| It's different with
doctors. For one thing, it's harder to shop around before you make
your move. For another, starting with a new doctor doesn't require
an up-front investment of tens of thousands of dollars. Early on, all
you've invested is some time and inconvenience. And finally, choosing the
right doctor potentially is a matter of life and death.
Many patients have the same attitude when
they're dissatisfied with their doctors that they would have if they were
dissatisfied with a car - "Oh, well, guess I'll just have to live
with it." This is the wrong attitude, since, indeed, in this
case you may not live with it. Doctors are serious business.
Choosing a doctor is an important
decision, but it's not an irreversible one. It's not uncommon for
discerning patients to run through two or three doctors before finding the
right match. And there's nothing wrong with doing it that way. So if
you've tried a new doctor and you're not satisfied with him, get another
one. Remember: You hired him; you can fire him.
The most important
factor in choosing a doctor
That would be communication.
If you can't communicate well
with your doctor, you're in trouble. This is the person, after all,
who will need to understand your wishes and values regarding your health
care. She is the one who will need to explain to you, so that you
can understand it, the nature of your medical problems - the causes, the
testing that may be needed, the potential treatments, the pros and cons of
the various therapeutic options, and why she's recommending one option
over the others. She's also the one who has to convince your
insurance carrier that the course of action you and she have decided upon
is the right one, that it's medically necessary, and that they - the
insurance carrier - ought to pay for it. Communication has always been
important in medicine. Now it's vital.
Is your doctor really
listening to what you are saying? Does he show he understands your
concerns by responding meaningfully to them? When he explains
medical issues to you, does he make them understandable? Does he
have more than one way of explaining a difficult concept? Is he
patient with you, waiting for you to grasp what he's saying, or does he
try to embarrass you into saying you understand, with shakes of his
head or rolling of his eyes? Do you like him, and more importantly, does
he seem to like you? (This may become very important when it's time for
him to go to bat for you.)
The inability to communicate
effectively with your doctor is sufficient reason to move on to someone
else. Without communication, you've got nothing.
The second most
important factor
Does your doctor know what
she's doing?
Sometimes its hard to know
for sure how knowledgeable your doctor is. But at a minimum you
should check to see if your doctor is board-certified in her
specialty. (Note: there are board certification exams in the primary
care fields of general internal medicine, family medicine, and
geriatrics.) Two sources can help. The Directory of
Physicians in the United States and the Official American Board of
Medical Specialties Directory of Board Certified Medical Specialists
list doctors who are board-certified. These books are available in
most public libraries, and your doctor should appear in them.
Does your doctor seem
smart to you? When you ask a question about one of you health
problems, are the answers quick, logical, and cogent? Do the answers
jibe with what you know to be true? Are her answers given
confidently, or is she dissembling? Keep in mind that it's often
fine for a doctor to answer, "I don't know," as long as she
promises to find out the answer, and then follows through on that promise.
For specialists you will be
seeing only once or twice, or who you are going to for some complex or
esoteric medical procedure, their experience, knowledge and ability are often much more important than
how well they communicate. If I'm having a heart valve surgery, I
care much less about how warm and fuzzy the surgeon makes me feel during
the pre-op interview, and much more about how many similar procedures
she's performed, and what have been her surgical results.
The third most
important factor
Is your doctor respected by
his peers?
Doctors watch each other
perform in the trenches, and in general, are pretty good at sizing each
other up. If you can get a recommendation on a PCP from a doctor you
know you can trust, that's likely to be a good starting point. If
you know some doctors, ask them what they think. Would they send their own
patients to your doctor? Or, better yet, do they send their own family
members to him? Do they use him as their own doctor? If
your doctor is invited to participate in the training of medical students
or medical residents at the local university, that's a reasonably good
sign that he's held in high regard by his peers. (A caveat from DrRich,
who was a lifelong academician himself - note that academics often sing
the praises of other academics not because they are especially good
doctors, but because they have published a lot, or are in positions of
power. Some of the most famous university doctors are not especially good
clinicians. Take the advice of an academic with a grain of salt.) Other
factors to consider Where
is your prospective doctor located? Is her office convenient to you? Which
hospitals does she have admitting privileges to? Are these hospitals
convenient to you, and do the specialists there (since the specialists in
those hospitals are the ones she will be referring you to) have a good
reputation? What are
her practice arrangements? Who covers for her when she is away? Is
her age, gender or race important to you? What
is her office staff like? Are they reasonably competent, friendly,
and helpful, or is their main job to keep you out? What
are her office hours and office policies? What
insurance plans does she participate in? This may be especially
important if you are likely to be changing jobs (and thus changing
insurance carriers.) Next:
Where to look Return
to YourDoctorintheFamily.com
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can't just get rid of it - why, it lost 50% of its
original value the minute you drove it off the lot. Besides, it's not life
and death, it's just a car. So if your new car turns out to be a
disappointment, you'll usually shrug your shoulders and resolve to live
with it for a few years, at least until you can justify buying another
one.