take up most of your visit. Have all your questions prepared in advance, and prioritized, and bring an extra copy to share with the physician the minute you walk into the examining room. And if you do have the option to request a specific physician, be sure to do so.
Cons: If you are getting nowhere fast trying your best to work within the system, sometimes, if at all possible, it's worth going "out of plan" for some answers. For the cost of an office visit and a lab test, you may be able to forego years of ill health. I am reminded of a military dentist who had a long list of hypothyroidism symptoms, but the military doctor she saw assured her that because he couldn't feel a goiter, she didn't have a thyroid problem. After numerous fruitless visits to the stubborn doctor assigned to her case, and months of ill health, she was forced to see a civilian endocrinologist, who ran TSH and antibodies tests, and easily diagnosed a case of Hashimoto's Thyroiditis in the first visit.
The Innovator is frequently found in the areas of holistic or alternative medicine, or pioneers of new conventional therapies. An Innovator is frequently breaking new ground, and these doctors are frequently the ones who are writing books, on television, hosting radio shows, or creating elaborate informational web sites.
Pros: An Innovator may be just the doctor willing to try Block Replace Therapy for hyperthyroidism with you, or open-minded to Armour or time-released T3 for hypothyroidism. So if you are interested in cutting-edge rather than cookie-cutter treatment, this might be a great type of doctor for you.
Cons: Innovators are frequently so busy writing, speaking, doing media appearances, or traveling that they have limited time to see patients or conduct day-to-day doctoring. Or, they may become so popular and in-demand due to word of mouth that a new patient visit isn't available for four to six months. You may want to use an Innovator as a "specialist" to work in conjunction with your day-to-day physician. Some Innovators also tend to be very expensive, and may not be covered by insurance, as they are offering alternatives that are not in the standard realm of reimbursable treatments.
Ultimately, choosing the right physician(s) for you is a function of your condition, your own personal style in taking care of your health, your attitude toward physicians, how involved you want to be in your own health care, and, what type of physician is available to you.
For information on how to find a new doctor, and what type of doctor you might want, read:
Do You Need an Endocrinologist?.