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Dumping Your Doctor

post #1 of 14
Thread Starter 

I hope that this isn't considered to be too controversial of a topic, but, now that I have your attention...

 

I tore my ACL Dec 21 and will need to have a knee reconstruction done soon, however, during the diagnostic process and clinic visits, I came away each time feeling that my OS, while seeming to be reasonably competent, was always short, and at times, very abrupt. I had to dig for answers, and, in general, he had poor bedside manners. It seemed like the ortho ward at my clinic was always operating in a rather harried and disorganized manner, though it didn't look very busy there during my visits. ..

Well, I decided to do some checking, and found some Dr. ratings/comments websites, and lo, there were some comments on my guy, from more than one website. They seemed to reinforce my gut feelings(and then some), which is eroding my confidence in following up with him. I haven't scheduled a surgery date yet, but I will need to do it soon, probably after finding someone else to perform the operation.  

My question is this - What's the proper way to deal with switching my surgeon/clinic?  I know that many would just silently 'drop' him/her, and this may be the norm, but this is at my regular clinic where I see my GP, so, while it's unlikely my actions will be noticed by anyone other than the ortho dept,(larger suburban clinic) I'm looking to follow proper protocol, if it applies in this situation. I don't want my GP(who is an excellent practitioner) to start looking at me funny the next time I see him, in case he finds out about my 'change of heart'.  

So, is there a proper way to 'dump your doc'?
 

post #2 of 14

You aren't the first and you won't be the last. Seek out a second opinion and if you choose to use a different surgeon then let your GP know of your decision. Then call the OS office, thank them for the care they have provided, let them know that you will be having your procedure with a different surgeon, and ask them how to go about getting your records to take with you. You don't have to apologize and you really don't need to explain. You also do not have to tell them where you are going or why. Common courtesy should do just fine.

 

ACL reconstruction is a common procedure and you should have a great result with almost any good orthopedic surgeon. In the end it comes down to whomever you are most comfortable with for your surgery, your recovery, and your rehab. I would encourage you to find your alternate surgeon prior to "dumping" your current one, just in case. I would also advise you not to be too swayed by any doctor reviews you find on the internet. Usually you will find extremes of opinions, either based on awful experiences or fantastic experiences. The vast majority of patient experiences will be somewhere in the middle and those probably won't be on websites. Good luck! You'll be skiing again before you know it.

 

post #3 of 14
Thread Starter 

I've got my MRI series on CD, so I can get a second opinion without notifying my current OS or GP at the clinic. Your advice is truly valued, coming from one working in the field. You are right about the web ratings/comments being polarized somewhat - I can't put alot of stock in such a small sample size... and while I don't think that my current OS is a bad person or incompetent, my comfort level with him plummeted even before I checked online... Which could be another story in itself.

I don't need the GP's referral either, to jump to a dedicated Ortho facility - I guess you can call my health plan 'free-range'.(damn expensive too, for a 2.6k deductible) Technically, I can switch surgeons without raising an eyebrow - just didn't know if it would be considered to be in bad taste to do so without courtesy notifications. Eventually, my GP will find out, but I'll never need to see the 'paedists at my clinic again.

I need to have a second(unrelated to this year's ACL) surgery this year too, for an old, partially-torn labrum, so I've got to cover that elsewhere also, if I make a switch... Keniski, If I don't need the original GP for a referral, or the original OS for the MRIs, should I still contact them out of respect after I make such a switch?

post #4 of 14

MNator-

 

You really don't have to do anything. This kind of thing happens all the time. If you don't really have a relationship with the ortho folks other than a consultation, then you probably don't need to tell them. Whatever you are most comfortable with is most important, so that you can focus on your surgery and recovery. If you have a very flexible health insurance plan, by all means take advantage of it. That's a lucky thing. Sometimes offices will follow up with patients about scheduling procedures, so letting them know might save you a slightly awkward moment if they do call (more for you than for them). No one will hold it against you if you need to use them in the future for anything else, which hopefully you won't need anyway. You can always use the excuse that you also need shoulder surgery too, so a full-service orthopedic group/clinic with subspecialists better fits your needs.

I would let your GP know regardless of what you decide to do. I assume this is a specific GP that you have been seeing and will continue to see. Your regular doc should always have as much information as you can give them without divulging any state secrets. From a marketing standpoint, I am always curious where people go if they don't come to me, but as a radiologist I am in a slightly different boat in that regard.  From a strictly business standpoint, if your GP is part of multispecialty group practice that shares revenues, or a clinic that subcontracts for specialty services, then they will certainly want to know if patients are choosing not to utilize their affiliated specialists.

 

Anyway. Hope this helps. You seem pretty knowledgeable and thorough. Whatever you decide to do is the right decision.

post #5 of 14
Thread Starter 

keniski,

 

You have helped me immensely.  Thank you!  I've never been in a situation where I've needed to consider this, so I am grateful for your opinions and guidance.  There's nothing I've been through medically to this point in my life(at 52, knock on wood) where my choices(and having a plan with the freedom to make them) have been so critical to my future.  I cannot imagine a life without the ability to ski again ably and comfortably, so why take chances?  I can only hope that I choose wisely now.  Thanks again!

post #6 of 14

Try to get a sports specific doc. An 'Ortho facility' that specilizes in work related injuries may be no better than where you are already. Sports specific docs understand your need to excel, not just get by and back to work. Non-athletic patients often just don't care about doing the work so their care givers stop caring, too. It is unfortunate, but true. A sports specific surgeon will appreciate you want to be able to rip it up on the slopes and a sports specific PT should be as much a coach as a therapist giving you encouragement and challenging you to do your best. Let your doc and PT know up front that you expect to be back to 100% and what it is you want to undertake after your recovery.

 

PT is as important as the surgery, if not more so. You'll have to work hard to get your strength back as well as flexibility. It won't be comfortable to do some of the things your PT will ask you to do.

 

When you go into a the new offices, look for pictures of their patients on their walls. Grateful and successful patiens will thank their doc with signed photos. If they are treating anyone athletic, they'll have them. I'm serious on this. If you recognize the names, even better.

 

Ask them who they treat. Pro Teams? College Teams? Occupational Injuries? Yes to the first two, good. Yes to the last, not so good. 

 

You can also exist and ski without an ACL. Physical strength can overcome the loss. Don't feel rushed to go with the next doc you see. You have time. My first ACL reconstruction was about 15 years after the injury. I don't suggest waiting that long, but don't feel compelled to get it done right away. There are plenty of threads here about recovery. Read them. You'll find them encouraging and they might show you new avenues that you can follow to recovery.

 

Best of luck with your search and your recovery.

 

MR

post #7 of 14


icon14.gif

 

I actually just had this conversation on the tram with Bob Peters last week. It's nice to live in the Denver area, where it seems like all the recommended orthopedic surgeons are also sports docs; expecting to get back into athletics is a given.

 

Quote:
Originally Posted by MastersRacer View Post

Try to get a sports specific doc. An 'Ortho facility' that specilizes in work related injuries may be no better than where you are already. Sports specific docs understand your need to excel, not just get by and back to work. Non-athletic patients often just don't care about doing the work so their care givers stop caring, too. It is unfortunate, but true. A sports specific surgeon will appreciate you want to be able to rip it up on the slopes and a sports specific PT should be as much a coach as a therapist giving you encouragement and challenging you to do your best. 

post #8 of 14
Thread Starter 

At the clinic that I am considering, about 40% of the Staff are sports specialists, and a few are team physicians.(although only at the HS level)  I'm not sure about the occupational work, but they probably do that, too.(ugh)   There's even a former Chief of Surgery from a good local hospital at the clinic location that I am considering.  They seem to have satellite locations all over town.  I don't know if this is a good thing,(the widespread reach) but, it looks like a can get what I need somewhere within their system.  I am going to do some homework on their PT facilities and philosophies before diving in.

 

MastersRacer, your point about taking one's time to 'get it right' is well taken.  Each day, my leg seems to get stronger - my quad is firing again and my ROM is almost the same as my good knee now.  I'm fairly light at 145lbs, so if it tightens up good enough, I'll have some wiggle-room to take my time in making a decision, without jeopordizing my menisci during normal activities.  I might grab a DonJoy and try some late-season turns if things are feeling right, but around here,(MN, of course!) late-season is at the beginning of March, and the terrain is hardly anything worth getting excited about.

 

I'm really bummed, because I'd gotten a season pass this year, new skis, and was looking forward to heading out to CO in April for the EpiGathering to meet more of you this year.(I got 1 day in with a few bears at Solitude last Feb, but missed most of the official activities)  Plus, snow has been good in both CO & MN this year.

 

Seg, I doubt that Bob remembers me, but I skied with him at Alta for the day in 1998 - there's a group shot in my gallery with him.  He took that photo of me chugging down East Greely, (I think it was?)  What a joy it was to ski with him!

post #9 of 14

Agree with MR too. Around me we are lucky as well, with a lot of docs who deal with a large number of athletes, young and old. Make sure you are honest about your expectations and your desire to get back to skiing, etc. Remember that when it comes to your health there are no dumb questions. Ask about the rehab programs, the facilities, the hours, etc, so you have no surprises. And don't be embarrassed.

 

Example... Recently a friend's daughter who is a high level college recruit tore her ACL. A mutual acquaintance, a high level sports orthopedic surgeon, had been her doc for many years and attended to all of her various injuries and emergencies, often after hours and at home. They discussed his plan for her ACL. He encouraged them to go see another specific doc who also does a lot of high level athletes, so they would be comfortable. They ended up using the second surgeon, because they were more at ease with the second doc's associated rehab facilities and the ease of access. Both docs are excellent surgeons. One place just made more sense for them.

 

There are multiple threads here which I am sure would prove useful for you as well. I haven't read them but I am sure there are lots of answered questions and at least you have some idea of the source. As long as you feel that you are making an informed decision that you are comfortable with, then you have made the right decision. And do remember that the vast majority of ACL cases turn out great, and a motivated patient always has a leg up!! (Couldn't resist). Keep everyone posted. Good, reliable information and experience is incredibly useful for patients, even when the situation isn't life and death. 

post #10 of 14
Thread Starter 
Quote:
Originally Posted by keniski View Post

There are multiple threads here which I am sure would prove useful for you as well. I haven't read them but I am sure there are lots of answered questions and at least you have some idea of the source. As long as you feel that you are making an informed decision that you are comfortable with, then you have made the right decision. And do remember that the vast majority of ACL cases turn out great, and a motivated patient always has a leg up!! (Couldn't resist). Keep everyone posted. Good, reliable information and experience is incredibly useful for patients, even when the situation isn't life and death. 


I read the whole ACL thread and learned alot.  I wish kcxd would come back and comment on her progress!  (She must be doing well if she's not visiting anymore) I browsed the Quad thread a little, but that's waay to big - maybe a Moderator should 'split' these threads when they get to 1000 comments.  I bet that would speed the whole website up, BTW.   I like your leg up pun; hyuk, hyuk, hyuk!

post #11 of 14

MNator:

 

As a surgeon (not ortho) I agree with what has been said.  While I occasionally have patients that do not come back it would be nice if you let your ortho clinic know that you have chosen to get care elsewhere.  If they ask why, just politely tell them that you chose a different specialist.  They likely won't even care.  I quit taking it personally a long time ago.  Sometimes the relationship just isn't right.  He may be a perfectly good surgeon with lousy bedside manner and the relationship didn't click.  Unfortunately, it is not that uncommon.  I also caution against paying too much attention to online reviews as the majority of people that take the time to post are unhappy customers.  If your GP knows that you went to the ortho in the same clinic you can let him know at your next visit why you didn't stay there.  Good luck if you have surgery and with your rehab.

post #12 of 14

I'm back! I'm afraid I got distracted by work for a while - it happens sometimes. ;) There's a proper update on my progress over on the ACL thread, but suffice to say that all is really good right now. I'm skiing - gently, but skiing - and that's enough to put a very large smile on my face. :)

 

With regard to the switching OS question, I went through something similar when I got the MRI results confirming my ACL tear. My family doctor had just gone on mat leave, so I spoke to a very helpful locum. She referred me to the guy she swore was the best OS in town (an opinion supported by my PT when I mentioned the name to him.) Unfortunately she also mentioned that I could be waiting between six months and a year just for the initial consult. Given that surgical wait times are at least 6 months after the consult, this horrified me and I asked my knee injury buddies (http://www.kneeguru.co.uk/KNEEtalk/index.php) if they had any advice. Someone told me that if I called the OS's office out of hours, the answerphone would often give the exact wait time for a first consult. I did, and it was 18-24 months - I think there's still a post on my original thread expressing my horror and despair at the idea of waiting three years to get into the operating theatre.

 

Anyways, I panicked and started researching all the options I could to find an alternative. (I'm a librarian by trade, so I'm kinda aggressive about research.) We came up with a list of options, which included staying with my in-laws over on Vancouver Island so that I could get operated on by a surgeon in Victoria, when I remembered that I'd seen a sports OS that I really liked four years previously after a kickboxing injury. He actually advised me against surgery for that particular injury (not common for someone who makes their living from operations) and I liked his style and approach a lot. I asked my family doc if it would be worth approaching his office about an appointment, and she said that I'd be treated as a new patient given that it had been more than two years since my previous injury and it wouldn't save any time. However, I thought I'd give it a go.

 

To cut a long story short, his office agreed to treat me as an existing patient and I got an initial consult in about a month, and was in surgery 6 weeks later. My family doctor sent a nice letter to the top OS I'd originally been referred to, and I didn't think any more about it. Ultimately a doctor is there to deliver a service to you, and if they can't deliver it - especially if you're in a situation where you're relying on insurance rather than MSP, as we are here in Canada - you have every right to pursue that service elsewhere. If you're not comfortable with your surgeon for any reason, you should look for an alternative with whom you are comfortable. After all, there's not much that you can trust someone with that's bigger than cutting into your body and drilling into your bones. You want to be 100% sure that you have the right person to be doing that.

 

post #13 of 14
Thread Starter 

I really appreciate everyone's contributions here.  I'll be seeing my new OS next Monday.  I won't cut any previous ties until I'm sure that this is the right move for me, but I realize now that I really deserve to have 'piece-of-mind' if I am to go under the knife, so I won't be shy about exercising my available options anymore.

post #14 of 14
Thread Starter 

Just an update on my appointment with the new orthopaedist... I copied my post from the ACL thread below.  I'll just add as a summary that on 12/21, I hyperextended my right knee, suffering a tibial avulsion of my ACL,(complete rupture) lateral tibial plateau avulsion fracture, and a grade 2 MCL tear.

 

 

8 weeks post-injury

OK, so I went to ortho #2 today, and, after telling him straight out of the gate that I used to race back in HS & College and that I want to be able to get back to skiing at a high level again, he studied my original MRI series(from 2 days post-injury) and then examined my knee quite thoroughly. He asked me alot of questions, checked out my ROM & did a joint laxity test,(some variation of the Lachman, not sure which one) and said that I was doing quite well at this stage for the injuries that I'd sustained. He reported no significant joint laxity and did not indicate surgery. He said 4 more weeks of 'no skiing', and to keep on doing whatever I'd been doing for PT.(which hasn't been much - just ankle pumps, and some other light ROM-increasing isometrics) Say wha-a-a-t? I'm very happy and a bit relieved, but left there feeling a little confused, as well.

He did not mention needing to use a brace, and I practically had to beg for a PT referral.("Do what you were doing and add the bike and other straight-line type execises" "Limit torsional stresses until you feel stronger on it") I pay 100% of my private healthcare premiums(self-employed) with a large 2.6k annual deductible on an HSA-elegible plan, so he really has no incentive to 'cost-cut', AFAIK. Doctor #1 said surgery at the 5 week checkup ..and now, a glowing progress report from #2.

I'm a little skeptical, but he apparently thinks that I'll become strong enough on it to be one of the lucky ones that end up in that top-third group who will be able to go on, skiing ACL-less.  I sure hope that he's right about that.

Time will tell. For the last week, progress has begun to blossom at a higher rate than had been the case during the first 7 weeks. It's still weak, but ROM is now on par with my good leg, and I have the go-ahead to start increasing my workout levels, with some restrictions. For now, I will count my blessings, look into PT,(out-of-pocket) possibly get a brace,(also out-of-pocket) and see how things progress. I will stay in touch as the saga continues on.

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