Ava Hoffman- Ava Hoffman
you can fire them
CW // medical gaslighting
I will never forget the moment that my mother told a doctor off.
It. Was. Glorious.
We were sitting in his office, candidly describing what life looked like, and begging him to change my medication and put me on a steroid.
He refused. He kept insisting that increasing my dosage would be a better option.
My mama reminded him that we’d done that already. Twice. I was sicker than ever.
He continued to refuse our requests, sympathetically nodding, asserting that he understood the severity of my symptoms, my difficulty in finishing school, and the limited life I was leading.
My splendidly fierce mother and advocate looked this doctor in the eye, straight faced, and said, “Go buy a bottle of Miralax, drink the whole thing, shit yourself 12 times, and go into work wearing an adult diaper. Then you can tell my daughter you understand.”
I didn’t know whether to gasp, laugh, or cry, and I’m pretty sure I did all three.
I never saw that doctor again.
Once upon a time, healthcare practitioners were inherently trusted. They were known to care for people, and we saw them as trained specialists with our best interests in mind. The patient was the expert of their health and body, and the provider was there to assist and offer in-depth clinical opinions.
Over the years, the profession and our society has shifted. Instead of being able to trust our providers, we’ve been conditioned to follow their advice, no questions asked. We’ve been trained to view those with lengthy credentials as the sole experts and authorities of our health and bodies.
We’ve all seen the growing mistrust towards the healthcare industry. Personally, I think it’s warranted. That doctor I told y’all about? He was receiving kickbacks from the company who made the medication that I wasn’t responding to. No wonder he kept upping the dosage and refusing to prescribe me something else!
More and more of us feel the traditional medical system and its staff are failing us. Our bodies aren’t well and the prescribed treatments don’t seem to get us where we want to be. Finding a provider who listens and see the whole picture feels impossible.
I’ve found so many of us long for better yet remain unsure how to walk forward. We know we are not okay with how our health looks presently, and we aren’t comfortable with our current care. But how do we get to a better place?
I think there’s a simple truth that can kickstart this shift!
Your healthcare providers work for you.
They work. For. YOU.
If your accountant messed up your taxes, you wouldn’t go back. If your contractor fell behind on the renovation, you’d fire him and replace him. If your grass people weren’t doing the landscaping how you wanted, you’d address the problem.
Same thing with our doctors and providers.
Chiropractor not listening? Go somewhere else. Doctor ignoring your symptoms? Find a different doctor. Dentist you just feel uncomfortable around? Get a different dentist!
It isn’t always this easy, though, is it?
For some reason, we are unsure what the red flags are. We don’t know how to fire a provider, and we certainly don’t know how to go about the transition.
That’s okay.
I’ve been in the healthcare system for 14 years. I’ve had over a dozen regular providers. I’ve fired three doctors. I’ve transitioned care three times. I’ve been there.
It's still hard for me!
So here are five red flags, five steps to take, and five things to keep in mind for the transition when you need to fire a provider!
RED FLAGS
1. Believes in Education over Experience
I am extraordinarily grateful for the time, effort, money, and debt our doctors put into their medical education. It makes them qualified to diagnosis and offer lifesaving, quality-of-life-improving treatments. HOWEVER, medical education will NEVER trump a patient’s experience. Regardless of how many years a provider has spent studying, at the end of the day, it is YOUR body. YOU have the symptoms. YOU know what feels off. YOU know what kind of life you’re trying to live. And take it from your friendly neighborhood geneticist, you WILL respond uniquely to viruses, autoimmune incidents, and drugs. Medicine has NEVER been one-size fits all. Personally, the best thing a provider can say to me is, “You probably know more than I do!” It means my years of living with the disease and my own education are seen, respected, and considered. A provider that tells me what I’m experiencing isn’t possible or unimportant isn’t long for my health care team.
2. Refuses to Cooperate
I find this red flag is especially important for those of us with multiple conditions and/or providers.
Providers need to be working for the best of YOUR health. Oftentimes, this means communicating with other healthcare professionals. It requires them to share notes, receive notes, and read your file each and every visit. It can be extra work coordinating with other offices!
This coordination is vital, though! It makes sure labs aren’t slipping through the cracks. It ensures repeat viral or bacterial illnesses are addressed in a timely manner, and it keeps your medical file up-to-date!
If a provider is refusing to coordinate your care, it may be time to replace them – for your own sanity and for the sake of your health.
3. Rude and Condescending
First of all, this behavior is never acceptable from anyone, especially people in a professional capacity. Service-related industries, including healthcare, cannot thrive when the caretakers and providers are bad-mannered and patronizing.
If you find yourself on the receiving end of an arrogant, insulting, inconsiderate doctor, dentist, surgeon, chiropractor, physical therapist, or any other form of provider, please start looking for alternate care.
You are a person, dignified and valuable. There is never a reason for your personhood to be demeaned. You do not have to sacrifice your dignity in order to receive care.
4. Reluctant Learner
It was my first appointment with a new endocrinologist. I had a list of questions, including ones about transitioning to a new diabetes technology. He was a friendly enough older doctor. The appointment was going well until he turned to the desktop to retrieve my file.
Ten minutes later, he peered over at me. “Would you mind…???” He scooted back and gestured to the computer. I pulled up my own medical records for this provider and didn’t ask a single question about diabetes tech.
Afterwards, I told my mother, “This isn’t going to work.”
See, the field of medicine is always changing! Technology is improving. Treatments are getting better, and there are more of them! New drug are constantly being trialed. I’m a firm believer providers should be as up-to-date as possible in their respective fields.
And many professional organizations agree with me! Doctors holding accreditation with certain medical organizations are required to attend a certain number of conferences, log a certain amount of time reading research, and perhaps even present occasionally.
This information is searchable. The organization lists accredited providers, and providers often list this in their qualifications, too. I always look for this when I am searching for a new provider – it indicates the possibility of a higher level of care than I would receive from someone who knows nothing of latest developments.
5. Offers No Explanation
Two words, friend. Informed Consent. It’s the ethical principle of communication between patient and provider that results in shared decision-making. It should involve the provider recommending treatment, the patient receiving information, asking questions, and making a decision about their care.
If any of that is missing or skipped, it is NOT informed consent.
Keep in mind, as the patient, we can also refuse the treatment if our questions are not answered or we have remaining concerns. Coercion is not a part of an ethical patient-provider relationship.
If you find yourself under the care of a provider who cannot explain the science to you or who recommends treatment without any explanation, be concerned! If said provider refuses to adequately answer your questions, see someone else.
You are entitled to informed consent, friend!
WHAT TO DO
1. Decide What You'll Tolerate
We all have our limits. What are you willing to tolerate? Can your provider accuse you of lying about your sexual activity? Can your provider insinuate that you are making up your symptoms? Is it okay for your provider to make a joke about school shootings? Is it okay for your provider to treat you like you’re an ignorant incompetent idiot? Will you pay a provider to share their political propaganda with you? Will you pay a provider who shows up 40 minutes late and never addresses your questions? There are a million more questions you can ask yourself, but the bottom line is this: How do you want to be treated, and what do you want your appointments to look like? Boundaries are healthy, friend, and knowing what is comfortable for you is vital, in this space and in other areas of life, too!
2. Choose Your Exit
The last time I fired a doctor, I walked out of the appointment room straight to the nurse’s desk and asked for a recommendation for another provider. Then, I went online and filled out a survey with a truthfully candid account of my experience. I also talked to the office manager about my experience with this provider.
A friend of mine also recently fired her provider. She said nothing, called the office to switch providers, and provided no details as to the nature of her request.
You can also choose to continue seeing the provider! I have reported a provider and remained their patient. It all comes back to what you want for your care, and when too much is too far.
All of these exit strategies are beautiful and appropriate! Here’s the key for your exit – do it gracefully.
We can hold providers accountable without making a scene, without a yelling match. It keeps our dignity intact as well as respecting the provider.
See, no matter how they’ve treated us, we are still responsible for our own behavior. I personally like to behave better than the 60-year old professional. It’s a subtle reminder that manners matter and your patient-care tactics have repercussions.
If you find yourself stressing out about switching a provider, know that you don’t have to confront anyone! Take the pressure off yourself, friend. Cancel the appointment and say nothing. No one is going to question you.
At the end of the day, walk this out how you feel most comfortable.
3. Know Your Non-Negotiables
Actually sit down and write or type these out, friend. It will be incredibly helpful! It becomes your personal standard for your care, and it helps weed out providers from the get-go.
Examples of non-negotiables may be: Doesn’t push vaccination Open to prescribing supplements Has a DO degree Understands the importance of nutrition Willing to treat symptoms with lifestyle changes first Spends time getting to know me apart from my medical file Active listener Respects my time Offers evening appointments Asks for my consent before ordering labs or performing tests and procedures
What is important to you in a provider? And depending on what field this provider works in, your non-negotiables may look different! You might add “doesn’t require me to swallow fluorine” if you are looking for a dentist.
Write your list and stick to it!
4. Research Other Providers
If you’re even thinking about no longer seeing a provider, I’d recommend going ahead and asking around for other options. It gives you a minute to do some research and make some phone calls!
If there’s a nurse in your practice you trust, ask them for a recommendation. Ask your community who they see and why they love (or don’t love!) their providers! Read reviews – many health care practices have reviews living somewhere on the internet. Look at the values of the clinic or practice – do they align with your vision for your health team?
Know this, too – it is okay for this to take a minute! I often see two or three doctors before finding one that fits my personal needs. Again, these folks work for you – find the best match for your needs, style, and vision!
5. Be a Self-Advocate
This one is so important, friend! From refusing to be pressured into scheduling an appointment to asking the receptionist “what would it take for this provider to fit me in,” don’t be nervous to ask the question. And don’t shy away from the word “no.”
Know what you need! And know when you need it, too!
One of my medications drastically increases my risk for skin cancer, so I have to have an annual skin check by a dermatologist. I was a year overdue already as my prescribing doctor failed to mention this to me, and dermatology takes forever to get into.
I called my derm office and asked them to place my name at the top of a waiting list for cancellations. They insisted they could not do this as I was a new patient (yay moving!). I informed them that while I was a new patient, I was not coming in for a new patient appointment and thus did not belong on said waitlist. My appointment was scheduled a month out instead of six months out.
Sometimes, self-advocacy is just being persistent!
Know what you need, friend, and be determined to make it happen. That’s self-advocacy.
FOR THE TRANSITION
1. Request Your File
If you are switching practices or offices, you will want to request your file at your final appointment. If you’re not comfortable doing this in person, you can always call the office and request it, too. They are legally obligated to provide it to you – it is your information!
Your new provider may be able to request your file, too, if they have your ex-practitioner’s information. So grab a business card at your last appointment that you can provide to your new office!
If you are staying within the same practice or system, you won’t need to do this because your new provider has access to the same system already.
2. Update Your Prescriptions
This is only really applicable if you are going to need a refill of a medication that has no more refills, so make sure you check medications you use often! Common examples include birth control, migraine medication, supplements, insulin, diabetes supplies, etc.
If you have a prescription that needs to be updated, ask for that at your final appointment. It won’t seem out of place or cause an uncomfortable conversation, I promise!
And it will ensure you make it to your next appointment with a new provider 😊
3. Wait
Let’s be honest – the medical system is sloooowwww and getting a new patient appointment can take MONTHS. When switching providers, take this into account, especially if you’re looking for a medical provider in a specialized field!
For some, this waiting period is nothing. It’s not a big deal, and you can walk through it with little to no thought. For others, though, this can be an agonizing period of time.
And friend, if this waiting for a new doctor is hard, I see you. I see the nerves that this new provider won’t listen. That the gaslighting will begin again. That the second opinion you were hoping for won’t be given. I see your hope – the one desperately wishing that this time will be different.
Take care of yourself in this in-between, friend. Lean into your support system. Embrace all the healthy coping mechanisms. Try out anxiety doodling. And don’t stop hoping!
4. Trust Yourself
I don’t know about you, but in my life, the doubt usually kicks in at some point. Was this the right decision? Am I blowing this out of proportion? Is it worth it to do all this extra work? Why didn’t I just turn the other cheek?
And I don’t know about you, but I need to remind myself why I made this decision. I remind myself how I was treated, how I was spoken to, and how my care was mismanaged. And I remind myself why that is not okay.
Your gut said something was off for a reason. You were uncomfortable for a reason. You wanted to be seen by someone else for a reason. Trust yourself.
5. Prepare Your Questions
It is rare that I walk into a doctor’s appointment without a list of questions! I write it organically as I experience symptoms or wonder what a different treatment protocol would look like. It helps me avoid the panic when the provider says, “so what can I do for you today?”
And it ensures all my concerns are addressed, too!
Write down your questions and wonderings prior to seeing your new practitioner. If you have questions about their background, their approach, their views on certain topics relevant to your care, write them down and mentally prepare yourself to ask them!
If you’re seeing a specialist or being seen for a specific reason, have all the questions related to your concern, condition, and symptoms ready to go before the first appointment. Be ready to catch your new provider up-to-speed!
There are a myriad of reasons you might be seeking a change in your care, friend - personality mismatch, feeling rushed at appointments, walking out confused, a general uncomfortability, opposing views on care. And each and every one of your reasons is valid.
This is YOUR health and YOUR care team. You get to choose who cares for you, friend. That is a fact that will never change, regardless of what the world says.
The beauty of our system is the endless possibilities and choices of providers. Don't settle for care that is less than, friend. Choose what is best for you - presently and for your future well-being, too!
