The Question: For the past three physicals, I have seen a senior resident with no input from my doctor. The few times I needed medical attention for minor things, I have been seen by a nurse practitioner or a newly trained doctor. Is there a danger something might be missed? Though I have been under this doctor's care for about 20 years, I have disregarded advice given to me, which may have alienated him.
The Answer: One of two things is happening here: Either your medical appointments are set up by office staff seeking the first opening, which happens to always be with someone other than your physician. Or your doctor is actively avoiding you because he is frustrated that you have blown off his advice. I'm inclined to think the first scenario is more likely, but whatever the case, you need to put it on the table.
Your clinic – with nurse practitioners and family medicine residents – sounds like a great environment. But that does not mean you have to take whomever they give you. Although a more senior doctor – yours or another – is supervising, you can request your own physician.
It's a fine balance faced by many Canadians, especially in July when a new crop of family medicine residents take up their positions in some of the country's hospitals and clinics. Though some patients may want to play a role in a young doctor's education, they may not want to lose touch with their own physicians.
Ken Harder, site director of the Chilliwack family practice residency program, University of British Columbia, said if he noticed a patient had been seen two or three times in a row by a resident, he would pop in at the next visit, mostly to keep in touch.
"Patients always have the option to say, 'I would rather not have a resident, I would rather have you,' " said Dr. Harder. "They have that choice."
Your clinic, he says, may not even realize that you have been repeatedly seen by someone other than your physician – they may have simply slotted you for the first available appointment.
As to whether your doctor is avoiding you, physicians usually do not take it personally if patients do not follow their advice, says David Price, professor and chair of the department of family medicine at McMaster University.
Though he suspects your issue is most likely due to scheduling, Dr. Price recommends you make an appointment with your physician and put it all on the table.
"If there's avoidance by the physician, then that's worrisome in that the therapeutic relationship has broken down," he said.
Dr. Price recommends you make an appointment with your doctor, and then say the following: "I haven't seen you for a while and I really appreciate seeing you. I know I don't always follow your advice. Does that bother you?"
It's a delicate, yet direct way of getting to the issue. But get to that issue you must.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org .