10. The healthcare resources you need are beyond the scope of the doctors and hospitals in your proximity. If you are in the 20% of the population who live in a rural area in the US, or maybe your health problem is more unique, the healthcare providers in your smaller urban area might not have the experiences, resources, and capabilities that your condition requires.
9. You need a second opinion. But kind of like the situation above, if that opinion is not available where you live by a physician in a different healthcare system, or if you value a second opinion from a physician at a more well known or academic medical facility, it makes sense to travel.
8. You have experienced poor care from the local healthcare providers or specialists. If this isn’t your first rodeo, and the only specialists nearby have not believed you, refused to see you, minimized you, misdiagnosed, or treated you inadequately or poorly in the past, it is important to take the time to search out a different healthcare provider who can give you the time, attention, and support that you need, in addition to a reasonable plan of care you both can agree on.
7. Balls are being dropped in your care. Is there anything more frustrating when you like your physician or specialist, or love the hospital system or clinic, only for your case to be lost among all of the other patients, charts, paperwork, and test results. Lack of follow up, on-line messaging being ignored, providers not knowing pertinent details about your case or your situation (like where you live, social support, co-morbidities, etc), it’s probably time to move on so you can rest assured that you will get the time and attention that you and your case needs.
6. Long delays in scheduling urgent tests or diagnostic procedures. If it takes the hospital system 2 months to schedule your special test or the physician ordered a test but did not mark it urgent despite rapidly worsening symptoms that could put you in the hospital tomorrow, it’s time to find a new physician or healthcare system to schedule that particular test or maybe to transfer your care altogether.
5. The testing required by your condition is unavailable locally. Maybe the MRI machine at the hospital is not pacemaker compliant, or you require a type of heart catheterization that no one on staff at your local hospital provides. If it cannot be done where you live, you have no choice but to seek out an academic medical center or hospital with more advanced testing available to meet your needs. Recognize that the local healthcare system or doctors may not tell you that this is the case unless you ask specifically for precisely what test you believe you need and ask specifically why they are not doing it. Many times other tests that are not as high yield will be done in your current hospital in lieu of the actual test you need only available at another facility, costing you time and resources while creating unnecessary delays in treatment. It’s important to do the research on your condition to know what questions to ask to be able to know if you are getting what you need for both diagnosis and treatment.
4. Local healthcare providers do not have a grasp of your case. Typically, local providers do an excellent job of handling the big stuff they see frequently (i.e., heart attacks from coronary artery disease, massive strokes, fractures, major organ dysfunction), but if they haven’t been able to pinpoint your diagnosis and are running out of ideas, this is your sign to seek help elsewhere. Patients with more rare diseases need to find not only a larger academic medical center or healthcare system, but frequently will also need to seek out a physician who has specialized experience in precisely their rare diagnosis or category of diagnosis (i.e. a specific rare cancer, lesser known cardiac issue, autonomic dysfunction, pericardial disease, etc). Don’t assume that an academic medical center holds all the answers either. Search carefully to find a specialist who takes a special interest in cases like yours, and has experience to back up their opinions and treatment recommendations.
3. Your local providers have exhausted all of their ideas and options to diagnose and/or treat your condition. In a perfect world, your current provider will assist you in finding another provider who can help you, whether across town or across the state, or even in another state to make the transition of care process seamless.
2. While local treatment is available for your diagnosis, the research studies or treatments available at specialty centers far surpasses what is available locally, may widen your treatment options, and even improve your prognosis. Think of the MD Anderson for cancer diagnoses or St Jude’s or Shriner’s Hospitals for children’s cancer or other diagnoses and treatments. While not necessary for most diagnoses, it’s good to even run your case by someone at a higher-level institution to see if your current treatment plan is on track. If you can stay local and get the care you need, this is always preferable to maintain your comfortable home environment, social support, and reduce the cost associated with travel medicine.
1. You don’t feel like an integral part of your own care team, and it is impacting the effectiveness of your treatment plan. If you intuition is telling you that something is off, even if you cannot pinpoint what it is, something probably is. If all your energy is being spent questioning what isn’t being done in your case, or whether everything is being done correctly, you will not have the optimal energy and mindset to heal. While there is no utopia of healthcare available anywhere (despite what all the shiny glass and metal and marble floors and walls and slick marketing portrays), you should feel heard, believed, and all of your questions should be answered to your satisfaction in the midst of a serious medical issue. If you feel out of the loop in your own healthcare, this is your sign to seek help elsewhere where patient-centered care is a value that providers are held to, and patient reviews concur is actually happening when care is being delivered.
Jill Murphy is a Doctor of Physical Therapy and founder of MotionWorks Physical Therapy and an advocate for patient-centered care. A Christian wife and mother of three, she survived a seven year journey through the broken American healthcare system in search for an answer to a heart arrhythmia that appeared during pregnancy. A stroke, open heart surgery for constrictive pericarditis, and several other surgeries later, Jill is telling her story of unfailing resilience in her upcoming book, Doctor Heal Thyself.
Having grown up on a dairy farm 40 minutes from Lambeau Field, Jill is an avid Green Bay Packers and Wisconsin Badgers fan, and is up for any outdoor activity with her three children, including walking, biking, throwing the football around, hiking in scenic locales, gardening, and coaching a middle school basketball game or two.
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