Thoughtful Thursday: Characteristics

February 21, 2013

Thoughtful ThursdayYou may have seen a news story this week about a lawsuit in Michigan in which a nurse is suing her hospital for allowing a NICU patient’s father to dictate that no Black nurses care for his baby. Strongblonde and I have been talking about this off-blog, since it’s her neck of the woods as well as her profession (nursing, not white supremacy).

Obviously we both object to the racial prohibition in this case, along with the rationale. However, we’ve both made choices of health care providers based on the providers’ characteristics. Depending on the situation, sometimes I have no preference and sometimes I have a strong preference.

Sometimes I’m put off by very young providers — not enough experience — and sometimes I’m not a fan of very old providers — unsteady hands, and perhaps not up to date on the latest science. As someone who recently moved to a new city, I have also purposely avoided old doctors because I don’t want to lose them to retirement almost immediately.

Sometimes I check where physicians went to medical school and residency, as a proxy (imperfect though it may be) for intelligence.

Sometimes personality also impacts my preferences. One of the dentists at my new practice is quite popular, but I will not be switching over to him based on what I can overhear across the hall: he is such a chatty Cathy. Friendly and personable, but he talks nonstop during people’s cleanings and procedures. For a different kind of doctor I might not mind, but at the dentist I am not interested in extended chit-chat with someone’s hands in my mouth.

I make choices when I’m choosing a doctor ahead of time. When assigned to someone, as I have been in the hospital or with other staff in a doctor’s office, I’ve never refused a provider. I’ve requested someone I liked better when making a return appointment, sure. But I’ve never refused, even when I actively disliked someone. Like the midwife whose cutesy schtick involved blaming pregnant women for premature labor. Ha ha. Hilarious. Even then, I accepted my fate. I was not friendly, but I didn’t demand a switch.

A friend of mine chose a hospital specifically because it was not a teaching hospital, and therefore she would not have to deal with medical students. However, the hospital did have nursing students. After the birth of her baby, a nursing student stuck herself then my friend with the same needle. After that, and the ensuing need to test for HIV etc., my friend banished all nursing students from her room for the rest of the hospitalization. Because of the incident, and because my friend had Dr. before her own name, the hospital respected her wishes, but I wonder if they would obey if a patient just walked in and said, “No students! I don’t like ’em!”

Bringing it back to the news story, a deceased relative who was a Holocaust survivor used to refuse doctors who came from Germany or had German lineage. No one ever seemed to have a problem with that. The two cases are similar in practice but very different in rationale. I wonder, though, where we draw the line: when is it okay to object on the basis of personal characteristics, and when it it wrong? I really have no idea.

Do you ever choose health care providers on the basis of personal characteristics? Have you ever refused to have a certain kind of provider?

12 Responses to “Thoughtful Thursday: Characteristics”

  1. Sara Says:

    For the most part, I am utterly indifferent when it comes to health care providers. I will take whoever is assigned to me, or to Gwen, and not have any problems. There was one time in college when after 2-3 visits I asked if I could see a different ob/gyn, but that was because the one I had been assigned was just not someone I was comfortable discussing birth-control reactions with.

    I totally understand about your dentist choice, though. I always feel obliged to respond to conversation overtures, and that’s really hard to do with a bunch of tools in your mouth. I much prefer dentists who just do their thing. One of the best dental visits that I ever had was about an hour after returning to Amsterdam from Sydney, so I was both terribly jet lagged and terribly tired, I told the hygienist this, and she didn’t mind at all that I got into the chair, closed my eyes, and promptly started dozing.

  2. Mina Says:

    I can’t remember not trusting a doctor I ever came in contact with. All my dealings with medical personnel start with me trusting them to be able to help me. So far I have been lucky to have only competent doctors. I never refuse medical students, because they need to learn. I don’t think I am able to refuse anyone actually. Unless something is obviously very wrong. Which hasn’t been the case.
    I did choose my gyno because she was a woman, but the fact that I knew her waiting room was well stocked with chocolates and current issues of foreign magazines was equally decisive. Does that count as a yes to your first question? 🙂

  3. celiadelia Says:

    I refuse drs with heavy accents, I don’t care how good they are. I don’t have anything against foreigners, but if you very hard for me to understand and we are talking about a serious medical problem that’s a deal breaker.

  4. Elana Kahn Says:

    I’ve never refused a doctor, though I would feel greatly uncomfortable if a male doctor of any type were present for my births (excluding C-Section). If I were put into a position where a male doc was going to come in for my birth, I might ask to have a female so I would not feel strange. I did have male doctors check me and such when I was pregnant with the twins, and I’ve had male gyns do speculum exams and whatnot, but there’s something about the birth itself that I would rather keep with a female. Nothing against male docs, that’s just how I feel about it.

    As much as I think choosing a care provider based on racial characteristics is wrong, it’s hard for me to say “well you can’t do that but I can say I don’t want a male doctor”. Because of Israeli/Arab conflicts maybe I would feel uncomfortable having an Iraqi doctor or something like that. Or maybe a Muslim woman wouldn’t want me as her midwife because I’m Jewish. No, it’s not “right,” but it is her body and her choice to have someone she feels comfortable with taking care of her, just as it is my choice for the same. Many times it can hurt feelings to be “rejected” based on your color, religion, sex, etc, but people also have the right to feel comfortable with who they are being treated by.

    I would say, in order to make everyone as comfortable and not offended as possible, for the patient to ask a third party to switch nurses or doctors or whatever and just say that they don’t believe it would be a good fit for them and could they have another one. Any medical professional should leave it at that and find them another one without further questioning.

  5. Elana Kahn Says:

    P.S. Patients have every right to refuse student nurses (and student anything, really). So it’s not just because your friend is a doctor. Anyone can say “no students please” and they are not allowed to send in a student.

  6. a Says:

    I will change doctors due to personal characteristics, but it’s the difference between class characteristics (i.e. skin color) v individual characteristics (i.e. ignorant behavior) for me. There is no one class of person who has specifically offended me – individuals do, certainly, but not an entire group. That said, I can see a Holocaust survivor refusing a German doctor, but maybe by the 2nd or 3rd generation, those feelings might be diluted.

  7. strongblonde Says:

    i am still giggling about how you were sure to clarify i was not a white supremacist! haha. i’ve never come right out and refused someone….even when i KNEW they were not smart. (eg: i had to see someone in my PCPs office when I was having chest pain, i was pretty sure that it was musculoskeletal, but i wanted a visit on the books *just in case*. the only gal that was available was someone who had missed a diagnosis on me previously. because i’m in healthcare, i took the appointment. i knew that i could dictate my care and get around her ignorance. i still didn’t refuse her. after a second crappy visit, however, i did decide that i will make it a point not to see her again as she listened to my lungs over my sweater AND spine…). having said that though, i didn’t think about it until yesterday when i was discussing family medicine v. internal medicine with a group of students. in general, family med has a bad rap for being dummies. i’ve been guilty for rolling my eyes a lot when talking to family med, but it’s really not fair. likewise about where they went to school. as you may know, american docs who got their training in schools in other countries are thought of as less intelligent, too. funny thing is that one of my good friends went to school in grenada, got a competetive residency in new york, did his fellowship in michigan, and is now a leading researcher in his area. and people *still* look down on him because of where he went to med school.

    so. i think that i try to make my choices for health care on intelligence and who will give me the best care. in general, i don’t care about bedside manner for MY care, but i do for the care of my kids. so, i asked for recommendations from trusted friends for the ped. same for dentists. i asked for recommendations and, for the most part, i’ve been pretty happy. gender is secondary, but all things equal, i suppose i would prefer a female ob. but it really doesn’t matter to me.

    but then again, i KNEW the people who put in my catheter prior to surgery, people who touched my breasts as i was learning to breastfeed, people who have done surgery on me, people who have injected me with chemotherapy. 🙂 i just want the people who touch me or my family to be smart. i suppose that is what it boils down to! )

  8. St. Elsewhere Says:

    I have always wanted to be ‘touched’ by an expert- someone who knows what they are doing.

    As a teenager, I have undergone a harrowing experience with a dental student who was fiddling with my braces, under the supervision of the main doctor. The pain was horrible. The guinea pig feeling was horrible.

    I have since then decided to exercise the word – No.

    I had another bad experience when I was admitted to the hospital post C-bub’s birth. It involved a student nurse, who possibly equated me with one of the dummies they do things to. I refused to be touched by her after it.

    Age is not my primary criteria. And I have never said no to someone just because they are young.

    I have on occasion, refused to be touched by someone if they have been rude with me, or depending on how ‘in’ they are going to get. Case in point:

  9. I put more into getting the best phlebotomist than the best PCP. Such a baby I am.

    It’s so hard to suss out the best PCP of the ones in your location who are, at the time you need one, taking new patients. I do look them up, but what it comes down to is a gut feel.

    Not a fan of med students.

  10. Ana Says:

    This is a really tough one. I thankfully haven’t had too many inpatient experiences, and in the outpatient realm, you can choose your own provider for the most part. I don’t necessarily choose a provider based on any basic characteristics, but I WILL switch if we just don’t click—and I typically give them a few visits before I make that decision.
    Yes, a chatty dentist would be a reason to switch; I refused to see an NP at our OB practice who told me something flat out wrong and freaked me out for weeks & also a midwife who continuously harassed & insulted me about my pregnancy weight gain, but the “refuse” in that case was simply making appointments with different providers. One of the pediatricians in our practice makes me uncomfortable because he is constantly harping on how his wife (who works at my institution) cannot get a faculty position and seems annoyed & incredulous that I was appointed. I do not make well appointments for my kids with him anymore, but I did see him once or twice for quick sick visits—he is a competent doc and good with kids. While I thought I preferred a female gyn/OB, I picked a great male RE and also loved the guy who delivered my 2nd baby. I definitely don’t have any problems with age, race, or qualifications (where you went to school & trained). In more complicated cases I WILL prefer an MD to an NP (or midwife if pregnancy-related) just because they by default have had more training. But for something simple I really don’t mind. I just saw an NP for my gyn exam, and I’ve seen NPs at my primary care office for asthma flares. That is what they are there for—the uncomplicated routine stuff, freeing the MDs up for the complex cases. I don’t mind med students or residents—they have to train somewhere & I feel the need to pay it forwards for the many kind patients who tolerated my training years!
    I can’t imagine any reason other than total incompetence or repeated significantly rude behavior that I would refuse any provider in a hospital setting, for myself or my child. On the other hand, if a parent is simply uncomfortable with a care giver, can you actually FORCE them to accept that person? If someone didn’t want me for a provider, absolutely REFUSED to have me care for them, I would rather be re-assigned, and not have to deal with the mis-trust and stress. I think the problem in this situation is that the nurse should’ve been talked to face-to-face by a hospital supervisor re: the situation and maybe together they would’ve came to the same decision (i.e. she should not care for the baby), but the fact that it was decided without her and implemented likely made her feel marginalized and discriminated against by the HOSPITAL not to mention the parent in question.

  11. staciet Says:

    I did ask to not have two nurses work with my boys while they were in the NICU. I didn’t do so because of what they looked like, instead basing my decision on their actions when they worked with the boys, but I wonder if it can be argued that what I did really wasn’t all that different than what happened in the story. I suppose I could say that I had given the nurses a “chance” and the father in the story did not, but…I don’t know if that makes a difference. I do know that while it was uncomfortable talking to charge nurses about the two nurses, I am very glad I did. It made our already traumatic time in the NICU just a tiny bit easier to not have to deal with those women ever again.

    That being said, I have continued care with a doctor I absolutely HATE with a passion (the man is one of the biggest assholes I’ve ever met) because he is sort of the only specialist of this type in our area. I would love to find someone else to take over our case and give him a big F-You as we walked out the door, but the options are very slim. I just suck it up and pretend I am in my happy place when we are forced to see him.

  12. I think in the US that is much easier to do than here, because you can go to websites and read physicians’ bios and see their photos. No such thing here. So my choices have either been based on friend referrals (which brought me to some great doctors/dentists) or the yellow pages (not a great idea). When I came here I took a GP from the yellow pages. She referred me to a specialist twice. Both were more or less disasters. I got rid of all three of them (but not in a confronting way at all, I just went looking for other physicians and then switched).

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