Dear Prudence

How Do I Break Up With My Doctor?

Prudie offers advice on elderly doctors and arguing parents.

A folder of medical records.
Photo illustration by Slate. Photo by Getty Images Plus.

Welcome to the newest addition to the Dear Prudence lineup: the Friday mini-column. At the end of the workweek, Prudie will answer two more questions from the mailbag. This week: elderly doctors and arguing parents.

To get advice from Prudie, send questions for publication to prudence@slate.com. (Questions may be edited.) Join the live chat every Monday at noon. Submit your questions and comments here before or during the live discussion. Or call the Dear Prudence podcast voicemail at 401-371-DEAR (3327) to hear your question answered on a future episode of the show.

Dear Prudence,
I have had seizures since I was about 13 years old. I couldn’t drive, and my life was severely limited. Then I got into an experimental drug trial, was able to get my license, hold a job, get married, and have a family. All of this is due, in part, to a specialist named “Dr. Smith.” I remained a patient of Dr. Smith’s, and she has helped for almost 40 years. My seizures now come once about every five years. I’ve traveled hours to see her. I have been in her waiting room for hours past my appointment time with no complaints. I have paid out-of-network copays because she has done so much for me. I am the last patient from that study that she’s still seeing. Now she’s 72, and I’m 60, and at my last appointment, I complained about memory problems. She prescribed a second medication that would work with the one I am already taking that she said would improve my cognitive functioning. She wanted to prescribe a more expensive medication that would classify as an off-label use, but her nurse told her that I’d have to have the prerequisite tests before she could do that.

I came home, Googled it, and read many, many comments from patients about how it had significantly dulled their memories. I then looked at some of the scholarly articles on this medication, and they said nothing about improved memory function in patients like me. I have decided not to take the medication. My problem is that I need a smart, reliable specialist in this field, and I no longer trust Dr. Smith to make the right choices for me. I’ve made an appointment to start seeing another specialist, but I know that my leaving Dr. Smith’s care will be noticed, and I’m afraid it will hurt her. Her practice is dwindling since she takes a lot of low-income patients. She always wants to hear about my life, my work, and my family—partly because it’s a way of tracking progress and partly because we’re such old friends. I’m firm in my resolution not to trust her with my care, and if I could just slip off into the night, that’d be fine. Unfortunately, my new doctor will request records, and that will definitely tip her off. Should I tell her the white lie that this new doctor is closer and helping me with my memory problems (not really her area of expertise)? After all this time, I don’t want to do anything to hurt her feelings or make her think I don’t trust her. If lying is the only way to avoid it, I’m OK with that.
—Cheating on My Doctor

If you hadn’t already made up your mind to switch to someone else, I’d encourage you to go back to your doctor with some of those scholarly articles and tell her that you’re concerned about what you’ve read. Since the two of you have known each other for decades and you’ve been very close, I think it would have been a good idea to bring up the long wait times and other concerns about your care before you decided to leave, if only to give her the opportunity to try to improve. But since you’ve already made your decision, it’s perfectly reasonable to seek out another doctor who specializes in an area of medicine that Dr. Smith is less familiar with. Frankly, I don’t consider it a lie at all. Moreover, as a single patient, you are hardly going to make or break the future of her practice. Go ahead and tell her that your new doctor is closer and specializes in memory issues. Do it before your new doctor requests records so that it doesn’t come as a secondhand surprise after 40 years, then schedule a lunch or coffee date so you can keep in touch as friends.

Want to see Dear Prudence live?

Check out dates and locations for our national tour. Tickets here.

Dear Prudence,
My parents are wonderful people who clearly still love each other after being together for nearly 30 years. They’ve always had the occasional big blowup argument (nothing violent), but in the past few years it’s become more and more frequent. I’m an adult who recently came back from living abroad for a year, and I’m staying with them briefly before moving out to my new flat. I’ve noticed these fights have become a daily occurrence, with some bitterness behind it I didn’t think was there before. I would leave them to sort it out themselves (they’re adults after all), but my younger sibling is still at school and living with them, and I’m worried this is creating a bad environment. Is there a way I can bring up maybe needing to go to couples counseling without seeming like I’m inserting myself where I don’t belong? I want to suggest it in a way that they can’t brush off easily. While they both love and respect me, they’re also very strong-minded when it comes to this sort of thing.
—Get Parents to a Couples Counselor

I think this is worth bringing up once. You certainly have grounds to respectfully share what you’ve noticed and offer the suggestion of counseling. I can’t promise you they won’t brush it off, especially at first, but if you keep your expectations reasonable and don’t assume you’ll be able to change a nearly 30-year habit in a single conversation, you stand a chance of planting a seed that may later bear fruit. At the very least, if your parents believe their fights aren’t very noticeable or don’t affect others, you may dispel the fiction.

My instinct is to talk to them both together unless you have reason to think they might react more calmly separately. It may help to start by saying that you love them both and aren’t trying to tell them what to do, but you’ve noticed their fights have gotten both more frequent and more intense, and it surprised you after such a long time away. Since you don’t remember conversations getting quite so heated in your own childhood, you’re concerned about the effect this may have on your younger sibling, not to mention how tiring it must feel to both of them. Tell them you hope they’ll consider what you’ve said, and stress that your main goal is to see them both happy and peaceful. It will be easier to distance yourself from the outcome once you’re settled into your own place. And even though it’s clear you don’t want to become the referee in your parents’ marriage, you’ll still have justification for asking them to take their arguments elsewhere or to speak more calmly if they start blowing up in front of you. Their private business does affect you insofar as they choose to have angry fights in your presence, and you’re not out of bounds for calmly objecting.

Catch up on this week’s Dear Prudence here.