Choosing Your Physician

A good relationship with your doctor is among the more important associations for a person with MS. However, finding a physician with whom you relate well may be not only difficult but also stressful.

Some basic principles should be understood when making a decision about the right doctor for you. Despite the fact that insurance companies and other health care plan administrators act as if one physician is the same as another, this simply is untrue. Family physicians are trained to take care of general problems, but MS is not considered a general medical problem. A person with MS does need a general physician, but clearly he or she also needs someone more specialized. Internists specialize in many complicated medical problems, but most of them probably have seen few cases of MS. Physiatrists are specialists in rehabilitation and are increasingly involved as MS doctors, especially for those who have significant disability. However, neurologists—physicians who specialize in diseases of the nervous system—usually manage MS.

Not all neurologists are the same. Although neurologists are trained to make detailed and difficult diagnoses of neurologic disorders, many of them are not particularly capable of, or interested in, managing a disease after it has been diagnosed. The person with MS needs to work with a physician who will care for him or her on a long-term basis. People with MS deserve specialized care, but choosing a professional caregiver is not always easy.

Several factors should be considered in making your decision. Although all physicians want to be helpful, some personalities simply do not mesh. Some patients want their doctor to tell them what to do, whereas others want more choices in the process. Neither is intrinsically good or bad, but if you are with the wrong type of physician, the personal chemistry might not allow for a pleasing experience. Try to be aware of the type of person you are and try to find a physician with whom you are compatible.

Remember that a patient who wants to entirely direct his or her own care is wasting money by paying a physician for advice. A physician who takes care of himself is said to have a fool both for a patient and for a doctor. Likewise, a patient should not try to direct specialized medical care. A healthy dialogue, with the patient ultimately in control, usually works best.

Another thing to remember is that good physicians are busy. All patients would like their physician to spend a lot of time with them, and that is a fair expectation. However, just how much time is enough may be difficult to determine. Before visiting your physi cian, write down the specific questions that you want answered. Get right down to your questions because they may raise other important questions from the physician. It helps to have a list of all your medications and their dosages, because your physician may not be aware of all the medications that you are taking.

Do not expect your doctor to fix everything that is wrong. It is hoped that he or she will be able to help with problems, but you should not have too high an expectation.

There may be no physician in your area who is understanding, capable, and competent to meet your needs. If not, go outside your area to find a physician. Talk with other people who have MS and try to discover where your needs may be met. Although it is vitally important to have a relationship with a specialist, it may not be necessary to see that specialist more than once or twice a year. It is important to see the doctor at least once a year to develop a strong and understanding relationship. It also is important to be able to contact his or her office with questions that arise between appointments. Because you know each other, a phone call often can save a visit.

Remember that medications prescribed by your physician may or may not be helpful. Do not categorically condemn all medications as unnatural and useless. Before the advent of modern medicine, the life span of many people with MS was not much beyond 40 years of age. Medications should not be taken without a purpose, but they should not be feared if they are used properly.

MS is a highly variable disease, and no single management program fits everyone. It is difficult for people who are distant from problems to grasp the total picture. Insurance review organizations, businesses, and others who would like to manage care have an especially difficult time with MS. They often like to force patients to see physicians whom they know well but whom the patient may not know at all. In the case of a chronic disease such as MS, the physician-patient relationship should not be taken lightly. It may be important to attempt to get your managed care company to recognize your special problems and to make allowances for them. The squeaky wheel gets the oil, so keep squeaking until you get what you need.

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