Your Tips on How to Get Off to the Best Start with a New Specialist

I'm looking for your best tips.
Starting a relationship with a new specialist can be daunting. You want to get off to a good start and ensure that you establish mutual respect and are able to develop trust. You want to know you're in good hands. What is their expertise and experience? What research are they doing? Will they listen and consider your input?

How do you get off to the best start with a new provider? What suggestions would you tell a friend who is going to see a new doctor?

Your tips in action:
Tips shared in the discussion below made this video. It's great advice: For patients by patients.

@jenniferhunter

@colleenyoung that's a good article. I saw 5 spine surgeons prior to coming to Mayo who would not help me. It was too easy for them to dismiss me and bring up a differential diagnosis of a possible disease instead of the symptoms caused by an old spine injury. Why? Because I had unusual symptoms and I also had overlapping symptoms from thoracic outlet syndrome causing nerve compression in my chest. They only expected me to have arm pain from the level of my disc problem, and I had pain everywhere. I had mapped that out on a dermatome map of the body and how it changed over time. This is a map of the specific areas that all the spine nerve roots supply from where it exits the spine. That worked against me when a surgeon suggested I might have an inflammatory problem like MS because of pain points in every single dermatome segment. I knew that I could change where the pain was in my body by changing the position of my neck, but he just dismissed my comment. He didn't want to take a chance on me and possibly lower his ratings of success because he didn't know how to connect my symptoms with my imaging. Insurance companies use these statistics to rate providers, and patients review doctors online. He is the respected co director of spine surgery at a university medical center and medical school.

I found medical literature with cases similar to mine, and none of my other doctors at that institution would point out this mistake to the director of spine surgery who was the surgeon who saw me. I didn't think he would listen to me if I sent him the literature. I actually found the literature because I read papers from a Mayo surgeon, and I looked up a term I didn't understand. That found the case study, so I wrote a personal letter to this Mayo neurosurgeon and sent that case study with my letter saying that I have similar symptoms along with my imaging, and I had requested that he review my imaging. A month later, I was given an appointment with this surgeon, and he offered to help me.

I thought I would have to plead for help, and I brought one of my paintings with me when I met the surgeon so he would understand what I did for a living and why I needed his help. That was the beginning of a great relationship, and he like my painting. I would bring my new paintings with me to followup appointments during my recovery, and he always wanted to see them. I had worked previously in research for a neuroanatomy professor, and I did the processing of tissues for the microscope, and I had also done some scientific drawings that were published in neuroscience journals. I brought a copy of this study to an appointment, and watched my surgeon's face light up when I showed it to him. He wanted to read the research study about the development of the visual system and how nerves are mapped from the eyes to the vision centers in the brain. It's also because of my prior experience that I looked to research and doctors associated with research as a better place for me to find the help I needed. As people, we are intrigued by new information, and it gets attention, and if you show a brain surgeon a study about the development of the brain, you're feeding his interest.

I kind of think of this a job interview for both parties. As a patient, I need to stand out as someone that needs help and can be helped successfully, and as someone who will cooperate and follow directions. I am also interviewing a doctor to see if I can trust them, and if their area of interest closely matches my needs, and my impression of the capabilities of the doctor. I know I'm not really qualified to make that call, but the doctor needs to explain enough about my case so I trust his qualifications and answer my questions.

If a surgeon thinks a patient will not appreciate their help, they are less likely to help the patient. I watched a video online and heard the same surgeon "director" who missed my diagnosis recommend to other neurosurgeons at a conference, that the time to say no to surgery is if the patient has mental issues. He said you can do the best surgery in the world and they won't appreciate it. I was a little shocked and I wondered if that had been part of why he didn't help me. I wondered if he didn't believe my symptoms were real. His nurse had repeatedly discredited what I reported to her, and she had refused to make some followup appointments for me. My neurologist at that institution had even stepped in and scheduled both an MRI and a followup with another surgeon who was a partner. His notes stated that he didn't know why I had the symptoms, and a month later, he took a job at a different hospital. At the last visit to the "director," he commented that he hoped the "partner" didn't just read and copy his notes about my case, and I could tell he was distracted and a bit irritated, and that comment should not have been made to a patient. I didn't let on that I knew and my neurologist had explained as she was just trying to help me get help. She told me where I could find the partner if I wanted to see him again.

I think one of the mistakes I made was to talk about things with correct medical terminology. The internet is a great place to find information, and then the patient can argue with the doctor about the diagnosis. I really was telling the truth, but because the doctor didn't understand my symptoms, it may have discredited me. I think it would also be pretty embarrassing for a patient to get the diagnosis right and the head of spine surgery misses it completely. The doctor has spent years in training and it's their job to diagnose, and the director had made a comment like that the first time I met him. When I met my surgeon at Mayo and the neurologist, I tried to describe things without using medical terms because I didn't know how that would be received. It may not have mattered, and my Mayo surgeon told me he wanted to explain my imaging to me even though I'd probably heard that before, so he did acknowledge that I had knowledge about my condition. He also told me I was the first patient that came to him because of his paper that I found. I guess that's novel too.

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@jenniferhunter @colleenyoung
Brava, Jennifer! I can sooo relate to your (frustrating, disconcerting) journey. Over the years, I decided that medical professionals are not gods and need to be regarded like any other professional — that there are good and bad apples, political ones (climbing the department ladder), compassionate (but not necessarily knowledgeable) ones, diagnostically intuitive (and not necessarily congenial) ones, ones who are driven by hidden agendas (viewing patients as potential research subjects or guinea pigs for practicing a new surgical technique, and not as individuals), ones who are potentially burned-out and marking time, ones who are arrogant by nature, ones who may love but don't like women, ones who didn't sleep well the night before, on and on. If you're lucky (and luck has a lot to do with it), you will come across someone who meets at least some of your wants on a personal level, and needs on a professional level. The Law of Large Numbers tells us one must be tenacious in our pursuit of a resolution.

I think people may need to be careful with mentioning the internet… some doctors immediately become defensive and dismissive and focus on attacking "internet medicine," ignoring the implications of a study because many published studies are questionable, out-dated, not peer-reviewed, funded by sources with financial interests, etc. (Finding meta-analyses are more difficult for them to dismiss. Also, mentioning your source as being from a well-known institution (Mayo, Cleveland Clinic, UCSF Medical, Fred Hutchison Cancer Research Center, etc.) gets their attention; or noting that "you have come across a study" might sometimes works. Presumably, it could have been from another medical professional….)

Most patients are not going to have the talents or educations to engage directly with a doctor's interests. Keeping a sense of humor (even when in pain), however, is common ground for most people. (I'm told that, during a past surgery, my anesthesia had not fully kicked in when I had been placed on the narrow surgical table, and that I went into an entire comedy routine with the surgeon, the anesthesiologist, and OR nurses as to whether the table made my ass look too big, etc.) Post-surgery, the surgeon had a totally different demeanor with me. A good (self-deprecating) sense of humor bridges many personality gaps.

And lastly, there is a huge amount of medical information out there and it changes by the minute. Mere mortals (specialists) cannot be expected to keep up with it all. Professionals, in general, do not want to be perceived as lacking knowledge. Be a compassionate patient and appreciate that. If you've done your homework, you likely have a number of things in mind. Ask if the provider has considered such-and-such. The mention of something new to the discussion may ring a bell… make them personally curious to pursue it or a related angle… reorder their thinking… or not. At the conclusion of an unsatisfactory visit, one which does not appear to be going anywhere for you, do not hesitate to ask for that person's recommendation on what to do or who to see next. It may not help, but it can't hurt to have additional resources to add to your "next steps" list.

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@colleenyoung

These are all great tips in how to prepare for a visit. I'd like to dig a bit deeper. How do you develop rapport with a new doctor?

Coincidentally, I came across this article today.
Getting Your Doctor to Really See You https://thedoctorweighsin.com/getting-your-doctor-to-really-see-you/

It provides strategies about how you can, as a patient, get your doctor to engage with you as a person. It is divided into 3 parts:
– Individual flair can ignite conversation
– Appeal to the physician as both scientist and healer
– Let technology pave the path

How do you present yourself to your doctor to establish the kind of relationship you want?

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@colleenyoung there’s some really good input here and from the previous responders.

On my first visit with my current PCP in 2014 we knew I was having problems but it took a very long time – too long- to finally get a diagnosis, and my neurologist was the first person who suspected there was a liver problem. .

On that first appointment I felt comfortable with my PCP and he even brought me into his office to show me a picture of his children that was on the wall. Obviously I had mentioned my two so that was a common theme. Being able to get a little personal with him surprised me because when I was researching to find a new doctor I had three candidates and two other doctors said he was very good but very impersonal. At this point I have concluded that he may be different with other doctors than he is with his patients.

The fact that he did not diagnose my cirrhosis bothered me for a very long time. It didn’t bother me immediately but when I discovered how many symptoms I had that were indicative of cirrhosis it did, and I think my rapport with him suffered due to these feelings.

Time has passed though and I think I am in a good place with him now. I think many patients are stiff with doctors, treating them like Gods, but I am pretty much myself, and even try to crack a joke or two occasionally.

I do feel that the current culture of doctors and hospitals, being that the doctors do not have private practices, makes doctors sort of “company men (or woman)” and that sometimes they forget that the patient should be their primary concern, not making unnecessary appointments to make more money for the hospital. I realize I often tend to be cynical but I know that the hospital here does encourage doctors to make appointments that are sometimes unnecessary.

I know, I am a bit off-topic here, but it is somewhat related..
JK

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I think that it's a good idea to plan your visit by writing down questions, as you think of them, then making a list from the most important questions to the least important questions. Type the list, making two copies, one for you and one for the specialist. You get a limited amount of time, so don't bring up things that are irrelevant to the specific concerns you have for the specialist. Be brief, be blunt. By planning ahead, I can cram in a lot into a short visit. And these days, the visits are getting shorter and shorter.

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@tim1028

I think that it's a good idea to plan your visit by writing down questions, as you think of them, then making a list from the most important questions to the least important questions. Type the list, making two copies, one for you and one for the specialist. You get a limited amount of time, so don't bring up things that are irrelevant to the specific concerns you have for the specialist. Be brief, be blunt. By planning ahead, I can cram in a lot into a short visit. And these days, the visits are getting shorter and shorter.

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@tim1028 Couldn't agree more.

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@hedjhog

These are all great. I include caffeine use and vitamins. Maybe since the folks I see are because of a TBI, I bring a plate of gingered cinnamon crinkles – always puts the staff in a positive mood.

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Welcome @hedjhog. My uncle swears his chocolate chip cookies get him the best care. It sure helps the staff remember him.
I'd also like to invite you to this discussion group on Connect:
– Adult Life after a Traumatic Brain Injury (TBI) https://connect.mayoclinic.org/discussion/adult-life-after-a-tbi/
I hope you'll hop on over and share your experience and status.

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@tim1028

I think that it's a good idea to plan your visit by writing down questions, as you think of them, then making a list from the most important questions to the least important questions. Type the list, making two copies, one for you and one for the specialist. You get a limited amount of time, so don't bring up things that are irrelevant to the specific concerns you have for the specialist. Be brief, be blunt. By planning ahead, I can cram in a lot into a short visit. And these days, the visits are getting shorter and shorter.

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tim1028, I also like to write down my questions. I also keep a list and I add to it between appointments.
I agree with the benefit of a typed or neatly written list for the specialist. On a first visit to a cardiologist, I also had my list that the nurse gave to the doctor before he came to see me., To my surprise, he had already read all my questions before he came into the room. He was able to work them into our conversation.

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@colleenyoung

Welcome @hedjhog. My uncle swears his chocolate chip cookies get him the best care. It sure helps the staff remember him.
I'd also like to invite you to this discussion group on Connect:
– Adult Life after a Traumatic Brain Injury (TBI) https://connect.mayoclinic.org/discussion/adult-life-after-a-tbi/
I hope you'll hop on over and share your experience and status.

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@colleenyoung I have brought baked goodies to my doctor’s office at holiday time, and very nice bottles of wine for him.
JK

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@rosemarya

tim1028, I also like to write down my questions. I also keep a list and I add to it between appointments.
I agree with the benefit of a typed or neatly written list for the specialist. On a first visit to a cardiologist, I also had my list that the nurse gave to the doctor before he came to see me., To my surprise, he had already read all my questions before he came into the room. He was able to work them into our conversation.

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@rosemarya now, that’s a good doctor.
JK

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I have learned, that there is a line between Patient and Physician professionalism. I would not advocate bringing anything to any Physician; as it's not really appropriate! I have a friend who brings her Physician presents for his birthday, holidays, etcetera, and she thinks it's appropriate ,and that she deserves some reward! I just wouldn't cross that fine line; however, everyone has their own opinions and makes their own decisions about what they feel is right for themselves! I wish you the best in making your own decision in this matter! I didn't mean to persuade, or discourage your own decision I was honestly offering my best and honest opinion!
I hope this somehow helps you in making the best decision for yourself! Let me know how everything works out! I do however, bring my Physicians a complete list of questions and symptoms to every visit; so I can give my Physicians an idea of what has been happening with me since my last visit!

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@contentandwell

@colleenyoung I have brought baked goodies to my doctor’s office at holiday time, and very nice bottles of wine for him.
JK

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@contentandwell @colleenyoung

Probably.

Have you asked yourself what your motivation is for giving your doctor a somewhat extravagant gift? If it is being given because YOU are grateful for good service, perhaps a handwritten note of gratitude is better. One normally does not acknowledge the other's gratitude with gratitude. If the recipient is questioning your motive, that's another reason why you may not be receiving an acknowledgement. If the physician has a personal policy behind not acknowledging gifts (s/he wants to avoid the appearance of a conflict-of-interest, like favoring a patient in the eyes of staff), your doctor may be giving such things away to staff. It would be similar with gifts from pharmaceutical or medical device representatives… avoiding the appearance of a conflict-of-interest.

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@rachelanne

I have learned, that there is a line between Patient and Physician professionalism. I would not advocate bringing anything to any Physician; as it's not really appropriate! I have a friend who brings her Physician presents for his birthday, holidays, etcetera, and she thinks it's appropriate ,and that she deserves some reward! I just wouldn't cross that fine line; however, everyone has their own opinions and makes their own decisions about what they feel is right for themselves! I wish you the best in making your own decision in this matter! I didn't mean to persuade, or discourage your own decision I was honestly offering my best and honest opinion!
I hope this somehow helps you in making the best decision for yourself! Let me know how everything works out! I do however, bring my Physicians a complete list of questions and symptoms to every visit; so I can give my Physicians an idea of what has been happening with me since my last visit!

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@rachelanne Hi, I presume this is in response to my post. I have a number of physician friends who always get many gifts from patients so it did seem appropriate, particularly when he was going out of his way to be helpful. Some of the gifts that I have known them to get are quite costly too. I consider my gifts to be token type of gifts.
JK

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@elizm

@contentandwell @colleenyoung

Probably.

Have you asked yourself what your motivation is for giving your doctor a somewhat extravagant gift? If it is being given because YOU are grateful for good service, perhaps a handwritten note of gratitude is better. One normally does not acknowledge the other's gratitude with gratitude. If the recipient is questioning your motive, that's another reason why you may not be receiving an acknowledgement. If the physician has a personal policy behind not acknowledging gifts (s/he wants to avoid the appearance of a conflict-of-interest, like favoring a patient in the eyes of staff), your doctor may be giving such things away to staff. It would be similar with gifts from pharmaceutical or medical device representatives… avoiding the appearance of a conflict-of-interest.

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@elizm
I know of no physicians who do not accept holiday gifts. I appreciate the responses though.
JK

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