What Should You Expect From Your Doctor? What Should Your Doctor
Expect From You?
Table of Contents
Introduction
You would think it is all quite simple. The thyroid gland is a
small organ, located in the front of the neck. It is a factory that
is designed to produce one product - thyroid hormone. It usually
makes just the right amount of hormone to meet the body's needs.
Occasionally it can make too much hormone. More often, it can produce
too little hormone. It can grow lumps, some of which can contain
thyroid tumors, including thyroid cancer.
It all sounds very simple, and so it seems, until you suddenly
discover that you or someone you know has a thyroid problem. Then
you realize that what sounds so simple at first actually can be
quite complicated and very confusing.
The purpose of this article is not to advise
you what to do about any specific area - there have been, and will
continue to be, informational articles on this website addressing
all of these areas - but to help you understand the nature of the
relationship between you the patient, and your doctor.
What Should You Expect From Your Doctor?
Nowadays, the traditional role of "the doctor" may seem
different, especially to those of you who remember the "good
ol' days of medicine," when your doctor was your friend, took
lots of time with you, got to know you and your entire family, took
care of all aspects of your care, saw you when you were sick in
the hospital, maybe even came to your house for a house call, and,
certainly, never hesitated to refer you to a specialist. Things
are just not that way any more.
Whether it was caused by the rising cost of health insurance to
employers, or the total cost of health care to the government, or
the influence of profit-driven "big business" into the
health care industry, or some other cause, there is a very different
approach to health care today. The influence of Managed Care has
greatly changed the doctor-patient relationship of years ago. Doctors
are constantly scrutinized over how much they are spending to evaluate
a patient's illness and treatment. Hospital stays are shorter, and
fewer tests are ordered. The overhead of a medical practice is constantly
rising, yet doctors in most parts of the country are not able to
raise fees because of contracts with insurance companies or with
Medicare. There is the tendency for doctors to have to see more
and more patients each day to cover their office overhead. There
is great pressure on primary care doctors to "do everything"
including, often, holding back early referral to specialists.
In the area of thyroid disorders, this fact is very evident. Often
patients are referred very late in the course of their illness and
often with many inappropriate (and expensive) tests having already
been done. Who suffers the most when this style of medicine is continued?
The patient is always the victim.
Nowadays, I personally recommend that the patient become her or
his own advocate in her or his relationship with the physician.
I hope to provide some tips to improve this relationship to seek
the ultimate endpoint of a satisfied and healthy patient.
Patients deserve to know what is wrong with them and deserve to
have all their questions answered in a prompt manner. The word "doctor"
is derived from the Latin word "docere," or, "to
teach." The primary role, therefore, of a physician is to teach
his or her patient what is wrong and how to improve or fix the problem.
It is said that the three major complaints that patients have about
their doctors are that:
- My doctor is always late.
- My doctor does not spend enough time with me.
- My doctor does not listen to me.
Perhaps you should anticipate these three areas and be prepared
to deal with them individually or change doctors if you cannot find
one who meets these needs.
Doctors, especially primary care doctors who work in large clinics,
are often forced to see large numbers of patients per day. The amount
of time you need might not fit into the doctor's schedule. Thyroid
diseases can often be very complicated, involving undergoing many
types of evaluations, including physical examinations, blood tests,
nuclear tests, ultrasounds, and biopsies, and often require detailed
explanations.
Many doctors who do formal training (i.e., residencies)
in either family practice, general practice, or internal medicine
do not spend much time in the Endocrinology Department. In addition,
most patients with thyroid problems do not have to enter the hospital
for anything except thyroid surgery, so young doctors who have learned
mostly from hospital experience often have not had much experience
in diagnosing or treating thyroid problems.
If you sense that you are not getting your questions answered,
your doctor seems defensive in answering your questions, defers
the answers to her staff, does not supply you with written material
when you ask for it, does not know what websites contain the most
reliable patient information, gives advice that seems farfetched
or confusing, perhaps it is time to seek consultation with a specialist.
This is always a very delicate and sensitive issue, but sometimes
patients just have to yell and scream loud enough to be heard.
I personally advocate early referral to a specialist for all forms
of hyperthyroidism, all thyroid lumps (nodules) all pregnancy-related
thyroid problems, all cases of thyroid tumors, and any time the
thyroid blood tests are confusing. Specialists (i.e., endocrinologists
or thyroidologists) should be able to do all of the above. The specialist
should have the time and experience to answer all your questions,
explain to your understanding even the most complicated thyroid
problems, be able to aranged the best place for your diagnostic
tests, hospitalization, lab testing, and surgeon if you need thyroid
surgery (within the limitations of your insurance company). He or
she should provide you with written material, recommend support
groups (like the TFA), inform you about websites, and make notes
for you to explain to your family at home. You are entitled to all
of this.
In addition, I feel that your doctor should help you make decisions.
You come to your doctor to understand what is wrong, be tested (but
not too much), and to feel better. Your doctor should keep up on
all the latest developments in the field. Your doctor should provide
for you the treatment options, where they exist, but should not
turn to you to make a decision without your being properly informed.
It is my personal feeling, that patients come
to medical doctors for advice on what to do. Doctors should be expected
to provide guidance to the proper decision, not leave it to the
patient to decide alone.
How Often Should You Be Seen?
It is hard to predict how often thyroid patients need to be seen
by an endocrinologist. Certainly, it depends on the activity of
the disease, whether the problem was newly discovered, partially
treated, or recurrent. The frequency may depend upon the age of
the patient, as well as how compliant the patient is. A rough guide
might be:
Hypothyroidism:
- Initially to establish the diagnosis
- First follow-up visit in 1-3 weeks to review the test results
- Follow-up visits every 6-8 weeks until the TSH is normalized
- Follow-up visit in 6 months
- Follow-up visit yearly thereafter
Hyperthyroidism (Graves' disease):
- Initially to establish the diagnosis
- First follow-up visit in 1-3 weeks to review the test results
- If radioactive iodine is used, treatment at the next visit
in either the doctor's office or at the nuclear medicine facility
of the medical center or diagnostic center
- Follow-up monthly (for first 6 months) or until hypothyroidism
is discovered
- Follow recommendations for hypothyroidism, above
- If anti-thyroid drugs are used, follow-up every 1-2 months
for the duration of the anti-thyroid drug treatment
Thyroid Nodule:
- Initially to establish the diagnosis
- First follow-up visit in 1-3 weeks to review the test results
- If surgery is recommended, follow-up within one month after
surgery
- If no surgery, and thryoid hormone suppression
is used, then follow-up visits every 3-6 months for the first
3 years, then yearly thereafter
What Should Your Doctor Expect From You?
Please be on time for the visit, or call if you know you are going
to be late, to see if rescheduling is appropriate. If you must have
an authorization number or form before you can see the specialist,
make sure that the specialist has this paper, or you should stop
by your primary care physician's office to pick it up.
If you are supposed to be on medications, please take them at the
proper time every day. They are for your own good. If you are not
so good at taking medicine, please inform your doctor. Sometimes
the strength of a drug is readjusted based on the assumption that
you are compliant. If you do have a problem remembering to take
the pills, perhaps a simpler schedule can be arranged.
If you have a lot of questions, please write them down on a list
and have it ready for the doctor when she or he enters the examination
room. Sometimes seeing the list makes it easier for the doctor to
answer the questions.
If you become sick, require an operation, or other members of your
family are concerned about you and want to speak to the doctor,
please designate one family member to be the spokesperson for the
family. Try not to make the doctor have to go over the same explanations
and facts on several occasions. If possible, try to have someone
at the patient's bedside when the doctor makes rounds, if the questions
are about a hospitalized patient.
Cooperate with your physician when she or he recommends a test
which cannot be done at the doctor's office and have it done promptly.
Make sure you tell the hospital or diagnostic center to send a copy
of the results to your primary doctor, and also to the specialist.
If you are seeing a specialist for the first time, try to gather
up copies of all your recent lab results and bring them with you
to your appointment. In addition, if you have had any recent thyroid
scans, sonograms, or CAT scans, please bring the original x-ray
films with you. Call ahead to the hospital or diagnostic center.
They should release them to you.
Please learn as much as possible about your thyroid disorder, because
the more informed you are, the easier you can be treated.
Patients, nowadays, deserve to be better informed than they used
to be. There are many resources available (including the TFA). But
use the resource most easily available and the one that you need
to trust the most - your doctor. In turn, cooperate with the doctor
so that you can return to good health as quickly as possible.
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