Changing doctors

Changing doctors is not a step to be taken lightly, but it can be a great relief if the relationship has deteriorated beyond repair. It is a good policy to exhaust all possible remedies prior to separating, or the same problems may arise with the new doctor. Communication, verbally or in writing, and mediation, using social service staff, can sometimes resolve the issues and prevent the disruption of changing doctors.

Although there are many reasons for changing doctors, some of the most common are:

• Not the most qualifed person.

• Grave medical errors made.

• Poor communication skills or refusal to answer questions.

• Serious clash of philosophy; for example, a paternalistic doctor and a parent who wishes to be informed and share in decision-making.

It is one of life's great struggles to face cancer. If the family has a physician they trust, can rely on for the best medical treatment, feel comfortable with, communicate freely with, and can count on for advice and support, the struggle is greatly eased. If, on the other hand, the doctor adds to your discomfort rather than reduces it, change doctors.

Do not change doctors because you're searching for a better diagnosis. If two reputable physicians, or a tumor board, have agreed on the diagnosis and treatment, it is best for the child to begin treatment immediately.

Many parents, fearing reprisals, choose to continue with a physician in whom they have no confidence. Such reprisals rarely happen at large centers of excellence. While there may be lingering bitterness or anger between parents and doctors, the child will continue to benefit from the best-known treatment. Children may actually suffer more from the additional family stress caused by a poor doctor/parent relationship than from changing doctors.

In a small treatment center like Group Health, there are only two pediatric oncologists. When parents change doctors, the situation becomes very tense because the terminated doctor still cares for their child nights, weekends, and when he is on call. I would not recommend changing doctors if there are only two doctors in the clinic. It's probably better to change treatment centers if possible.

Once the decision is made, parents must be candid. Either verbally or in writing, they should give an explanation for the change and make a formal request to transfer records to the new physician. Physicians are legally required to transfer all records upon written request.

We've had wonderful docs, mediocre docs, and one who made a terrible mistake. We've had warm compassionate docs, ho-hum docs (on a good day they're nice, on a bad day they're neutral), and we've met some world-class jerks. Sounds pretty much like a slice of humanity, right?

Parents hold doctors to a different standard since the stakes are so high—our kids' lives. But the reality is they are usually overworked, exhausted, and deal with newly diagnosed families on an almost daily basis, day after day, week after week, year after year. I can't even begin to imagine the emotional toll that must take.

I tell my kids all human relationships are like a goodwill bank. If you make lots of deposits, an occasional withdrawal won't be so noticeable. I tell my docs and my kids' docs whenever things go right. I like to write, so I send many thank you notes. When our pediatrician went on sabbatical, he took me into his office and showed me every mushy Christmas card I'd sent him lined up on the back of his messy desk.

I also have been known to bring in brownies for the office staff. We did this on my daughter's last day of radiation and several people broke down and cried when they saw the thank you note she drew—a picture of herself holding a Snow White and the seven dwarves audiotape. She listened to that during every radiation session because I'd promised that day's radiation treatment would be over before the dwarves appeared.

I recently asked one of my favorite doctors (a pediatric oncologist who has incredible compassion) how many thank you notes she had received from parents over the years. She said she could count them on two hands. I asked how many complaints, and she said, "You wouldn't want to know."

So, while I think docs should be called on for bad behavior and bad medicine, I also think we should acknowledge good medicine and good behavior I'd like to encourage the good ones to stick around—new little innocents keep getting cancer every day.


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