20 types of doctors you should avoid (part one)
It’s been 15 years since I wrote How to Talk with Your Doctor: The Guide for Patients and Their Physicians Who Want to Reconcile and Use the Best of Conventional and Alternative Medicine. In that book, I tried to help readers navigate the fraught doctor-patient relationship.
Things haven’t gotten much better since then. Like in the dating pool, there are warning signs that forecast trouble ahead. This week and next, I’m offering my updated recommendations on how to spot problematic doctors:
1) The Gaslighter: Medical “gaslighting” occurs when healthcare professionals dismiss, minimize, or invalidate a patient’s symptoms, causing the patient to doubt their own physical or mental health experiences. “I can’t find anything wrong; maybe it’s all in your head?” is a frequent refrain.
Dismissing patients’ concerns, or causing them to doubt their own lived experiences, is a form of abuse and disempowerment. The term “gaslighting” derives from the classic 1944 movie Gaslight in which a sinister Charles Boyer plots to make his wife—portrayed by Ingrid Bergman—question her sanity so he can steal her fortune.
2) The Condescender: You’ve heard of man-splaining? This is “doctor-splaining”. “Don’t overthink this,” your doctor may say. “I’ve got this—I’m the one with the medical degree.”
I encountered this once when asking my orthopedic surgeon about what it would entail to remove a titanium rod implanted in my leg to heal a hip fracture. His curt reply: “Don’t you worry—that’s my problem.” My firm retort: “How is it your problem, when you’ll be up to your wrists in my leg yanking like a blacksmith to retrieve an 18-inch hunk of metal embedded in my femur?!”
He backed down and explained. You’re entitled to a full description of the rationale for any contemplated course of therapy—including full disclosure of risks and benefits—in understandable language, but not baby-talk.
3) The Avuncular: His or her bedside manner is superb; they’re relatable, someone you’d be happy to have a beer with. Rapport is quickly established around shared interests, hobbies, cultural background, politics.
But you get an uneasy feeling that the hourglass of your short visit is running as you trade banalities. The doctor seems more interested in your social currency than in your medical problems. Is your case being taken seriously, or are you being “schmoozed”?
You agree to go boating together; you share a table at a society benefit; you arrange mutual playdates for your kids. Eventually, it graduates to stock tips.
Banter is fine to establish rapport, but without boundaries, a clinician’s objectivity can be compromised. How to tell a “buddy” that they can’t get another prescription renewal for an addictive anxiety med? Or that they’re in serious danger of eating themselves into oblivion? Or that you can’t help them out with a dubious disability claim?
Or, as in the case of celebrity doctors who courted Jeffrey Epstein, you’re to overlook reportable offenses?
It can be problematic to treat friends or family members. That’s why medical ethics discourages it. A certain detachment is needed to remain aloof from emotional entanglements. A doctor without clear boundaries may seem appealing at first, but their clear-eyed vigilance may take a back seat.
4) The Proselytizer: He or she is a champion of veganism, ultra-long distance running, Tai Chi, Transcendental Meditation or Rapamycin for anti-aging. All good, in their place, but zealotry about one or another salutary lifestyle measure that works for them doesn’t substitute for personalized recommendations.
5) The High-Pressure Salesman: “ABC—Always be closing”—the sales mantra made famous in David Mamet’s drama Glengarry Glen Ross. Physicians are there to help, and want to apply their hard-won expertise, but sometimes high-pressure sales techniques—driven by the profit motive—tip the scales toward unnecessary, pricey interventions.
Under this scenario, routine annual physicals become mere auditions to harvest pathology for an upsell to more profitable “flagship” treatments. That’s why private equity is snapping up medical practices like hotcakes.
Examples of which are how patients are sometimes persuaded to undertake unwarranted heart, back, knee, or hip surgery. These can be appropriate fixes, but studies highlight a high rate of overly-aggressive procedures that invite complications, require corrective surgery, or do not ultimately improve quality of life or lifespan.
These same considerations may also apply to integrative practitioners who seek to enlist patients or clients in lengthy therapeutic programs, or use of fancy gadgets and expensive shots, when a “less-is-more” approach might suffice.
Unfortunately, the current reimbursement incentives for doctors and hospitals often align with lucrative, high-tech fixes. After all, without a steady stream of bodies, costly leased or purchased equipment might lie fallow, and “productivity” goals might not be attained.
6) The Ghoster: After a promising initial visit, you encounter some new issues. You reach out to your doctor; repeated phone calls, emails and texts remain unanswered.
Leaving you wondering: “Was it something I said?”
A common variant on that theme . . .
7) The Barricaded: Doctors, partly out of necessity, try to insulate themselves from a deluge of patient requests and questions. They hire staffers and surrogates to field inquiries. But too intense buffering, and a maze-like system of phone trees, messenger apps, and portals, can throttle down important communication. These days, inefficient, impersonal systems may make you feel like you’re getting the runaround.
8) The Namedropper: He or she is a celebrity doctor; their office is adorned with pictures of the health guru posing with stars and public figures. You wonder if you’re a C-lister, less worthy of the doctor’s attention.
Currying favor with big shots is a drain on a practice—stars are often high-maintenance and want to turn physicians into their perpetually on-call pets.
Besides, namedropping highfalutin clients is a violation of patient confidentiality. As a Manhattan practitioner, I’ve treated many prominent people, despite not seeking them out; you’ll never hear me breach their confidentiality.
9) The Spent: Physician burnout is pervasive, affecting as many as 40% of practitioners. If your doctor appears exhausted or depressed, they might not be firing on all cylinders.
Burned out doctors tend to view each patient encounter with dread or annoyance, as an obstacle to be overcome on the way to the safe haven of the weekend, a vacation, or early retirement. Their weariness is palpable.
10) The Distracted: If your doctor is preoccupied, breaking off to take frequent phone calls, glancing at their cell phone, or pausing to put out fires elsewhere in the office, they’re the medical equivalent of a distracted driver.
It doesn’t matter whether they’re embroiled in a contested divorce, wrangling office staff, closing on a new house, chasing their remodeling contractor, conferring with their stockbroker, or attending to a malpractice case: You’re the priority, and deserve full attention.
Have you ever encountered doctors like those listed above? Next week, I’ll be wrapping up the list with ten more types of doctors to avoid, but in the meantime, share this newsletter with your loved ones so they too can avoid a toxic doctor-patient situation.