Read an Excerpt
Choosing A Primary Care Doctor and Getting the Best Specialist Care
Dr. Justice arrived at the emergency room shortly after his patient did. The ER staff wasn't surprised, as Dr. Justice and his medical colleagues always liked to care for their own patients when possible. The patient had called Dr. Justice (who had returned his phone call promptly) to tell him that he had chest pain. Dr. Justice told him to call 911 and get to the ER by ambulance. He would call the ER, give them some orders, and would follow along shortly.
Dr. Justice spoke with his patient in a calm and unhurried manner and assured him that he would get the best possible medical care. He and his medical group would oversee each step of his care in consultation with the specialists in the hospital-the same specialists that he would use if it were for himself.
Dr. Justice then invited the patient's wife into the examining room with her husband and reassured her in the same quiet, confident manner as he had reassured her husband. He held her hand while sitting in the chair next to her, all the while listening to her concerns. He addressed each question in a respectful and easy style that immediately calmed the worried wife. Finally, when she had all her questions answered, he hugged her and left the room to see another patient. The nursing staff could see an immediate positive difference in the whole family after Dr. Justice had finished.
Who wouldn't want a doctor like this? Sound like a fantasy doctor from Central Casting? Well, it's not. There are many wonderful doctors in the practice of medicine who provide this same kind of caring and compassion. This is the kind of care we'd all like to have and deserve to have. It is possible to find a doctor or doctors like the one in our little scenario.
It will take some time and effort on your part, but it's possible.
Think about this:
* The number of physicians in the United States is 700,000.
* The number of accidental deaths caused by physicians per year is 120,000.
* The number of accidental deaths per physician is 0.171 per year. (Health and Human Services Dept.)
Then think about this:
* The number of gun owners in the United States is 80 million.
* The number of accidental gun deaths per year (all age groups) is 1,500.
* The number of accidental deaths per gun owner per year is .0000188.
Statistically, doctors are approximately nine thousand times more dangerous than gun owners. FACT: Not everyone has a gun, but almost everyone has at least one doctor.
The above is a joke making its way around the Internet that might just contain a bit of truth. It's a humorous way of letting you know that finding the right doctor is extremely important to your health because, according to a 1998 Gallup Poll, 83 percent of Americans visited a doctor in the previous year. While most people saw a doctor for routine care of common problems, many others required a specialist's care for more serious and complex issues.
The biggest problem that many people have in medical care is finding the right doctor. In survey after survey, people have defined the "right" doctor as one who is compassionate, kind, listens to what they are saying, and includes them as partners in their treatment. Many of us are blessed with a doctor we can trust and who provides wonderful care for us and our families. Many others of us are not.
We won't kid you. Finding the right doctor for you can be hard work. It takes time and may require considerable effort. In some cases, you may get lucky and strike gold right away. It's good to keep in mind that anything good and worth having in life usually requires some work, and the feeling of accomplishment you get when the job is done and you find the right doctor makes it all worthwhile. After all, in this case, we're talking about your health and maybe your life.
Buying a Car and Finding a Doctor
How many of you have bought a car in the last several years? We bet most of you have. Did you do a fair amount of research before you bought your car? We bet you did, because a car is something you live with for years, and it's one of the biggest dollar outlays that a person makes other than the purchase of their home.
When you finished doing your research by talking to friends, looking at car ratings on the Internet, in Consumer Reports, or whatever other rating service you decided to use, did you then take your finalists out for a test drive? We bet you did that too, because by doing so, you noticed little things about the car that you couldn't have found out by simply reading or talking to someone else about it. It doesn't matter that someone else loves a particular car model; your car has to fit your personality and be comfortable for you.
Those who sell cars and trucks know that the average consumer also makes their final decision about the vehicle they choose based on a number of intangibles. Was the sales staff nice? Did one dealer promise better service after the sale than another? Was the dealer's showroom clean and appealing? Is the dealership convenient? Does the dealer have a reputation in town for honesty and caring service? Did the particular car and model have a reputation for reliability and good service?
Let's take that same analogy and apply it to choosing a doctor. How much time and effort did you take before choosing your present doctor or a doctor that you've seen in the past? Did you do your research by checking out your doctor through the state medical society, specialty board, or on the Internet? If not, why not? You may not make a big dollar investment in your doctor, thanks to insurance, but aren't you potentially investing your life (and possibly your family's lives) in your doctor's hands? We think you are, and that's why we think this chapter is so important.
Did you take the doctors you are considering out for a test drive by scheduling a brief meeting with them in their offices? You may find that despite all your research, the doctor's support staff or office left a lot to be desired. You may find that the office hours just weren't convenient and that your potential future doctor wasn't available after standard office hours or didn't have coverage in emergencies. Maybe, when you sat in the waiting room prior to your appointment, some of the other patients mentioned some concerns they had about the care they'd received. These are some of the things that you can find out only when visiting your potential doctor's office personally. Isn't it worth your time to do so? You do it when you're buying a car. Why not when choosing the person who will have an even greater impact on your life?
How do you find the best doctor for you? When do you need a second opinion? When should you consult a specialist for care? What kinds of questions should you ask when looking for a doctor? These questions, and more, are at the heart of this most important chapter.
Finding the Best Doctor and Getting the Kind of Care Your Doctor Gets
Getting the best care isn't really just a function of how much money you have. What you need is something more important . . . information. And the very best kind of information when it comes to health care is insider information. The good news here is that in the world of medicine insider information is legal . . . and that's what we want to share with you.
So who has this insider information? Doctors do. Doctors definitely have the inside track when it comes to finding the best doctors and getting the best care. Your friends who are doctors know who the best doctors are, how to get in to see them quickly and without waiting, and how to get referrals to the best specialists, if and when they need them. The key to staying healthy and out of the hospital is to be in the hands of the best primary care physician you can find. Most of us have no idea how to find one or how to evaluate one once we join their practice. Doctors, on the other hand, spend their lives in clinical settings. They know their way around the world of health care the way a professional golfer knows his way around a golf course.
Very simply, the way most people go about choosing a doctor is all wrong. And it is one of the costliest errors that you can make. There isn't anything more important to most of us than our health and the health of the people we love. When we are diagnosed with an illness or even when we're choosing a physician to take care of us, we want nothing less than the best, and the best care starts with your primary care physician.
Your Primary Care Physician: The Most Important Member of Your Health Care Team Your primary care physician is the most important person on your health care team. This doctor will be the coordinator of your overall medical care much like a head chef oversees the kitchen staff in fine restaurants or an executive producer manages and coordinates the Today show every day.
When the Today show airs, there is an executive producer who coordinates all the various story segments and program features and brings them together into a final product that flows seamlessly. He or she might be coordinating twenty or more features with as many different producers. This is a very difficult job because it means limiting certain stories and expanding others in the hope of appealing to the widest possible audience five days a week, fifty-two weeks a year. We wouldn't want that job. It's just too stressful.
Your primary doctor provides much the same role for you. He or she should be supervising all aspects of your medical care and ensuring that all members of the team blend together to provide the best health care for you. It too is a very difficult and stressful job because other team members may not communicate with the primary care provider as they should, reports may get lost, and results may be slow in getting back to the doctor's office. And, if things should go wrong, the primary physician is often second-guessed, especially with the twenty-twenty hindsight that many people develop. A doctor who does this job well is to be respected and cherished.
Your primary care provider should be your initial contact for almost all your medical problems and will be responsible for evaluating, diagnosing, and treating your various illnesses and ailments. If necessary, they are often responsible for referring you to a specialist for more advanced care. Many managed care organizations (MCOs) call this latter role being a "gatekeeper." If you don't get the approval of your primary doctor before going to a specialist, then the MCO will pay substantially less (or not at all) for that care. By placing the primary care physician in the "gatekeeper" role, the MCOs often avoid unnecessary and costly specialist care because a good primary care doctor can handle most medical problems that you have.
How to Go About Selecting Your Primary Care Physician
Let's take a minute and look at an event that happens to millions of Americans each month. You're moving. It can be to another city or to the other side of town. It doesn't matter. One way or another, you are being uprooted. You are going from the familiar to something new and different. There are many adjustments that have to take place-some good and some not so good-and all these changes can be potentially stressful.
One of the biggest concerns that we hear from people when they move from one place to another is "How am I going to find another doctor that's as wonderful as the one I have now? I don't know anyone in this new city, so how will I know who's good and who's not good?" We know this is traumatic, but we also know that we can help make the job of finding a new doctor less stressful for you.
If you've got children, if you've got some chronic medical problems, or if you're just concerned about taking good care of yourself, when you move, you need to find another doctor immediately. How do you go about it? First of all, let us say, there is no quick or easy way to go about this if you want to do the job right. Sure, you could go to the list of doctors that most companies provide through their health benefit plan and blindly pick a name off the list. Needless to say, we don't suggest that approach. We think there is a better way to find the best doctor for you.
Before you go about doing anything, you need to decide what kind of doctor you really want. What are your preferences? Do you want a male or female physician? Do you want a group practice or a solo practice? Do you want someone older or younger? Do you want someone who practices in a particular hospital? Most of us have preferences about the kind of person we want caring for us. You need to define them or else any doctor will do (and we know that's not the case). So, let's get started and let's find the right doctor for you.
First, if you have a doctor in your previous location, ask him or her if they know a good doctor in the new city. They may not, but sometimes they do, and that can shorten your search. Either way, it's worth a try, and you just might get lucky. Even if she doesn't know a primary care specialist, there may be another doctor in the city whom she knows and trusts and who can give you the names of some doctors.
Second, when you get to your new location, ask your neighbors what doctor they use and how they feel about him or her. You can learn a lot from their experiences. If you're at a new job, new church, or school, ask your coworkers, church members, or parents in the school if they have any preferences for doctors. Get them to explain what they like and don't like about their choices. You can often get some great leads this way.
Third, most hospitals have referral lists of available physicians that they will provide to you. When you speak to someone from the hospital, ask that person where he or she goes for medical care. Hospital personnel often know the good doctors from the bad. Don't hesitate to ask why they like the doctor they recommend.
You also have some choices to make about the type of primary care specialist that will care for you. Do you want a family practice physician (a doctor who cares for all family members regardless of age), an internist (a doctor trained in general medicine who cares only for adults), or a geriatrician (a physician trained to care for older adults). It really doesn't matter which of these doctors you choose as long as they are board certified and are skilled in caring for your particular medical problems.
After gathering some names, look these doctors up on the Internet and begin doing some research on them. Are they licensed in your state? Are they board certified? Do they have any disciplinary actions against them from the state board of medical examiners? Did they attend a reputable medical school? Have they published any papers in medical journals? Here are some Web sites that can be useful in helping you evaluate your doctor. www.docboard.org: This site is run by a consortium of thirty state medical boards and provides some very helpful public information about particular doctors. The quality of the data varies from state to state and is largely based on public documents. For instance, the Massachusetts site provides information reported by the doctors themselves. It is not checked for accuracy, so the data can potentially be old or incomplete, and not tell the whole story. The North Carolina board site provides data found only in public documents, while the Maryland site provides more extensive data about doctors. www.abms.org: The American Board of Medical Specialties provides information on this site. It is a good, free site that tells you whether or not a physician is board certified and what that means. When a doctor is board certified, it means that he has demonstrated a certain basic level of competency in his particular specialty. Some specialties like family practice and emergency medicine require recertification every several years, while others require no recertification or proof of competency (hard to believe, isn't it?). www.fsmb.org: The Federation of State Medical Boards is a consortium of all state medical boards.
Fourth, phone the office of all the doctors you are considering and ask some basic questions. Is the doctor accepting new patients? Will another doctor be available to treat you when your doctor is off? What happens in emergency situations? What are the office hours? What insurance does she take?
Last (and we think the most important step), make an appointment to meet and interview the doctor. We know this may take considerable time and effort (and possibly some money), but this is the most important step in finding a doctor you can trust and care for you.
Think back to when you were dating. You often knew within a few minutes whether or not you wanted to see someone again. By being in their presence and seeing how they interacted with you, you immediately knew on both a conscious and unconscious level whether you clicked with that person. The same thing occurs when you meet your doctor. Here are a few questions you need to ask yourself when meeting with a potential doctor:
* Does the doctor really listen to what I'm trying to say or does he or she interrupt before my thoughts are finished?
* Do I feel rushed by the doctor?
* Are his/her thoughts about wellness or prevention similar to mine?
* Do I feel comfortable in his/her presence?
* Was I treated courteously and with respect?
* Were my questions answered honestly and without being evaded?
As we mentioned above, there are some other things to consider when selecting a PCP, such as the location of the doctor's office (Is it convenient?); the hospital where a doctor admits his or her patients (Is it the best hospital for your care?); the health plans he or she takes (Do you have to pay more by going to this doctor?); the age, race, and sex of your doctor; his or her understanding of your cultural background; and the languages that the doctor speaks. You have to decide what factors are most important to you and make your final selection based on them.
Trust your gut instincts when reviewing your visit with the doctor. They are more often right than not. And, don't make a final selection about a doctor until you interview a few physicians. Your health is just too important to be left to chance.
When Is It Time to Look for Another Doctor or Specialist?
In the course of interviewing patients and speaking to friends, we often hear horror stories about medical care gone awry or doctor-patient relationships that are less than optimal. All relationships can't be perfect, and dealing with a doctor is no different. Sometimes you need to find another doctor because things just aren't working with the one you've got or you need help from a specialist. What are some of the signs and symptoms of a doctor-patient relationship in trouble or needing assistance?
Communication between you and your doctor is mediocre at best: Getting the best medical care requires high-level communication between both parties that is characterized by trust, careful listening to the other, and respect. If these traits are absent or sorely lacking, it's time to move on, provided the problem lies with your doctor. If the problems in communication are your fault, then finding another doctor won't make any difference.
The information you receive from your doctor is inaccurate: No doctor can be perfect because there is just too much information for one person to know. What you can expect is that your doctor is right almost all the time or he or she tells you, "I don't know but I will find out, or I can direct you to someone who does know." If you don't trust your doctor's opinion, then you need to go elsewhere.
Your doctor lies or is evasive: You should expect honesty and directness from your health care provider. If either of these is lacking after you've confronted your doctor about them, then find someone else.
You're not making progress with a particular medical problem: Sometimes looking at a problem with a new set of eyes and ears is all it takes to get to find a solution. We're sure you've seen this in many situations. You're struggling with a problem and then someone walks in and almost immediately comes up with a solution. It's not that they're smarter than you, it's just that they can view the problem from a different perspective. And if your doctor is having trouble treating you, it doesn't mean that she is incompetent. Ask to be referred to a specialist for a second opinion. This won't threaten good doctors if what they're doing isn't working. They know everyone needs help at times. Doctors also know that asking for a specialist's opinion is one of the best ways to learn.
Your doctor never has time to answer your questions adequately: Wherever we go today, it seems like everyone is in a rush. Managed care organizations want doctors to see more patients in less time so they can make more money. Doctors sometimes have as little as eight minutes per patient to evaluate, diagnose, and treat a person. It doesn't leave much time for questions. Despite this, good doctors make the time to address your concerns. If your doctor doesn't have time for you, you don't have time for him or her either. Keep these warning signs in mind and take action if you notice them in your relationship with your doctor. When you are ready to discharge your doctor and go to another, you should formally ask in writing that your records be transferred to another doctor's office. If you don't have another doctor yet, ask that a copy of all your records be available for you. If the doctor's office doesn't want to give you a copy, then have them mailed to another doctor when you finally select one. We also suggest that you indicate the reasons why you are leaving in your letter in hopes that your doctor will address your concerns; if not with you, he or she might change their behavior in the future, if appropriate. Only about 25 percent of patients ever tell their doctors why they are leaving the practice. If more patients explained why they were displeased, there is a better chance that a doctor would make some changes.
What we all want is a mutual relationship built on respect and trust with a caring, compassionate doctor. Part of the reason we don't get some of what we need from some doctors is because they don't learn it in medical school. One of the things that patients often assume is that because their doctor has gone to medical school and has M.D. after his name, he's learned a great deal about all aspects of medicine. This couldn't be further from the truth. Medical schools are so focused on the science aspects of medicine that students learn little, if anything, about many of the subjects that patients are extremely concerned about.
Why are we telling you all this? We want you to realize that there is no way that any doctor can be all things to all patients, so don't develop unrealistic expectations. Instead, make sure to ask your doctor his or her views on the following areas:
* The art of medicine: learning how to care for and listen to patients
* Death and dying: treating those dying to improve their quality of life
* Physical therapy and rehabilitation: maximizing a person's return to normal functioning after a medical illness or surgery
* Obesity care
* Nutrition, diets, and herbal supplements
* Alternative medicines: what we can learn from nontraditional approaches to a problem It's not a knock on your doctor if she is not proficient in some or all of these areas. It simply means that if you need this kind of help, you need to ask for a referral to someone more skilled in this area.
--from Special Treatment: How To Get the Same High-Quality Health Care Your Doctor Gets by Kevin J. Soden, M.D. and Christine Dumas, D.D.S., copyright © 2003 Kevin J. Soden, M.D. and Christine Dumas, D.D.S., published by The Berkley Publishing Group, a member of Penguin Group (USA) Inc., all rights reserved, reprinted with permission from the publisher.