Two of Maine's Best Rated Doctors Tell You
How to Choose and Partner With a Doctor for Best Results

Jennifer McConnell, MD, practices at the Winthrop Health Center outside of Augusta. She's a family practice doctor who loves to take care of entire families, from babies to grandparents. Dr. Jenn is really pleased when patients are able to talk to her about things they can't talk to anybody else about, such as feeling anxious or depressed.

Roy Nakamura, MD, practices at Martin's Point Healthcare in Brunswick. He's a family practice doctor eager to help his patients feel at ease, so they can share what's really on their minds. When a patient says "By the way, doctor...", that's when Dr. Roy knows the patient trusts him enough to tell the hard truths.

We asked Maine Doctors McConnell and Nakamura questions that we've heard patients ask over and over again. These questions are sometimes hard to ask your doctor. Both doctors felt these questions were important and were pleased to give these answers.

"I need to find a doctor who is right for me and my family. What should I look for? What should I expect?"

Dr. Jenn: It's important to find a doctor that you can communicate with, that you can talk to. I try to create a safe place for people to make their own choices, get information, ask questions, talk about things they don't necessarily talk about with anybody else. I also try to stay up on the latest information in the medical literature. I'm a big believer in patients taking charge of their healthcare and working with me as a team.

Dr. Roy: It's hard for patients to get information they may want about a doctor. Patients often have to resort to word of mouth from other patients' experiences. Be clear about what you value in your care, such as the services offered, hours the practice is open, what kind of after-hours care is offered. Don't be afraid to ask where the doctor went to school, how many years of training they've had.

I think each of us comes to a doctor with different expectations and hope of what type of relationship we want. I'm more of a consultant-type physician, where a patient comes in with concerns and I give advice but I don't make choices for the patient. That's up to them. When you see a provider for the first time, it's important for the visit to be a time where you're learning whether a long term patient-physician relationship will occur and not just assume it will occur.

"I often feel that doctor visits are rushed, that I don't have enough time, especially to ask questions. Is there anything I can do about this?"

Dr. Jenn: I really like my patients to come in with a list of what they want to cover - concerns, topics, or questions. Most of the time, I find that, if they know what it is they need, we can cover it. If they don't know, if they're nervous about asking, or if they're forgetful, then it becomes harder and harder to cover. If the list is really long, we might not cover everything in one visit, but we can plan another visit to be sure all the concerns are addressed.

Patients need to be empowered to be good consumers of their own healthcare. I think patients can get overwhelmed and confused by information or the plan for treatment or further testing. I think they can also leave a visit and still not feel like their questions were answered. I encourage patients to ask for clarity at the end of a visit if they are unsure, or if they have unanswered questions. They can even ask to have things written down. They'll have a more effective and valuable visit if they feel empowered.

Dr. Roy: I think personally it's good for patients to write things down ahead, even though doctors might get real nervous when a patient pulls out a list. The scary thing is when there are 10 things on it! But we can plan together which are the most important to tackle today and then set up a plan. Patients often say the most incredible things after you've spent 20 minutes talking about nothing important. Finally you've built up their trust and they have the courage to say something. But then we're scrambling for a lack of time.

Also, patients should ask their doctors to write things down. I find it's helpful to write things down. And I also give my patients a game plan - so they know what should happen next and when to call me or return to the office.

"I feel nervous about asking my doctor for a second opinion or about asking for more information about my health problem. The doctor might think I don't trust them. What about this?"

Dr. Jenn: I'm very comfortable with patients asking for another opinion. I try to refer people for second opinions if they request it and sometimes I even suggest it. Second opinions can be very helpful. Overcoming fear of physician disapproval in requesting another opinion is clearly a strong boundary for a lot of people. But I think patients need choices, and I'm comfortable with them making choices.

It's helpful for patients to learn about their conditions, to know what the latest guidelines are for their own care. It gives more responsibility to the patient and puts them more in charge. I tell people: "I don't want to work any harder than you do, but I'm here for you and I want to work together as a team."

I also have had patients who searched the Internet and come to a visit with lots of information. That can be very helpful. I have even suggested certain sites to patients if they are internet users. But I try to help patients understand that they can't actually believe everything on the internet, and that I can help them understand what is valuable and what isn't. I believe it's my job to try to help keep patients safe.

Dr. Roy: I always give second opinions... because my philosophy is I want the best care for patients possible. If my patient wants a second opinion and I'm confident in the care I'm providing, there's no reason for me to be afraid. It's something that I almost welcome. You want patients to be careful consumers, because if you do make a mistake, you want them to catch it too! It shows the patient's interested in their health and wants to take care of themselves.

And, I always encourage patients to find information on their own. I have 2 favorite web sites. I tell them to go to WebMD or to the Mayo Clinic. I do always caution them to be careful about doing general searches on the Internet. They need to be prudent consumers that really look at the source of information. They'll get better information from a not-for-profit company like the Mayo clinic, or a government agency or an association that deals with a particular illness or concern.

"I take some vitamins and herbs and also see a massage therapist, but I haven't told my doctor about any of this. I'm not sure they would approve. Should I bring this up?"

Dr. Jenn: I believe in holistic or complementary care and work with many other kinds of providers. I believe in Reiki, massage therapy, yoga, and stress reduction techniques, just to name a few. I have chiropractors, naturopaths, osteopaths, etc. that I'm comfortable with and that I often refer people to if they have an interest. Patients need to have a trusting relationship with their providers so they can discuss complimentary care..

I actually had a patient come into a visit with me and brought her holistic care provider with her! The patient believes she is getting excellent healthcare because we have this team approach. It was fascinating for me. I do believe this patient is receiving better care because she shared the other part of her care with me. I don't think we do enough team approach. The difficulty is finding the time and having the resources.

More recently I've also begun to ask a lot more patients about their spirituality. I believe that we don't do enough to connect mind, body and spirit. Treating just one part is not always effective.

Dr. Roy: Most insurance companies will authorize and pay for some types of alternative treatments which are really becoming more mainstream care for certain medical conditions like back injuries. And over 40% of my patients are on some sort of over the counter medication or herbal remedies. It's a fact of life that patients take these medications. I try to be respectful and not overly critical. I think if you ignore it, patients get afraid, so I ask.

There's also a safety issue. Some patients have a general mistrust of organized medicine and so they look at alternative medicine. I had a lady recently who was diagnosed with breast cancer. Her first thought was to try out the alternative treatments and diets she had read about movie stars using. It took a few weeks for me to convince her to see an oncologist, a cancer specialist. This was scary to me.

"I expect my doctor to do a good job taking care of me, but I don't always follow their advice. What should I do?"

Dr. Jenn: I believe that patients need to take more responsibility for their long term healthcare. It's important for patients to understand that the choices they make will affect their long-term health risks. I believe that my job is to help define an individual's health risks, and begin the education process. However, I also need to empower the patient to seek more education as needed, and I need to help them be responsible for actually changing their behavior. For almost all behaviors that affect long-term health risks, there are no quick answers. A great example is weight loss.

If I had a quick fix, I could retire. But instead, I believe my job is to help educate on why a behavior change is important and what types of programs may help. But then I have to empower the patient to be in charge of actually making the changes and following through.

I often talk about issues such as exercise, preventing osteoporosis, getting to or staying at a healthy weight. I actually promote Weight Watchers and I talk about simple walking. These are lifestyle changes that I think are easier to manage long term, and people are more successful at making small steps. I tell them to start small, walking just 10 minutes a day, 4 days a week, and then slowly move that up week by week.

Dr. Roy: I like to educate patients so they can make appropriate choices. I feel long term that I have better compliance with better educated patients who are making the treatment decisions. They're much more likely to stick with a treatment plan of their own choosing.

For example, a person comes in with high blood pressure and asks what to do. I'll explain what it is, what their risks are, and that there are lots of choices in ways to manage this, through diet, exercise, lifestyle things like quitting smoking, etc.

It's important to talk with patients about lifestyle issues in a way that doesn't judge them, won't make them afraid. I try to show that I'm not overly critical. We also have disease management programs here to help patients take more responsibility for certain conditions. For example, our patients like to see our dietitian right here in the clinic, instead of having to travel.

I think each of us comes to a doctor with different expectations and hope of what type of relationship they want. I'm more of a consultant type physician, where a patient comes in with concerns and I give advice, but not so much directives. It makes me more comfortable too, to see patients that want the same doctor-patient relationship I like. It just makes for a better fit.

"Do doctors and nurses understand that it's sometimes hard to be a patient? It can be hard to make choices, to speak up, to get the system to work."

Dr. Jenn: I think it's really easy to become removed from what it feels like to be a patient. It's also hard to remember how complex and cumbersome the healthcare system can be to maneuver through. Every time I've had to be a patient it's reminded me of that. I've had the experience of being sick and not knowing when the healthcare provider would call me back. It would have been so much easier if I had known.

Particularly when I'm in the parent role, it's been a good experience to figure out how to advocate for good healthcare. One of my earlier teachers was caring for my daughter and kept asking me "What else do you want to make sure we talk about today?" He must have done that 4 or 5 times. It was so helpful. It made it much more effective for me to make sure I talked about the things that were concerning me, so I wasn't driving home saying "Oh man, I forgot to have him look at that rash!"

I try to end every visit by asking patients: "Are you clear? Does this feel okay to you? Do you have any other questions or concerns?" If they're confused or unclear or uncomfortable with the final plan, they need to be able to speak up.

It makes sense that patients are sometimes afraid of making their provider angry. Then they might not get good care. I always try to let patients know that I'm not going to get mad if they don't do what I think they should do. And I've had patients that weren't comfortable with me as their healthcare provider, and they've moved on to other providers. That's okay.

Dr. Roy: One thing interesting is when I moved here from Oregon 6 years ago. We ourselves were patients and had to make our own choices of whom to see and we were stuck with lack of information. Even for me, I had to ask in a crude way: "Who's a good family doctor for my wife?" And we had to choose doctors for our children as well.

I try to talk with patients in an objective way, say things in a way that's respectful. For example, if I'm talking to a 16 year old, I don't say:" You're not sexually active are you?" Or, "You don't smoke, do you?" I would ask something like: "Is birth control of concern to you?" You really want to say it in ways that's not putting stigma on it.

Here's another example. A 40 year old man schedules a physical. Very few 40 year old men schedule a physical that doesn't have another agenda. Usually something has happened. Their best friend died of cancer, or they really need to talk about something personal, like erectile dysfunction or maybe depression. So, I ask about other concerns and 99% of the time they'll say yes. And it's probably something they really could not tell the receptionist about when they made the appointment.

When patients are honest with me about their real concerns, that goes a long way to create a good doctor-patient relationship. And if a patient sees another doctor when I'm not here and feels like they're communicating the way they want, it won't hurt my feelings by asking for that doctor in the future.