Karen Leitner, MD

Physician Case Manager, Advance Medical

My name is Karen Leitner and I am fortunate to be a physician case manager at Advance Medical. I am trained as a primary care physician and work in urgent care.

One of the things that has surprised me over the past few years of working with patients at Advance Medical is how frequently I work towards empowering them to be their own advocate. With that in mind, I have put together a short list of what I views as some of the most important key points in patient advocacy towards being satisfied with the medical care you receive. It is far from comprehensive but I think is a nice start at some of what I commonly discuss with patients:

1. You really should like your doctor

My real hope is that you love your primary care doctor. Not that you have to be best friends, but that you feel a connection to them. You want to feel that they listen to you and care about you and you trust them. If you don’t feel good about your PCP you should ask yourself what is keeping you as their patient. There may be other reasons that they are right for you based on geographic or other factors which is fine, as long as you are making a conscious choice. I think a good doctor patient relationship needs to be based on a relationship of mutual respect and trust and if you don’t have this, it might be time to look elsewhere because inevitably it will affect the quality, or your perception of the quality of care you receive. To me it’s a no brainer. And if you like them, chances are they like you which is also a good thing.

2. Be prepared for your visits

In this day and age doctor visits are often shorter than one might like. One way to make the most out of your visit is to prepare ahead of time. That might mean:

  • Bring your medications with you so that you doctor can know exactly what you are taking.
  • Bring a list of the questions that are most important that you have answered while you are face to face .
  • If there is routine blood work that you know your doctor will want, see if you can schedule the bloodwork a few days ahead of time so that you can discuss the results while you are sitting in the office with them.
  • If you know you hate when a doctor falls behind, try scheduling your visit for first thing in the morning. If you know your visits tend to run over, schedule for end of day when the doctor might be able to spend a little more time with you. If you have a lot to go over and it won’t fit in one visit, ask to schedule a follow up appointment in a short time frame rather than trying to cram too much into one visit which inevitably results in too little attention being given to each concern as opposed to a thorough approach.

3. Own your medical records

Often time these days our care is fragmented. You might see doctors in more than one medical setting or system. You might move or change doctors because of insurance. Having a copy of your records is legally your right and can be very helpful in making sure important information does not get lost in transition. If having the entire record is too much, try to keep a copy of important records like operative notes or pathology results or imaging (X-ray, CT, MRI) results on disc etc. Usually You will need to sign a consent form at your doctor’s office to have these released to you. We are very efficient at doing this at Advance Medical and are happy to help you if you need it.

4. Don’t let non-medical staff impede your access to care

Sometimes it is necessary to be seen urgently for acute illness. I have spoken to patients who have called their doctor wanting an urgent appointment and been told they cannot be seen for weeks to months. This even happened fairly regularly at my own primary care office where I would have squeezed the patients in to be seen had I known they were calling and asking. It is understandable from the office staff perspective that because hundreds of patients call every day wanting to be seen, they just cannot accommodate everyone. On the individual patient side however, sometimes being told to wait to see someone is impractical because the issue might resolve before you get to be seen, or it may be acute enough that you really need urgent medical attention. ( In emergencies, an Emergency room visit is most appropriate.) Often times I help empower patients to know the best way in which to ask for what they need. It is very important to be polite while self advocating. An ounce of politeness goes a long way! Here’s an example:

What doesn’t usually work:

Patient calling doctor’s office:
“I need to see Dr X”

Office staff:
“I’m sorry, there are no appointments available until 2018”

Patient gives up and goes to the ER for their condition that could have been handled by their doctor with shorter wait time, less expense to patient, less expense to health care system as a whole.

Alternate suggested script:

Patient calling doctor’s office:
“Hello, I am having an urgent medical problem and I need to be seen by a provider at the office as soon as possible”

Non-medical Office Staff:
“I’m sorry, there are no appointments today.”

Patient:
“I understand. I really need to be seen however.
Can I please speak to the triage nurse or another nurse?”

(sometimes they have better access to the providers’ schedule)

“Can I please come in and wait to be squeezed in? I understand it might be a bit of a wait.”

“Can I please speak to the physician assistant or nurse practicioner or see another provider today?”

“Can you please ask dr X to call me at the end of the day today, it is really important. Please tell her “that I am experiencing (new leg swelling, pain with urination, blood in my stool, depression”etc. I don’t think I need the emergency room, but I do need to see them soon. Can I be scheduled first thing tomorrow morning?”

I hope these tips have been helpful. Here’s to your health!