How to Choose or Change Doctors: A Podcast With Dr. Danielle Scheurer

Dr. Danielle Scheurer is the chief quality officer and a professor of medicine at MUSC Health. She is also a board-certified internal medicine physician whose life's work revolves around improving the quality of care and patient safety in all health care settings. In this episode she offers insights into how to choose or change doctors.

“Good physicians should never take offense to the request for a second opinion, because at the end of the day, we all get one body and it's ours to take care of. And we have to feel really confident that we're getting the best care possible.”
Danielle Scheurer M.D., MSCR

Topics covered in this show

• Scheurer describes how she approaches new patients and her intention when walking into a hospital or exam room with a new patient for the first time.
• Resources you can use to search for a new provider.
• Questions you should ask a physician you are meeting for the first time.
• How to interpret online reviews of physicians and how to research their experience online.
• Use of MyChart and telemedicine to ask questions.

Transcript

Erin Spain [00:00:06] Welcome to Advance with MUSC Health, the show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. I'm your host, Arianespace. Today's guest is going to talk about one of the most important health care issues patients face, how to pick a doctor you not only like and trust who can also give you the highest quality of care possible. Dr. Danielle Scheurer is the chief quality officer and a professor of medicine here at MUSC Health. She's also a board certified internal medicine physician whose life's work revolves around improving the quality of care and patient safety and all health care settings. Thank you so much for joining me.

Danielle Scheurer [00:00:50] My pleasure.

Erin Spain [00:00:51] How do you approach each new patient that you meet and what's your intention when walking into a hospital or exam room with a new patient for the first time?

Danielle Scheurer [00:01:00] So I take care of adult patients in the hospital. Most people don't want to be in the hospital to begin with. So I always take a very compassionate approach and sort of what I call a warm greeting. So what I mean by that is I try really hard to know as much as I can about them before I enter the room by reading their medical record and their history, seeing if any consultants have already seen them. I think that helps gain trust. The biggest piece with new patients is if patients don't trust their care team members, it's very difficult for them to follow a treatment plan or have trust in their diagnosis. And so really taking the time to get to know them and showing them that you really care about what's happening to them and that you're invested in getting them answers as well. I try to use very plain language, even for patients that have been and the health care system for a while, there's no reason to expect patients and families to understand medical jargon. So I do try to be really careful about the language that I use and just try to make it as simple as possible and use analogies that they can relate to.

Erin Spain [00:02:07] You sound like the kind of doctor I would like to see. You know, insurance and location or convenience are really big factors for a lot of people. When choosing a doctor, you know, patients can choose any available primary care provider and their insurance plans network and same for their children. But beyond those parameters, what are some things that we can do when first starting the search for a new provider? What are some routes we can take to find the very best care?

Danielle Scheurer [00:02:33] One thing that I have found to be very effective is to where possible, try to get referrals from other health care providers. Typically sort of having an insider view of the health care system makes for good referrals where relevant certifications might be important. So, for example, if you're getting knee surgery or a bariatric surgery, making sure that that surgeon is certified in that type of surgery would be really important. Definitely at the time of the appointment, I always recommend bringing someone with you to an appointment. It just helps verify information they had may have questions or find things that that you didn't notice. They're able to take notes for you so that you can pay attention. Writing things down is also really helpful and really important when you're meeting someone for the first time.

Erin Spain [00:03:23] So it doesn't bother you at all if you walk into a room and see a couple of extra people and some note taking going on?

Danielle Scheurer [00:03:29] Not at all, no. In fact, I mean, it's it is literally I feel like it's almost impossible for patients and their families to really absorb everything that we're talking about, especially if it's an emotional time, if it's a new diagnosis or they're trying to understand how they're going to cope with this new diagnosis or new treatment plan. So it's actually really important. And I at least for my care setting or I'm seeing people in the hospital and things are happening very quickly, I encourage them to write things down in between times when I see them so that when I come back, they can remember what questions I had.

Erin Spain [00:04:03] Now, would you go through this process every time you need to see a new physician, or is it some of these newer diagnoses where you might need someone more specialized?

Danielle Scheurer [00:04:11] Yeah, I agree. I think the new diagnoses or new treatment plans are probably the two reasons where the stakes are higher, if you will. I mean, with some diagnosis, they're pretty straightforward. So, for example, if you're getting diagnosed with diabetes or high blood pressure, those are very common conditions that are relatively easy diagnoses to make just with a simple exam or vital signs or lab test, but for more complicated diagnoses like a new neurologic condition or autoimmune disease or cancer, these are very high stakes diagnoses that can be misdiagnosed. And definitely for those situations, I would do all the due diligence possible to make sure that you're in the right setting and that the team that seeing you is coming to the correct diagnosis, because once you get a diagnosis that drives the entire treatment plan and then once you're in the treatment plan phase, similarly, you want to make sure that the team or physician taking care of you can really help walk through what is this treatment going to look like for me? How am I going to feel? Can I work? Can I drive? What does it mean for my life? What are the common side effects, what can I expect? How long is going to last? You really want to make sure that you're with a provider that can really answer all those basic questions at the front end and that they've seen plenty of patients with that condition, so they know what to expect.

Erin Spain [00:05:37] So a lot of people turn to what we affectionately call Dr. Google in times like this, not only to research there are new diagnosis, but to look for a doctor that might be a good match. What are your thoughts on the online reviews? Are there actually reputable websites that we can rely on as patient?

Danielle Scheurer [00:05:55] So online reviews are a little bit tricky. It is difficult to verify that that patient or family member actually saw that provider. There's really no good verification process. So you do have to take some of those with a grain of salt. Now, having said that, if you if there's an online provider that has, say, five hundred spectacular reviews, there's a pretty good chance that that matches what they're really like, other sites that I would recommend. So every state has a licensing board for medical practitioners and that is a good site to visit and look up the provider that you're seeing just to make sure they don't have any major red flags, like a revocation of their license or major complaints or major lawsuits. Sometimes you can also find a provider's work history online, which I think is can also be very helpful. So if it's someone who's had a different job or move to several different cities in the past every two to three years, sometimes that can be a red flag. You do want to just like with any other work history, you want to make sure that they're they have some history of stability, and it doesn't look like they're sort of escaping from something.

Erin Spain [00:07:09] This is work that you can do on your own before you even set up an appointment. What about using patient portals like My Chart? Are those helpful for those initial conversations with physicians?

Danielle Scheurer [00:07:20] They certainly can be you know, a lot of the patient portals through the medical record are fast and easy way to communicate with care teams. Sometimes there's a whole team chat if you will. So you're not necessarily always going to get the answer directly from the provider. But they are a good, fast, easy kind of low-risk way to get quick questions answered.

Erin Spain [00:07:40] So once you're in a room with a physician and really you can think of it as if you're interviewing that person to be your provider. Right. What are some things to look out for? What are some red flags to look out for once you're in person in that conversation?

Danielle Scheurer [00:07:54] Yeah, I think the biggest piece is making sure they feel comfortable answering your questions. I mean, if you're in a room with a provider and they seem assured or annoyed with questions, you know, obviously you're there to get your questions answered. And but they can't explain it how they came up with your diagnosis or how they derived your treatment plan. I think it's going to be hard to build that trust. So that to me, I think that would be a red flag.

Erin Spain [00:08:19] Well, and for a lot of people, this bedside manner, it's everything. And being treated with compassion and respect is very important. But is good bedside manner really an indicator of good care?

Danielle Scheurer [00:08:32] It's a great question. I would say it's necessary, but insufficient. So I would say trust but verify. I wouldn't recommend necessarily having blind faith. I would say maybe 20, 30 years ago, the many medical professionals, they people would just blindly follow their lead, which I do think in this day and age, most medical professionals do expect it to be more of a reciprocal relationship between patients and providers and that we welcome questions so. While compassion and respect is super important and an absolute essential, bedside manner is not necessarily an indicator of good care.

Erin Spain [00:09:09] So we're talking about all these different ways you can choose a physician. Let's talk about telemedicine, because this is something that, with the covid-19 pandemic has become really important for health care providers. What are your thoughts on just using telemedicine in general and using telemedicine to have these initial conversations with different physicians that you're considering?

Danielle Scheurer [00:09:32] Yeah, telehealth and telemedicine in the medical industry really across the world and certainly in the US really exploded over covid, obviously, because it was so difficult to do in person care. I think it's a very safe and effective and efficient way to get really good care, in particular, if it's for follow up care or what we call urgent care. So something that's time sensitive but not an emergency, those are great indications for telehealth and telemedicine. It obviously works less well for conditions that require a physical exam to come up with a diagnosis of treatment plan. So it doesn't work very well there. But I would say in about 80 percent of our interactions outside the hospital, most patients and providers can very successfully have a new. Or through about 80 percent of their care via telehealth, so if you haven't tried it, I would definitely recommend it again as a very safe, efficient, effective way to get really good care.

Erin Spain [00:10:32] Walk me through that telehealth experience with patients that you see. What's what is it like for them? Is a video chat. Just explain the process.

Danielle Scheurer [00:10:42] It does sort of exist on a continuum of care, if you will. So at the low end of the spectrum, we have what we call asynchronous visits, meaning that a patient will go online, and they'll report what they're experiencing and then a care provider minutes to maybe hours later will evaluate their symptoms, maybe ask them a couple of other questions. It's almost like a text string or email cascade and come up with, again, either diagnosis or treatment plan in an asynchronous fashion. And then more commonly, we have synchronous telemedicine or telehealth visits, which, again, kind of range from just kind of like a telephone visit or with or without a camera. And then the most sophisticated, which we do use in the hospital setting in some home health settings is where you actually have a telecast on the patient side of care whereby you can do things with the help of someone in the room, such as having a stethoscope or an otoscope, or you can look in their eyes or their ears or listen to their heart or their lungs and have up close if you need to do a skin exam, etc. So you can really even do some significant portions of a physical exam when you have a telecart, MUSC Health in particular. We have several hundred programs whereby we have cards all over the state in schools and other hospitals, emergency rooms, et cetera, where we help deliver care anywhere from ambulatory care up to intensive care unit care. So there is a when we when we say telehealth of telemedicine, it really is an umbrella term, again, ranging anywhere from asynchronous, simple ambulatory care conditions all the way up to Synchronoss card based intensive care unit care.

Erin Spain [00:12:37] I mean, as futuristic in some ways as the sounds, it does kind of harken back to the days of when doctors would come into your home, the local doctor to visit. Do you feel that as well?

Danielle Scheurer [00:12:48] Yeah, absolutely. And that's why it really is kind of a fun way to practice, because, I mean, one of the limitations, again, just speaking from being a hospital medicine provider, one of the biggest limitations I feel that I have in helping patients get better is I have no real idea of what it's like for them in their home care environment. You know, do they have access to food? Do they have a confusing medicine cabinet? Do they have clean running water or are there trip hazards? There's just a whole environment in which they live that I have no access or understanding of. And so we also do use virtual home care whereby we can dial into their home environment and do things like go through their pill boxes and see how they get in or out of bed and evaluate their fall risk. And we can do that so much better than just asking them questions about what medications do you take, which almost never really get you an accurate history. So it's actually a really satisfying and fun way to practice medicine. And I think it leads to more accurate assessments and better care.

Erin Spain [00:14:00] And patients might be more comfortable to it can be a lot of work to get down to a hospital or to a big campus setting up the park and figure out where you're going. If they can just do this from the comfort of their home.

Danielle Scheurer [00:14:12] Absolutely. It's so much easier for them. I mean, we really I think for decades we took for granted that all they had to do was show up, you know, and that's not easy. Not everyone can drive, or they don't have access to safe transportation or a down payment or they're really short of breath or they get chest pain when they walk ten feet. I mean, having lived through a lot of this with my in-laws, I just I was very it was very eye-opening to me how incredibly difficult it was to get my father-in-law to a single visit. We would have to plan three days in advance to get him to one visit. And it was you know, I was like, wow, this is really eye-opening. So I agree. I think it's I think it's a better way to care for patients where they're at and they can get more care, more frequent care, and more accurate care via that modality.

Erin Spain [00:15:04] And the bottom line is also it is within a patient's rights to get multiple opinions through telehealth or in person to choose the physician that they want. Isn't that right?

Danielle Scheurer [00:15:15] Oh, absolutely. Absolutely. I would say good physicians should never. Really should never take offense to the request for a second opinion, because at the end of the day, we all get one body and it's ours to take care of. And we have to feel really confident that that we're getting the best care possible. Good physicians should feel very confident getting a second opinion. They might get a different answer. And that's not necessarily bad. Medicine is not a perfect science. There's often more than one option as far as treatment plans, and it's really just a matter of fitting those options into the context of the patient and what their goals are to come up with a treatment plan that works for that patient.

Erin Spain [00:15:52] I'm wondering for you personally, what do you do to optimize your own health and live well?

Danielle Scheurer [00:15:59] Oh, my gosh, that's a great question. You know, I've actually thought a lot about that. I mean, I'm almost fifty years old now, so I probably think about it maybe more than some of my younger colleagues. But I do pay a lot of attention to what I eat and how much I sleep. I did not pay a lot of attention to that in my younger years. I really feel very strongly that with a job like mine in particular, that I have to come to work as my very best self or I'm not delivering on the service mission that that I'm destined to deliver on. So I have to, you know, I have to feel as good as I can as well. I do. I exercise every day. I think it's a form of meditation for me. And the better I eat and the more I sleep, the more I'm able to exercise. So it's sort of a virtuous cycle, as they call it, that you feel better and better. And those three things add to each other. So that is the recipe of my self care. Oh, I love it.

Erin Spain [00:16:57] And do you rely on any technology to help you with those a watch or a tracker or something like that?

Danielle Scheurer [00:17:04] Not an ounce in. That's so funny. My literally my whole family, they have like gadgets coming out of their ears. I mean, they all have watches and, you know, look at their heart rate and track how many miles. And I just I know how I feel, and I know if I do it too much, you're not doing enough. And I push myself as much as I can. And but no, I really don't use any, like, sleep devices or our gadgets at all.

Erin Spain [00:17:29] But I love the message that you're saying is to really listen to your body.

Danielle Scheurer [00:17:33] A lot of people don't listen to their body in many conditions. What I tell them is that I'm going to have to follow their lead. So, for example, if they've had a condition with their stomach and they're just getting back to eating, when I tell them, it's like you really have to pay attention to what your body is telling you. You know, if you feel like you're ready for solid food, let us know, start bland. But that's going to be the best indicator. Instead of me saying in eight hours you're going to start solid food. So I really try to also teach my patients to really pay attention to their body as well. It usually gives us the right signals if we're listening.

Erin Spain [00:18:10] Well, I love that philosophy. And thank you so much for all the advice today. Choosing a physician can be very intimidating. And I think you give us some great tips to get started if anyone out there who's looking for a new physician.

Danielle Scheurer [00:18:23] Yeah, my pleasure. Thank you so much for having me.

Erin Spain [00:18:27] For more information on this podcast, check out Advance.MUSCHealth.org