Wednesday, August 14, 2013

Picking Good Doctors

Conversations with friends recently reminded me of this piece that I wrote nearly 6 months ago.  Interesting, as we have very recently bid Dr. Getty goodbye, and we are relying again on Dr. Gingo.  The sentiments are constant, however.

We have been blessed in this life with good doctors.   Some we looked for.  Some simply fell into our path.   The vast majority of folks in our medical journey have been terrific, although, as in life, there will always be some people that rub you the wrong way. 
How do you pick a good doctor? 

When I first moved back to Ohio, Dan and I were looking to start our family and I needed an OB.  I was young and healthy, and had no primary care doctor to ask for a referral.  So, I asked around at the restaurant where I worked, and was referred to a gentleman who was very nice, by a coworker, who incidentally, had no children. 
Dan and I were excited about starting our family, and as a first time mother, I did exactly what I was told, came to my appointments as scheduled.  It was all going along swimmingly.

After one episode of false labor (first time mom, you don’t know what to expect or what “real” labor is), my OB had me in for another ‘weigh-and-measure’ appointment.  He checked me, and I was 3.5 cm.   Nervous, he recommended that I be admitted and induced.   Okey-dokey. 
So, petocin (a drug which I now have evil feelings about) was ordered up.  Progress was rapidly achieved, but I honestly feel that this man had dinner plans that he did not want to be late for.  Because, he personally turned up the petocin, at a point when I had no breaks whatsoever between contractions. (My extensive subsequent experience in hospitals has shown that doctors do not in fact operate IV pumps, never touching them, except on very rare occasion, to silence them)    Epidural (too late), and Alex was born in 3 ½ hours, making me officially a mom.  He was nearly dropped (Dan still talks about this man’s very small hands, understanding that Alex was a slippery little bugger, but suggested that my next OB have a catcher’s mitt)  While I was thrilled to be a mom, I thought that maybe another doctor might make the next experience a bit better.

So, I needed to find another doctor.  My sister had 4 children, so I used her OB for Brent’s delivery.  I felt that I could trust her experience, and her opinion.  I loved this doctor.  Brent was brought into this world sans petocin (per my request which was both heard, and honored) in an hour and a half.  He was born in time to watch a World Series game with Dan, who teasingly complains to this day about how rough it was for him to stand so long, and that no one offered to give him a foot massage.   (Ahem…)   Dr. El-Dabh was terrific.
But our insurance then changed, and to go out of network for another delivery with him as my doctor was cost prohibitive.  I really considered it though.  Looking again…

I went to a smallish Christmas party with a printout of my OB options.  I asked the ladies there to cross off any docs that they did not like (be warned if you try this, there are passionate feelings among women about such things) and to circle the good docs. I asked questions about the circled docs.  Wait time? (OB offices are prone to occasional delays, given the unpredictable nature of birthing, but some are notoriously over booked, and I had 2 toddlers to consider)  Efficient staff?  Does the doc take time with you or rush through?  Confidence in him?
Among those circled I found Dr. Anthony Gingo, who has been an angel whispering in my ear, for over 10 years now.  I have been grateful ever since, for that last minute Christmas inspiration, grabbing the list and asking ladies that I didn’t even know so well at the time, their opinion on a pretty personal matter. 

I cannot exaggerate the positive impact that this man has had on my family and the trust that I place in him.  His guidance has served me well each and every time it has been offered.  I credit him with Lauren’s life, both on the day she was born (cord around her neck) as well as when she was sick the first time, alerting me of the need to “find answers” which helped me push a little, when we were initially told by another doctor to just ‘come back in 6 months’ for a re-evaluation. As it turned out, she had a rare unpredictable cancer, which would not have been discovered for another 6 months, with who knows what results, except for Dr. Gingo’s words banging around in my head.
I am grateful for his care of me, for respecting my wishes in difficult situations, of his attention to my family and his consideration of my daughter’s future.  He has been invaluable for thinking ahead and preparing us for possibilities we would rather not consider and hopefully preventing catastrophes, unlikely for the average patient, but worthy of very serious consideration for both Lauren and for me.  I have hardly been the routine or average patient.  He is an exceptional doctor, so I feel that we are a good match.  I am so grateful for his guidance.

When your child has cancer, it is not like you can bring a list to a Christmas party and expect that anyone can help you, or offer an opinion.  (When your child has cancer, you haven’t time for socializing so it is just as well)  You land where you land, shell shocked and trusting that doctors in general, and the oncologists in particular, are much smarter than you are, and that they can fix it. But they are human, fallible and sometimes just not a good fit, despite their exemplary medical qualifications.
Sprinkled across our medical story are a few doctors that I cannot say offered unreasonable opinions, or came to conclusions that were unsound, but they were just not a good fit for us.  This was not simply because they raised concerns or possibilities that we did not like, or arrived with recommendations that we found disagreeable (nearly all doctors we spoke with had big problems to report, and unpleasant recommendations) There was almost always a manner whereby these few doctors communicated with us, or failed to communicate, that we found very difficult. 

So, the euphemism in our family is “not our favorite” for docs that are not a good fit for us.  Only occasionally, have they irritated us enough to garner a private nickname, like Dr. Doom-and-Gloom, or Dr. Chicken Little (They sky was always falling for that one).  But these people have earned the respect of the title of “Dr.” even if the surname is slightly altered to more accurately reflect the quirk of personality that rubs us the wrong way. And, these have always been nicknames that help remind Dan and I (or very recently, our children) that they offer one possibility, have their own perspective, and are entirely human.  The ‘Dr.’ part is to remind ourselves that they are truly trying to look out for us using their experience and education, despite how it feels.
I contrast this handful of doctors who focused perhaps too narrowly on one aspect of a problem or failed to communicate altogether, with the vast majority of docs who have meshed well with us, been compassionate and thoughtful in the way that they spoke to us while presenting the unfortunate result, recommendation or information that they were required to report. The best doctors took the time to explain their thoughts and concerns.  They also listened to our concerns and answered our questions.

I think of the affection that Brent has for Dr. Getty, a man who explained to him why it was prudent to amputate his leg, and how challenge ridden a reconstruction of the hip would be.  He led with “I have options for you, and I am sorry to say, unfortunately, you aren’t going to like any of them.”  Honest, but compassionate. I believe that the most important thing he did, was to strongly encourage us to seek other opinions, preparing us for those conversations with other doctors, and ensuring that we were best informed about perhaps the most significant decision of Brent’s cancer journey.  He has been unwavering in his support of our decision, despite the obvious restrictions in the ways that he can help us at this point. 
Perhaps because all of our options were bad, the negative consequences of our choice (the persistent concern and worry about this hip construction) are more easily tolerated.  But somehow, I don’t think that Getty is an “I told you so” kind of guy.  He is far too humble, and respectful of both his patient, who, by definition is in a very bad situation, and of the disease, which is unpredictable, in spite of his vast experience with it. His part in our journey might not be direct, having never actually performed surgery on Brent, but could hardly be considered tangential. 

Besides, he is just a really great guy.
This humility is something that I respect in a doctor (coupled, of course, with extensive medical knowledge).  One of Brent’s oncologist said to me once, that he doesn’t cure, that he doesn’t have the answers.  He merely assists and guides.  There is so much mystery, so much uncertainty.  And he volunteered that he couldn’t say what makes the difference from one outcome to another. This might make someone else crazy and think “why am I here if you don’t really have answers?” But for me, I think that this acknowledges the limitations of scientific understanding, and recognizes the exceedingly complex nature of human beings.  And, it may have been the first that I heard a doctor openly refer to the philosophical and spiritual aspects of our being human and its influence on medicine, which I think has its place along with science. 

But that is just me, and maybe someone else might develop a nickname for these same doctors, to demonstrate that they were “not a fit” for their family.  

We have been blessed with so many ‘fits.’

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