Dr. You

Choosing the right doctor is a crucial step in managing your healthcare. It involves gathering and evaluating information from different sources to make an informed decision. This section offers updated strategies and resources to help you find the most suitable physician for your needs.

Patient Story – (The story is true; the patient’s and provider’s names have been changed.)

Karen spent her 30s suffering from various health issues due to misdiagnoses and improper treatment. After 12 years of declining health, including botched brain surgery, she sought care at Mayo Clinic. There, pharmacogenomic testing revealed genetic mutations affecting her medication metabolism. Karen was initially misdiagnosed with acromegaly, leading to her unnecessary brain surgery. Despite treatment, Karen experienced memory issues, irritability, and other symptoms for over a decade.

After 12 years, Karen turned to Mayo Clinic for a second opinion. Mayo Clinic doctors discovered her genetic mutations within six months, explaining her adverse reactions to medications. Karen’s medications were adjusted based on her genetic profile, leading to significant improvements. Karen is now regaining cognitive functions and experiencing better overall health. Karen credits Mayo Clinic’s collaborative approach and willingness to listen for her improved care. She believes that without this change in medical providers, she “would have died by now

Choosing a Primary Care Physician (PCP)

Your PCP is a key person in your care. S/he serves as your main point of contact for healthcare, providing comprehensive care and coordinating specialist referrals. Ideally, they should understand your medical history, preferences, and help you make informed decisions. Consider that a typical primary care physician may see 2,000 to 3,000 patients, and they may see as many as thirty patients on busy days.

Key Steps to Finding a PCP

1. Check Your Insurance Network. Contact your insurance provider or visit their website to identify in-network doctors. This will minimize out-of-pocket costs.
2. Determine the Right Type of Doctor. Common PCP types include:

• Family Medicine: Provides care for all ages.
• Internal Medicine: Focuses on adult care.
• General Practice: Offers broad medical care for various ages.
• OB/GYN (for women): Specializes in women’s health, including pregnancy and gynecological care.

3. Seek Referrals. Referrals can be a reliable way to find a good doctor. Ask trusted friends, family, nurses, and other healthcare professionals for recommendations. Sources of Referrals include:

• Primary Doctor: Your PCP can recommend specialists.
• Trusted Individuals: Seek recommendations from family, friends, neighbors, or coworkers.
• Online Referral Sites: Use websites like FindADoc.com or DoctorScorecard.com (evaluate these sites critically).
• Insurance Company Ratings: Your insurance provider may offer performance data on doctors in their network.
• Hospital Quality Data: Some hospitals provide data on patient outcomes and satisfaction.

4. Consider Convenience. Evaluate factors like:

• The practice office hours and communication methods (phone, email, patient portal).
• Hospital affiliations (where the doctor has admitting privileges).
• Office location and accessibility.
• Availability for urgent appointments.

5. Schedule a Preliminary Call. Contact potential practices to ask essential questions (listed on next page).
6. Evaluate a Physician’s Qualifications. Before committing to a doctor, carefully review their qualifications and background. Key Areas to investigate include:

• Medical School and Residency: Look for reputable institutions.
• Board Certification: Certification indicates the doctor has met rigorous standards in their specialty. Prioritize board-certified doctors who have completed residency training in their specialty. Verify board certification status through the American Board of Medical Specialties (ABMS) at https://www.abms.org/.
• Professional Associations: Check the website of the relevant medical association for licensing, certification, and support information. For example, the American Academy of Family Physicians (https://www.aafp.org/) for family medicine doctors.
• Disciplinary Actions: Check for any history of professional misconduct on the Federation of State Medical Boards (FSMB) website: https://www.fsmb.org/. This site will direct you to each state’s medical board.
• Conflicts of Interest: Investigate potential conflicts of interest by checking the Open Payments database, which discloses payments from drug and medical device companies to physicians: https://www.cms.gov/openpayments/.

7. Check the Doctor’s Reputation. While subjective, a doctor’s reputation can offer valuable insights. Methods for assessing reputation include:

• Talking to current patients: If possible, speak with patients in the waiting room to gather their experiences (be mindful of privacy).
• Consult with other healthcare professionals: Nurses, pharmacists, and other doctors can provide informed opinions.
• Check online reviews: Explore reputable review sites like Healthgrades (https://www.healthgrades.com/) and Zocdoc (https://www.zocdoc.com/). Be cautious of solely relying on online reviews, as they can be biased.
• Identify local resources: Check local magazines, newspapers, or websites that may publish “top doctor” lists (consider these as one piece of information).

Focus on Facts: Prioritize objective data, such as the number of procedures a doctor has performed or patient satisfaction scores.

Contacting the Practice

Your initial phone call to a practice can provide valuable insights. Here are some essential questions to ask:

• Are you accepting new patients?
• Do you accept my insurance plan?
• What is the typical waiting time for an appointment?
• How much time do doctors typically spend with patients during appointments?
• Can I have a same-day or an urgent appointment if needed?
• What are the office hours?
• What is the procedure for after-hours care or emergencies?
• Is the doctor part of a group practice? If so, can I learn more about the other doctors?
• Which hospitals are affiliated with the practice?
• What is the cancellation policy?
• Is lab work done in-office or at an off-site facility?
• Does the practice assist with insurance claims?
• Observe the Phone Etiquette. Assess how quickly the phone is answered and the politeness and helpfulness of the staff.

Key considerations for the interview:

• Practice location, accessibility, and parking.
• Hospital affiliations.
• Location of lab and X-ray facilities.
• Wait times for appointments and availability for urgent appointments.
• Friendliness and courtesy of the staff, and timeliness of call returns.
• How does the doctor handle after-hours calls, and does the doctor work in group practice?
• How do they process claims?

During the appointment, assess if the doctor:

• Communicates openly and honestly.
• Encourages questions.
• Listens to your opinions and concerns.
• Answers your questions clearly.
• Is not defensive.
• Has experience treating your condition successfully.
• Spends adequate time with you.
• Respects your preferences.
• Explains things in a way you understand.

Additional Points to Consider

• Coordination of Care: Ask your PCP if they are comfortable coordinating and managing your overall treatment plan.
• Medical Home Model: Consider doctors who follow the “Patient-Centered Medical Home” model, which emphasizes team-based care, coordination, and patient involvement. Learn more about the principles at the Agency for Healthcare Research and Quality (https://www.ahrq.gov/).
• Electronic Medical Records and Communication: Ask if the practice uses electronic health records and offers secure communication channels (e.g., email, patient portal).

Finding Specialists and Surgeons

When you need specialized medical care, finding the right specialist or surgeon is crucial. This guide provides updated information and step-by-step advice to help you make informed decisions. The key factors are outlined below:

1. Check Your Health Insurance Coverage

Network Providers: Contact your health insurance provider to get a list of specialists covered by your plan. Out-of-Network Options: If you want to see a doctor outside your network, understand the out-of-pocket costs. If you are changing your job or health plans, consider your doctor preferences before deciding.

2. Start with Your Primary Care Physician (PCP)

Your PCP is your first point of contact. Ask for referrals to specialists who are experienced in treating your specific condition. Ask for multiple names. One good question is “If you were in my situation, which doctors would you recommend for yourself or a family member?” After getting referrals, research each physician’s qualifications, experience, and patient reviews.

3. Evaluating a Doctor’s Experience and Expertise

Experience Matters. Studies suggest that doctors with more experience treating a specific condition tend to have better outcomes. Find a doctor with a proven track record of successfully treating patients with your specific illness or performing the necessary procedure. Do consider that some doctors handle very difficult cases, and they may be better qualified, even if their success rates aren’t as good.

4. Research Specialists and Surgeons

Consider the following:

• Hospital Affiliations: Research the hospitals with which the doctor is affiliated to assess their quality and reputation.
• Board Certification: Verify that the doctor is board-certified in their specialty. This indicates that they have met rigorous standards of education, training, and competence. You can typically verify board certification on the member organization’s website. For example, you can verify a surgeon’s certification on the American Board of Surgery website.
• Disciplinary Actions: Check for any disciplinary actions or malpractice claims against the doctor. Most state medical boards provide this information online.

Online Resources: Use online resources to gather information about potential specialists. Here are a few of the best:

• Healthgrades: (https://www.healthgrades.com/) Provides doctor profiles, patient reviews, and ratings. It provides information on a doctor’s education, hospital affiliations, and patient satisfaction ratings.
• Vitals: (https://www.vitals.com/) Offers doctor information, patient reviews, credentials, and patient ratings.
• Zocdoc: (https://www.zocdoc.com/) Allows you to find doctors, book appointments, and read verified patient reviews.
• RateMDs: This site uses a five-point scoring system and provides information on doctors’ hospital affiliations, educational background, and languages spoken. Users can search by gender, area, and specialty.
• WebMD: In addition to its physician directory, WebMD offers information and public forums for finding healthcare providers based on ratings and reviews.
• American Board of Medical Specialties (ABMS): The ABMS maintains a database of over 997,000 physicians and offers a “Certification Matters” service for patients to verify a doctor’s board certification status.
• Yelp: While primarily known for business reviews, Yelp now includes reviews for medical practices and individual doctors

5. Consider Telehealth and Virtual Consultations

• Many specialists now offer telehealth or virtual consultations. This can be a convenient option for initial consultations, follow-up appointments, and managing chronic conditions.
• Telehealth can save you time and travel costs, and it can provide access to specialists who are not located near you.
• Telehealth may not be appropriate for all conditions or situations. Some examinations and procedures require an in-person visit.

6. Schedule a Consultation

Prepare Questions: Before your appointment, prepare a list of questions to ask the specialist. This may include:

• What is your experience treating my condition?
• How many procedures like the one I need have you performed?
• What are the risks and benefits of the recommended treatment?
• What are alternative treatment options?
• What is the expected recovery time?
• Bring Your Records: Please bring your medical records, test results, and a list of your current medications to the appointment.

Bring a Support Person: Consider bringing a trusted family member or friend to help you take notes and remember important information.

7. Shared Decision-Making

• Active Participation: Be an active participant in your healthcare decisions.
• Express Concerns: Do not hesitate to express your concerns and ask questions until you fully understand your diagnosis and treatment plan.
• Treatment Options: Discuss all available treatment options with your doctor, including the risks, benefits, and potential side effects of each option.
• Personalized Care: Collaborate with your doctor to create a treatment plan tailored to your unique needs and preferences.

8. Seek a Second Opinion

• Complex Cases: For complex or serious conditions, consider seeking a second opinion from a specialist in a related field.

• Peace of Mind: A second opinion can provide you with additional information and reassurance.

• Insurance Coverage: Check with your insurance provider to see if they cover second opinions.

9. Your First Visit

• Office Environment: If the office is dirty, poorly furnished, or the staff is not courteous, consider finding another doctor.
• Doctor’s Demeanor: If the doctor appears overworked, distracted, or fails to listen to you, consider seeking a different doctor.
• Share Information: Make sure the doctor has all necessary medical records.
• Complete Forms: Please complete any necessary forms in advance.
• Medication List: Please bring a list of all medications, including their dosages and frequency.

10. During Your Appointment

• Communicate Openly: Share with the doctor how you are feeling, including any concerns about your emotional health.
• Ask Questions: Ask the doctor to explain anything you do not understand.
• Treatment Options: Ensure the doctor explains all your treatment options clearly.
• Follow-Up: Know when you should return for another appointment and what the purpose of that appointment will be.
• Action Plan: Ensure you are clear on the steps to take between appointments, the warning signs to look for, and how to effectively communicate with the doctor between appointments.

11. Doctor Recommendations

• Be Cautious: Be cautious when a doctor recommends another physician in their practice, as they may have incentives to do so.

12. Making the Right Choice

Your doctor is your choice. Whether the doctor has recently, frequently, and successfully treated my illness or performed the necessary procedure is a key factor. Remember, you do not have to accept a doctor with whom you are not comfortable. Taking control of this choice is critical to getting safe, quality, and affordable healthcare.