When my physician finally came in the next day, I told him I wanted to go home. He said that I couldn’t because he wanted me to stay another night. I then informed him that I would go without his permission to which he said if I went without permission my insurance would not cover the stay or treatment. As he was leaving I told him he was only covering himself. He turned around, pointed his finger in my face and said “ABSOLUTELY”!

Later that day a social worker came to see me which is routine in my hospital. I mentioned the doctor’s behavior and what he said me and she responded “He knows better than that”.

When I was finally allowed to leave, I went home and called Medicare and my co-insurance. Both told me that what I had been told was not true; they would have covered the care up to the point I left, even if I left without physician approval.

When I went for a follow-up in his office, he opened the exam room door and immediately said “You are the hard headest patient I have ever had”.

I don’t see how I can continue seeing this doctor. I thought his pointing his finger in my face was not only impolite but also unethical.

DEAR READER:
The social worker who saw you in hospital was absolutely correct. The doctor does know better than to behave that way. He should also know that Medicare and other insurance will cover hospital care even if the patient leaves “against medical advice” (AMA).

Patients are free to leave hospital whenever they choose, but if they leave AMA they are required to sign a form telling them of the potential risks they are taking and that should any adverse events occur because of their premature leaving, all hospital personnel involved in the care and the hospital as a whole are not responsible.

Your physician was out of line for his behavior. It is common practice for physicians to cover themselves, especially in cases of suspected strokes and heart attacks; however, your physician went about the entire situation incorrectly. He should have expressed his concerns and given reasons why he thought you needed one more night of observation.

I have said it before, physicians are not gods, and their word is not infallible. Patients must take responsibility for their own health. Doctors should give options, explain the benefits and consequences of those options and then allow patients to make up their own minds.

If you feel you are not receiving proper care from your physician, by all means switch. There is no law stating you have to stay with one primary care physician for the rest of your life. Ask around, talk to your friends, family, even the hospital or local nursing services for their opinions of physicians in the area. Make get acquainted appointments with a few to see if you can find one with whom you feel comfortable. When you have found one, tell your physician to transfer your medical records to the new doctor.

My doctor said surgery is not an option. I can’t determine if his decision is because of the cost involved, or for other reasons. I’m on disability and have a very limited income. If I had surgery, I would have to depend on Social Services to help with the expenses. It may be that they have already refused my doctor’s request, and I don’t know how to find this out. Would it be a good idea to get another opinion? Do you have any advice for me?

DEAR READER:
I must begin by indicating I am a primary care physician, not a radiologist. To the untrained eye, the CD you sent only covers the lumbar/sacral spine and, in my opinion, is abnormal.

Without knowing all the circumstances, I cannot determine why your doctor stated surgery is not an option. Do you have other medical conditions that would have a bearing on the outcome of the procedure? As I have said repeatedly, the benefits must outweigh the risks. If your doctor feels you could end up in worse shape than you now are, then he is justified in his decision.

Could insurance be the issue? Whether your coverage is through disability or you have the best plan money can buy, you are entitled to proper medical care. The surgeon will be paid according to regulated state standards and will make up any perceived lost funds on other carriers that might pay higher rates. It has been my position to advise insurance companies of recommended procedures and state my reasons based on the patient’s physical condition. If quality of life is an issue, it must be addressed and managed appropriately — regardless of cost. I can confirm that I have had to make repeated requests to carriers when I have been rejected. They don’t want exorbitant bills (despite the fact it’s cheaper to provide necessary surgery than to provide several types of narcotics every month for years), but a doctor doesn’t want to see his patient in constant pain either.

Begin by making an appointment with your primary care physician. Write down all unanswered questions, beginning with why surgery isn’t an option. Take a friend with you who can maintain an objective view. If you are still dissatisfied after the visit, get a second opinion. Request pertinent information be made available to the new doctor. If he or she agrees with your primary care physician and is justified in view of the details provided, then you should probably back off. If not, put yourself in the hands of the new doctor and make a permanent change. Good luck.

To give you related information, I am sending you a copy of my Health Report “Choosing a Physician”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Do you think it has to do with the type of insurance a patient has?

DEAR READER:
Yes and no. Oddly enough, many of my questions come from readers who are either afraid or too embarrassed to ask them of their primary care physicians. Or, as is often the case, they have asked time and time again, to no avail.

Doctors can have a bad hair day, as can anyone. A visit you’ve waited days or weeks for with great anticipation turns out to be a waste of time and you know less than when you got to the doctor‘s office. When this occurs, perhaps it is time to clear the table, ask straightforward questions and request straightforward answers. Tell your physician if you are dissatisfied with the visit and need more appropriate responses. If you have attempted this approach and you are still unhappy, request a referral to another physician or specialist who can take the time to work with you, and order appropriate testing.

You are correct that older people often appear to be misdiagnosed or are not listened to by some doctors. Fortunately, some physicians limit their practices to geriatric patients. When a senior doesn’t get a fair shake, can’t be understood, or is simply confused about medications, perhaps a change to a geriatric specialist is appropriate. In this instance, don’t be afraid or embarrassed to ask for a referral to such a specialist. Health is an important issue and should be addressed successfully.

Insurance and managed benefit programs are often a major consideration for people of any age. A patient might demand to know everything, but refuses to undergo any testing, or in the case of managed benefits, might be restricted in what testing can or cannot be performed. When these issues occur, a physician is put on the spot and must gather all his or her diagnostic skills to make an appropriate decision and recommend treatment based solely on symptoms and a history given by the patient. Hopefully, for both the patient and the doctor, the choices are correct.

To give you related information, I am sending you a copy of my Health Report “Choosing a Physician”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I am a 75-year-old male in fairly good health. For the last three months, my right nipple has been very sore. Some days are worse than others. When I told my doctor about it, he said it is from the beer I drink. When I asked about the possibility of cancer, he said I didn’t have cancer because I didn’t have a lump.

Dr. Gott, I don’t think this is caused by beer. I drink about three days a week when I go to the local VFW and I only consume light beer. I don’t drink alcohol at home. My doctor claims it’s only caused by the beer and hasn’t given me any other possible cause.

I’m worried about this since it is only on one side and (to me) doesn’t appear to be related to alcohol.

DEAR READER:
As I have written before, men can develop breast cancer, especially if there is a strong family history of breast cancer, such as in your mother, sister, grandmother or aunt. It is especially worrisome if you have another male relative who was diagnosed with breast cancer. Because you do not give a family history, I do not know if there may be a genetic relation. Symptoms can include nipple discharge, a lump, swelling, tenderness and pain. Just because you do not have a palpable lump does not rule out cancer. I urge you to make an appointment with an internist (a diagnostic specialist) who can perform a breast exam and order appropriate testing such as a chest X-ray, mammogram or breast ultrasound. He or she may choose to order a CT scan or MRI which can provide more detailed images.

If your doctor is dismissing your fears without proper testing and examination, you should find another physician. I hope, for both your and your doctor’s sakes, that the cause of your breast pain is benign. The time wasted by your current physician in getting you proper testing could make the difference in detecting disease in its early stages and necessitating minor treatment and finding advanced disease that needs extensive and powerful medications and possibly surgery.

It is ALWAYS important to follow-up on a patient’s health concerns, even if they are something the doctor feels are minor. It is the doctor’s job to make the patient feel comfortable and that includes answering any questions. Your doctor has completely failed you in this respect. You need to find a physician who is kind, respectful and willing to sit down to discuss health concerns with you. Good luck. Don’t delay any longer in getting the testing you need.

To give you related information, I am sending you copies of my Health Reports “Breast Cancer and Disorders” and “Choosing a Physician”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).