Doctor Shopping

HOW TO GET THE BEST

by Hal Alpiar

Comparison shopping for doctors builds your confidence, gets you better healthcare value, and produces better results. An article entitled "How Is Your Doctor Treating You?" that appeared in a 1995 edition of Consumer Reports stated:
"As doctors have become more and more reliant on sophisticated tools, those personal aspects of medicine have often been minimized. They shouldn't be. The way your doctor talks and works with you is critical to the quality of your medical care.
"If you work with your doctor as a partner, rather than as a passive patient, you're more likely to feel in control, to tolerate symptoms well, and to take responsibility for improving your health.
"More important, you may also be diagnosed more accurately, respond better to treatment, and recover more quickly."
When it comes to shopping for healthcare professionals, healthcare services (hospitals, nursing homes, rehab facilities), and healthcare products (drugs, medical supplies), you always have alternatives to choose from.

THE TELEPHONE INTERVIEW CHECKLIST
The time to get to know your doctor is before you need a doctor.
To begin with, you must be prepared for your call to the doctor's office before you call. Call during the mid or late afternoon (avoid Mondays, as these tend to be unusually busy). Take some deep breaths both before you call and while the person who answers is speaking. Be polite but assertive. Have your list of questions ready and don't stray from them. Be prepared to jot down notes about everything, including the attitude of the person answering the phone, the number of interruptions during your conversation, and the amount of time, if any, you spend on hold.
Depending on your comfort level, start out with a greeting and go directly to your list of questions; you can easily introduce and explain yourself along the way once you feel the person you are speaking with is worth your energy. If you feel uncomfortable with that approach, you might begin with an opening statement such as: "Hi, my name is Sherlock Columbo, and I am looking for a new doctor for immediate care, and I have a few questions. Can we talk right now, or should I call back later?" If the response is "later," find out when, and be sure to call back when requested. If the person on the phone is willing to answer your questions, proceed.

THE QUESTIONS
Certification

  • Is the doctor board-certified? For what? By what Board(s)? When? You can confirm the answers by calling the Boards directly.
  • Training

  • Does the doctor have any fellowships? In what areas? From where? When were they completed?
  • Experience

  • How long has the doctor and/or practice been in practice?
  • What specialized clinical experience (like involvement with amateur or professional sports teams, research or treatment institutes, or military medical service) does the doctor have?
  • How many patients does the doctor normally see in a week (or month or year)? For surgeons, how many surgeries does the doctor normally perform in a week (or month or year)? What types of surgery by percentage does the doctor typically do? What is his or her overall success rate? Overall complication rate?
  • Professional Relationships

  • What hospital(s), Medical Center(s), or Institute(s) is the doctor affiliated with? At which of these establishments does the doctor have admitting privileges (which place can he get you into as a patient)?
  • What teaching situation(s) is the doctor involved with? Doctors who are actively teaching tend to have a more informed, more up-to-date working knowledge of current research and experimental procedures than those who are not teaching.
  • What are the doctor's (or group practice's) managed-care organization affiliations?
  • Accessibility

  • How available is the doctor for emergencies? How far away from the hospital does she/he live? What are his/her backup arrangements? How does the doctor's on-call phone service work? Be sure to get the name of any doctors that are mentioned as providing backup care and follow-up with them.
  • Is there a case manager who maintains ongoing communications with you and/or your family? A case manager arrangement, though not often available, is highly desirable because it helps ensure that patients, families, and referring physicians will be kept informed of status/ progress on a daily/hourly basis, even when the doctor isn't available.
  • How "accessible" is the doctor personally? In other words, what can the person on the phone tell you about the doctor's bedside manner and personality?
  • Administrative

  • Do you accept my insurance plan (if you have an insurance plan)? How much help can I (we) expect in processing claims? How much help can I (we) expect in completing other paperwork (e.g. releases, family histories, etc.)? In copying and forwarding records? In having access to copies of records?
  • What exactly are your billing practices? Do you accept credit cards? Do you see Medicare and Medicaid patients? Do you ever make exceptions?
  • Regardless of whether you are able to get through all these questions or not, be sure to thank the person responding to you for his/her time and attention. Remember, although your desire for information is justifiable, you have nevertheless been intruding on that individual's time and normal work routine.

    SOME ADDITIONAL POINTS TO INVESTIGATE
    Who's "privileged" to do what, where?

    Make sure that you end up with a doctor you want who is "active" and/or "on-call" (has admitting privileges) with a hospital you want. You really can have both, and you need not settle for anything less, unless there's only one hospital within reasonable traveling distance and affordability.
    Knowing what hospital(s) your doctor(s) has(have) what kind of privilege(s) at is especially important in your selection of (for example) OB/GYN's, internists, cardiologists, pediatricians, and orthopedic surgeons. These doctors deal with many more emergencies and intensive treatments than (for example) most dermatologists or optometrists.

    Will you be treated as a partner or a patient?
    Ask a doctor what she/he expects from you as a patient, or patient family member. The response you get will be very telling. The spectrum can vary from "nothing," to "pay the bills," to "not bug me," to "act as a partner," to "take responsibility for doing what I tell you," to simply: "do what I tell you," to: "be honest," to: "not see any other doctors without calling me first," to: "follow directions."

    Ask about diagnostic and treatment procedures
    Are they painful? If the response is that some (or minimal) discomfort is involved, ask to have that discomfort described to you in detail so that you can understand exactly what to expect. Doctors, obviously, do not want patients to think about pain (especially in elective surgical procedures) because it may cost them canceled appointments and procedures.
    You need to know (and are entitled to know) what to expect. This will make the experience more bearable; it's the unknown that causes fear.
    Are the diagnostic and treatment procedures in question effective? How have they worked for others with similar circumstances? Are there side effects? After-effects? Being anaesthetized, for example, may or may not produce any immediate reactions and may or may not produce significant long-term reactions, yet many cases of nausea, muscle or joint pain and backache have been reported as attributable to anesthesia for months after surgery.
    Most doctors should automatically provide appropriate educational materials, but when they're not offered, ask for them. Ask for diagrams. Ask for videos, audiocassettes, booklets, and information sheets. Ask for books and references you can consult. Request information on support groups, national hot-line numbers, recovery organizations, in-home rehabilitation services, related hospital or institute programs. Any doctor who can't or won't provide reasonable amounts of information or appropriate resources to contact is simply not a good doctor by any measure. Go to someone else.

    TAKING DOCTOR LIMITATIONS TO THE LIMIT
    Patients often recognize the need for two-way communication. Doctors often do not. To turn a monologue into a dialogue, you need to break down your own expectations, and those of the doctor. To do this, you need to take responsibility for prompting the doctor to abandon his or her (one-way) lecture and replace it with a more open (two-way) discussion.
    What are your expectations about communicating with your doctor? The following tips on expectations are excerpted from a book by Kate Lorig, R.N., and James J. Fries, M.D., entitled The Arthritis Helpbook (3rd edition, Addison Wesley, Reading, MA, 1992). To communicate (better) with your doctor:

    1. Ask questions. To be sure you don't forget, go to your appointment with a written list of two or three important questions. Think about exactly what you want from this visit. Don't wait for the doctor to ask for questions. Ask them when you first enter the office. Research has shown that it is important to ask questions early in the appointment. Later, if you don't understand something, ask. "How many aspirin?" "What kind of exercise?" "What do you mean by synovitis?"

    2. If for some reason you know you won't or can't follow the doctor's advice, let the doctor know. For example, "I won't take aspirin. It gives me stomach problems." "I hate exercise." If you don't share your problems, there is no hope of finding solutions.

    3. If you have problems with your treatment, let your doctor know. Don't just stop or change doctors.

    4. Finally, don't be afraid to ask financial questions. You have a right to know how much an appointment will cost. You can ask the receptionist when you call the doctor's office. If you feel a treatment is too expensive, ask if there are any alternatives. For example, an exercise class at the Y or senior-citizen center may be as effective as working with a physical therapist. You may be able to test your own urine at home.
    There are almost always solutions to such problems if they are discussed. In short, to get the most from your doctor, be a CAD: Come prepared, Ask questions, Discuss problems.

    From Doctor Shopping: How To Choose The Right Doctor For You and Your Family, by Hal Alpiar. 1996. Excerpted by arrangement with Health Information Press. $12.95. Available in local bookstores, or call 800-633-7467.


    What Does Board-Certified Mean?
    The term "board-certified" suggests that a doctor has received extensive training and undergone examinations to achieve these credentials. This is not always true. Many physicians are affiliated with professional organizations or self-designated boards and are guilty of misrepresenting themselves by advertising as board-certified in the Yellow Pages directories. In addition, many of the "specialists" in the specialty guide haven't been trained in the specialty under which they are listed. See information below to find out how you can check your doctor's credentials.

    How to Examine Your Doctor

  • Questionable Doctors: Disciplined By State or Federal Government, by Public Citizen Health Research Group (Ralph Nader's organization). Itemizes details of offenses ranging from prescribing errors to felony crimes, as well as disciplinary actions taken. Check your local library for a copy.
  • American Board of Family Practice. Lexington, KY, 606-269-5626. To check on licensing and certification of a Family Physician/Practitioner (FP).
  • American Board of Medical Specialties (ABMS). 800-776-CERT (2378). To verify a physician's credentials, call M-F 9am-6pm EST. Information includes whether a physician is board-certified, the year certified, and the board or boards under which the physician has received certification.
  • MedSeek. http://www.medseek.com. Locate a physician, learn about their work and philosophies by searching their MedSeek Portfolios on this Internet directory. Currently lists 280,000 physicians and links to over 450 hospital information sites, searchable by city and state. Information is promotional not critical.