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Dear Doctor

A Letter Thyroid Patients Would Like to Send and Thyroid Doctors Need to Read

By

Updated June 19, 2012

Dear Doctor

It can be a challenge to find smart, competent doctors for thyroid care.

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As thyroid patients, it’s no secret to us that it can be a challenge to find smart, competent thyroid doctors who can be our partners in the search for solutions. Here’s the “Dear Doctor” letter that many patients wish they could send to their doctors, and that many doctors clearly need to read.

Dear Doctor,

As a thyroid patient, I am grateful to have you as my physician, and look forward to a productive and successful relationship. And I’m hoping that you we will have an effective partnership. But as far as doctors, I need to be honest. I’ve been burned in the past. And so I’m hoping that this letter will outline some of the concerns I’ve faced, so that we can avoid it in our interactions.

First, please take a moment to review my file before my appointment. There is nothing worse than having you ask the same questions that I’ve answered many times before, or having to tell you what I’m being treated for, because you can’t remember. I know you see many people each day, but at least skim my file so that you remember who I am and what I’m here for.

Next, please don’t keep me waiting for a long time. I know you’re busy, but so am I. And while I understand that emergencies do come up, if I have to consistently wait a long time after my scheduled appointment time with you, it’s a sign that you’re both disorganized and disrespectful. At least have your staff keep me informed about the wait time, and have the decency to apologize when we start our appointment. Even better, your staff can call me ahead of time and let me know you’re running late, so I can arrive later, and not waste my time sitting around reading four year old copies of Field and Stream! (And while we’re at it, keep a good supply of decent, current magazines on hand...please!)

Please take the time to actually talk with me, and listen to me. I know you’re busy, but I’m a customer, the client, the one who is paying for your service. I deserve a few minutes of uninterrupted attention. That means, please don’t be looking at your phone, sending texts, typing on a computer, popping out for phone calls, or reading while I’m having an appointment with you.

Please don’t talk down to me, or act arrogant. I’m a smart, empowered patient. I do my homework. And I’m capable of understanding complex information. It doesn’t help if you act condescending, or talk to me as if I’m a child.

If I bring up something I’ve learned on the Internet, please don’t immediately dismiss it. There are many valuable and reliable sources of information on the Internet, including all the major medical journals, and the National Library of Medicine. Everything on the Internet is not “foolish quackery.”

If I bring up a symptom or concern, please don’t automatically tell me that the problem is age, not enough sleep, eating too much, a "mental problem," or not enough exercise, and fail to explore the real medical causes. And if I complain about gaining weight, please don’t tell me I have “Fork in Mouth Disease,” or that my Graves’ disease symptoms are “like being in love.” You may think you’re funny, but honestly, you’re not.

It’s important that I hear back from you and your office in a timely manner. If I call, I expect to hear back within a certain amount of time. You get to set the policy regarding what that timeframe is -- by the end of the day, within 24 hours, 48 hours, 3 working days, whatever -- but whatever your policy is, please make me aware of it, and then stick to it. There is nothing more frustrating than calling and leaving a message, and never getting a call back.

If I request a test for a particular condition, please don’t dismiss me with “You don’t have that condition,” and refuse to order the test. At least give me a rational explanation, so I can make a reasonable decision going forward.

If you won’t approve medication refills without a visit, please let me know from the start. It’s very frustrating to realize that I’m running out of medicine, call for a refill, and be told that I need to make an appointment. Worse yet, if you do have that policy, then please do your best to fit me in quickly. Because if your policy is no refills without appointments, and I’m running out of medication, an appointment in three months is not going to be of much help to me.

Please hire good office staff, and pay them well. There is nothing worse than unresponsive, disorganized, or rude staff, who mix up the files, send the wrong bills, confuse appointments, and act as if I’m a nuisance simply for showing up for an appointment. (And please make sure your staff members understand the HIPAA regulations. I really don’t want to hear them making fun of another patient by name while I’m sitting in the waiting room, because I know that when I’m not there, they are probably doing the same thing to me!)

If you recommend vitamins, supplements, or books, and want to sell them in your office, that’s great, and can be very convenient. But don’t mark them up so that it’s obvious that you are charging far more than I’d pay anywhere else. It makes you look opportunistic and greedy.

If you offer blood tests or imaging tests -- like ultrasounds, CT scans, or TSH tests -- in your office, that’s terrific. But please don’t use it as an opportunity to pad my bill with unnecessary tests and hefty markups. Everyone who walks through your door does not need a pricey ultrasound...and word gets around.

If you do thyroid blood tests in your office, that’s helpful and convenient, but if you’re running a cash practice, please don’t mark up the tests so much as to make them completely unaffordable. And if I have an insurance plan that covers blood work, please be willing to give me a lab slip and get the blood work done somewhere my insurance covers. I’m willing to pay out of pocket to see you, but requiring me to have the lab work done with you -- at marked up prices and without my insurance coverage -- is inhumane in today’s economy.

If you want to display drug company swag -- i.e., mousepads, pens, pencils, prescription pads, calendars, mugs, patient information literature, wall charts and posters, plastic thyroid glands, and other paraphernalia with drug company logos -- I will have to assume that you are beholden in some way to that particular drug or drug company. Even the medical journals have shown that a doctor who gets a mug from a drug rep views that drug more favorably.

Please keep an open mind, and understand that when it comes to thyroid disease, no matter what you’ve been taught, one size does not fit all. The TSH test doesn’t accurately diagnose everyone. Levothyroxine is not the cure-all for all hypothyroid patients. Everyone with Graves’ doesn’t need radioactive iodine tomorrow. Practice the art of medicine, and remember that I am a patient, and not a lab value.

This is especially important...since you are treating thyroid patients; make sure you’re knowledgeable about thyroid diagnosis, symptoms, and treatments. Read the journals. Talk to colleagues from a cross-section of disciplines -- including integrative and conventional practitioners. And whatever you do, don’t tell me outright misinformation or utter nonsense, like hair loss has nothing to do with the thyroid. Or that natural desiccated thyroid is dangerous, made from cows, and going off the market. Or that no one will feel symptom unless the TSH level is above 10. Or that thyroid patients are suffering from psychosomatic symptoms.

Finally, if you don’t know the answer, please tell me that you don’t know the answer, and that you’ll find out. I can respect that. And it’s an honest response. What I can’t respect is if you make something up, dodge the question, or dismiss it as irrelevant.

Sincerely,

Your Thyroid Patient

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  5. Dear Doctor: A Letter Thyroid Patients Would Send to Doctors, Outlining Typical Complaints in the Patient-Doctor Relationship

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