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Archive for May, 2012

We’ve discussed when you might want to look for a new health care provider. MiddlesexMD advisor Dr. Sheryl Kingsberg minces no words on that point: If your health care provider isn’t addressing your sexual health concerns, find a new one. If your current physician isn’t listening or is talking down to you, find a new one. If you are uncomfortable and can’t communicate with your provider—you guessed it—find another.

Gulp.

Changing physicians is a daunting task. The process is fuzzy, and credible information is hard to come by. Maybe that’s why we put up with less-than-ideal situations for so long.

But the relationship with your doctor is too important to settle for an uneasy status quo. Trisha Torrey, who writes extensively about the issue, says it’s like choosing a spouse, except that you may be more intimate with your provider.

If you’ve been dissatisfied with your provider or are just putting up with a situation because you’ve been avoiding the task of finding a new one, here’s a plan of attack.

If possible, out of fairness to your current physician, try to address with him or her the reason for your dissatisfaction. If you aren’t a good “fit” with her personality or style of practice, a heart-to-heart might not be very productive. It’s unlikely that he can change such basic traits. But if you have a problem with her staff or have health care issues (such as sexual complaints) that haven’t been addressed, you should give your doctor an opportunity to discuss the causes of your dissatisfaction.

Also, as Torrey points out, “nice” doesn’t necessarily equal “competent.” A good bedside manner is pleasant and soothing, but for my money, I’d rather have competency.

If you’re convinced that you need a different provider, don’t leave your old provider until you’re sure you have a new one. You don’t want to come down with a cough or find a lump without a regular physician. According to a 2008 article in the New York Times, “Studies have found that it is hard to get an appointment at short notice when cold-calling, and that patients with a regular source of care get better care, even when they are uninsured.”

Then, as you begin your search, consider these issues:

  • Insurance and hospital affiliation. Finding out what providers are covered by your insurance is probably your first order of business, unless you’re okay with paying for medical service out-of-pocket. Call your company for a list. Does the hospital a physician is affiliated with make a difference to you? That could also factor into your search.
  • Age. Do you want an older person with more experience but who may or may not be as familiar with the latest treatment options? Or do you want a younger provider, who may be around for your golden years, but who lacks long-term experience (at this point).
  • Language-gender-culture. Are any of these variables important to you? Would you prefer a provider of the same gender? Do you have religious or cultural preferences or prohibitions? Do you have a hard time understanding accents?
  • Special health concerns. If you have diabetes or allergies, do you want your primary care provider to have more expertise in that area? Some general practitioners have extra training in various subspecialties.
  • Location and hours. Do you want a provider near at hand, or are you willing to travel to someone you’re comfy with? Would evening hours be a bonus so you don’t have to take time off work?

Once you’ve mulled over these parameters, your next challenge is to find solid, trustworthy information about the providers on your short list. The bad news is that it may be easier to get information about a washing machine you want to buy than about a doctor you’re considering. Websites that provide information and ratings on physicians are in their infancy, and sites that feature patient reviews have to be carefully vetted for objectivity.

“The truth of the matter is that people are hard pressed to make well-informed decisions when they choose a doctor, and they’re doing it blind,” said Joyce Dubow, a senior adviser in the office of policy and strategy at AARP in an article in the New York Times.

When you call your insurance company for participating providers, ask if they have a review system or an “honor roll” of providers. Some companies are starting to do this.

Some online sites rate physicians, but they vary in quality and credibility. You wouldn’t trust a review of a washing machine from the company that sells it; neither should you find a doctor on a site hosted by a pharmaceutical company. Pay attention to who created the website, who funds it, who makes money from it, how complete it is, and how current it is. Check out healthgrades.com for basic information and some reviews or healthline.com.

Doctors must be licensed to practice in a state, but board certification indicates a higher level of competency. Most providers are board-certified, and yours should be as well, either with the American Board of Medical Specialties for MDs, the American Osteopathic Organization for DOs, or the American Board of Physician Specialties, which accepts both disciplines. A doctor may be certified with other boards as well, but these three are widely recognized and demand a certain level of competency and achievement. To find a health care provider with specific menopause-care knowledge, you might start with the North American Menopause Society’s website at menopause.org; there’s a practitioner search you might find helpful.

Word of mouth is still a common and effective way to get information about local providers, especially if the word comes from someone in health care. I found a terrific dentist from a hygienist who taught at a dental school. Another woman found her internist from a trusted pharmacist. Ask family and friends who they see and how they like the person.

Check social media sites and search engines like Google. It’s easy and worth a shot, just make sure you’re getting information about the right person.

Finally, schedule consultations with the providers on your short list. You’ll probably have to pay for the appointment, but you’ll be able to assess the provider’s attitude and personality, the office environment, and, very importantly, the attitude of the staff.

Bring a list of questions, such as whether she schedules same-day appointments for illness, how he handles emergencies, whether you’ll see the doctor or members of the staff (physician’s assistants or nurse practitioners), how she handles prescriptions, where he went to medical school, how long she’s been in practice (if you haven’t ferreted this out already). Ask about board certification and any special training. And tell him or her you want to feel free to discuss matters of sexual health.

Finding a provider is a challenge, but it’s a critical and long-term relationship, so it’s worth putting in the effort upfront in order to avoid ongoing dissatisfaction down the road. And take heart from Dr. Sheryl: “If a women is smart enough to have found the MiddlesexMD website, she’s savvy enough to ask friends and other health care providers and to do some basic research to find someone she’s comfortable with.”

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I get occasional questions about erotic use of various household objects. I am, after all, long trained as a physician, so safety and hygiene are among my first concerns. And, since starting MiddlesexMD, I’ve seen some very well designed vibrators, dilators, and dildos that I know are safe, easy to clean, and designed specifically for older women’s pleasure.

That said, I encourage women and their partners to be playful. These are the things I would look for to be safe: Are there sharp edges, seams that might pinch, protrusions that might surprise you? Can you clean the material thoroughly—before and after use? Is it compatible with any lubricants you might use? And, less clinical but just as important, will it make you feel like a valuable, sexually alive person?

With those cautions, have fun exploring.

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Dr. Sheryl Kingsberg is a MiddlesexMD advisor and a psychologist specializing in women’s sexual health. She talks to physicians a lot about why it’s important to at least ask about a patient’s sexual health and maybe take her sexual health history. So she’s very familiar with the view from the physician’s side of the desk when it comes to talking about sex with patients.

Generally, she says, health care providers have little training in women’s sexual health, even though they deal with those organs all the time. So—“they’re not going to ask about a topic they don’t know much about because they feel like they’re walking into something blind,” Sheryl says.

Plus, they’re probably embarrassed, and they’re afraid the discussion will take too much time. “All health care providers struggle with this issue,” she says.

Patients are often embarrassed to bring up the S-word, too, even though they may have questions or problems. Or—they may think (studies prove this is true) that nothing can be done about the problem anyway. This is because, in general, women’s sexuality is complex and can be affected by everything from physical changes to cultural morés. There are treatments for women’s sexual problems, but they’re just not as simple as a pill, because, well, our sexuality isn’t that simple.

As a result, sex is the elephant in the examination room. It’s the health care version of don’t ask, don’t tell.

What Sheryl tells physicians is that not only is it important to give a woman permission to talk about sex and to be prepared either to treat her problem or to refer her to a specialist, it’s also their responsibility as a practitioner. Here’s how she puts it:

  • Sexual issues are very common. About half of women will have some sexual difficulty at some point in their lives.
  • Sexual health is a basic human right, according to the World Health Organization. It is the health care provider’s responsibility to be concerned about and to manage the patient’s sexual health.
  • Sexuality is important to a woman’s overall health and quality of life.
  • Patients are uncomfortable bringing up the topic. They don’t know if it’s appropriate, and they don’t think anything can be done to help them.
  • Patients won’t be offended if the provider asks about their sex life.
  • Asking about a woman’s sexual health doesn’t have to take a long time. At the very least, the health care provider should communicate that it’s okay to talk about sexual problems, and be prepared to refer the woman to a specialist.

That’s it. That’s the manifesto. It’s your right to have your sexual health questions and problems addressed, and if your physician can’t or won’t do that, Sheryl says: “Find a new provider.”

The medical landscape is changing, she says. Rather than the old “doctor knows best” mentality whereby you, the patient, comply with the treatment regimen your doctor prescribes, now the approach is to work together with your provider to develop a regimen you can adhere to rather than passively comply with.

Sexuality is important, and if your health care provider hasn’t asked you about this quality of life issue, bring it up. Then, if he or she doesn’t respond, well, there are lot of other providers in the pond.

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The provider-patient relationship is delicate and fraught with opportunity for misunderstanding. On one hand, you have a busy professional in a somewhat risky, stressful profession who is pressed for time and is trained to speak a foreign language—medical mumbo-jumbo.

On the other, you have ordinary people who may or may not be good at communication and who are paying a lot of money to entrust to this person their most precious possession—their health.

On one hand, it takes time to become familiar with someone’s personality and communication style. And it takes time to develop trust, which is a critical ingredient in any relationship that will last a long time, including this one.

But on the other hand, the stakes are too high to overlook for very long a bad attitude, questionable treatments, or ongoing discomfort on your part.

So how do you know when to finally pull the plug and find another health care provider? And how do you go about that process, anyway?  We’ll answer the first question in this post and the second in a later post.

The top reasons to look for another health care provider:

  • Your health care provider interrupts or doesn’t listen. Your questions are prepared and succinct. You aren’t rambling on or complaining about your job, yet your provider is glancing at the clock, seems preoccupied, or keeps checking his or her Blackberry. Or—you’ve barely begun to ask your questions, and your health care provider interrupts. (Some studies indicate that providers interrupt their patients within 23 seconds after a conversation begins.)
  • Your health care provider is arrogant, argumentative, or unapproachable. Your health care provider must be able to listen to challenging questions and to answer them thoughtfully and without defensiveness. A health care provider who doesn’t welcome questions from his patients, who blames the patient, or who becomes hostile, defensive, or argumentative either has a personal problem or doesn’t understand the first thing about a professional relationship. If you like being bullied, stick around; otherwise, head for the hills.
  • You can’t get in for an appointment. You may have to schedule a routine physical several weeks in advance, but you want to be able to see your health care provider when you’re ill. At that point, even a few days are too long. If you can’t see your health care provider when you need to, that’s a problem.
  • Your health care provider’s staff is unfriendly, unhelpful, or incompetent. Unreturned calls, lost paperwork, billing errors, curt or snippy responses to questions, and long stretches on hold—these annoyances seriously impede your relationship with your health care provider. You owe it to your provider to let him or her know about your experience with the staff, but if nothing changes over time, you’ll have to assess whether the relationship is worth the aggravation.
  • And finally—your health care provider is unwilling or uncomfortable addressing your sexual health. Sexuality is a big part of your identity and a major contributor to your quality of life. Yet, as we’ve discussed before (and will again), most providers don’t bring it up. And they should. Dr. Sheryl Kingsberg, sex therapist and MiddlesexMD advisor, takes no prisoners on the issue. (More on this later, too.) “If your health care provider is that uncomfortable or indifferent to your quality of life, then I’d consider getting a new provider.”

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