The Right MD for Me
Internist Dr. Carolyn Clancy recalls a time when her husband got a recommendation for a physician from a close friend. The specialists she knew in the field were booked.
“My husband went in with very high hopes and found very, very quickly that this was not a good fit for him,” said Clancy, director of the Agency for Healthcare Research and Quality, part of the U.S. Department of Health & Human Services. After one or two visits, her husband changed doctors.
“He didn’t speak to his friend about what made a good doctor,” she said. “He didn’t ask: ‘Why do you think this person is good?’”
Clancy used the story to illustrate a point made repeatedly by doctors and other experts discussing a vexing problem with finding the right physician: “Someone who’s a good doctor for me may not be for you,” she said.
Prospective patients should ask many questions as they’re seeking a physician. They should inquire about a provider’s credentials and experience and ferret out convenience issues about the medical practice. The issue that’s perhaps the most important but hardest to nail down is personal.
“It’s all about relationships,” said Dr. Colleen Conry, a professor of family medicine at the University of Colorado School of Medicine. “Every doctor is a little bit different.”
Checking Credentials
Whether the issues are practical or personal, far too many people don’t do enough homework before selecting a physician.
“The average person spends probably more time shopping for a mattress or a color TV than they do for their doctor, which is obviously a mistake,” said Don Powell, a psychologist and president of the American Institute for Preventive Medicine. “A physician could be saving your life.”
An American Medical Association brochure titled “Choosing Your Physician: A Guide to Getting Quality Health Care” provides 21 questions for people to ask before deciding on a physician. They range from which medical school the physician attended to how she handles patients’ health maintenance.
By asking such questions, Conry said, “You can learn enough to make sure that the doctor you pick is well-trained and has credentials to make him provide good care.”
You may be concerned if a doctor has a degree from a foreign school, but even the experts say that may not matter. Dr. Christina Finlayson, a surgical oncologist and professor at CU’s School of Medicine, said those doctors must take the same tests as American-trained physicians and might be asked to redo some training if they don’t score well.
While experts agree that professional associations don't seem to matter much to patients, they say that board certification is vital.
Most states maintain publicly accessible registries that list complaints and legal actions against health care providers. In Colorado, for example, it’s the Colorado Medical Board, part of the Department of Regulatory Agencies.
If you're seeking a specialist, you should start with your primary care physician.
“They often know the quality issues that you would never find out,” Conry said. “And, if you go through your primary care doctor, it ensures that your primary care doc can coordinate your care.”
Also, specialists sometimes aren’t good at explaining things, “so you want your primary care physician to be in the loop so they can explain to you what happened,” Conry said.
The Role of Insurance
Most insurance plans are managed care plans, which fall primarily into two groups: health maintenance organizations and preferred provider organizations.
HMO members' health care costs generally are covered only if care is obtained from a provider who is part of the HMO network. They usually must start with a primary care physician, who serves as the “gatekeeper” for access to specialists. PPOs also create networks, but services obtained from a health care provider outside the network may be partially covered.
Some traditional insurance plans, which allow you to see any health care provider you choose, still exist, but they are generally much more expensive than managed care plans.
“Greater choice comes with some additional cost,” said Susan Pisano, vice president for communication of the trade organization America’s Health Insurance Plans.
“One of the great benefits of a (managed care) health plan can be the network of providers, because the health plan will have done some homework with respect to the credentialing of the providers,” Pisano said. The plan’s directory displays providers’ gender, specialty, hospital affiliations, board certifications and languages spoken, indicates whether they are accepting new patients and lists details such as office locations and hours.
“I tell people not to look at what a plan is called," Pisano said. "I tell them to look more at how it works.”
If you have no insurance and earn too much to qualify for government assistance, says Don Powell of the American Institute for Preventive Medicine, ask the doctor if she has a different fee structure for uninsured patients and if charges are negotiable.
Convenience and Personal Issues
The AMA brochure suggests you ask for the names of the hospitals with which a doctor is affiliated. That could mean a great deal if you’re hospitalized.
Other convenience issues to ask about include the doctor’s hours, whether parking is available at the office, who covers for the doctor when he’s on vacation, communication avenues and how long it usually takes to get an appointment.
To some people, the age and gender of the doctor are important. Gender is usually a comfort issue while age, Clancy said, “cuts both ways."
"Studies find more experienced doctors over the years have accumulated a kind of clinical wisdom,” she said, but younger doctors are “closer to the cutting edge of science.” Still, she added, some patients don’t want a doctor to “look like a high school kid.”
Some prospective patients, Conry said, seek a middle ground with doctors’ ages: “The ink on their diploma is dry, but it’s not so old it’s falling off.”
Getting Information
Experts differ in their views about what prospective patients can learn from telephone and website research. Although some websites, such as healthgrades.com and ratemds.com, purport to rank doctors, Finlayson expressed reservations. “I personally don’t know how valuable they are,” she said. “They’re not controlled; you don’t know who’s putting up what.”
No matter how much preliminary research you do, Conry said, “What you can’t do is figure out if they’re a good match for you.”
That’s where face-to-face meetings come in. At the first appointment, consider how well you and the doctor can relate. Clancy says you should note how easy it is to communicate with the doctor. Powell suggests you watch for eye contact and note whether the doctor answers your questions in an unhurried manner. Conry says the doctor should listen to your concerns and let you share in the decision-making.
A sizing up of the staff is also necessary.
“If I call a doctor’s office and the receptionist is rude to me, I should not go to that doctor’s office,” Conry said.
“In the end you need to find someone you can communicate with easily,” Clancy said. “Communication doesn’t help health care -- communication is health care.”