October 10, 2013

October 10, 2013
How to Find the Right Doctor
Part 2

Welcome to another day in my life. Today is Thursday and I hope you are having a beary safe and great week so far. It is another busy week for Dab the AIDS Bear and me.

One thing all men, women and children living with HIV have to have is a good doctor. But how do you find the right doctor? Yesterday I started blogging on this subject and will finish it today.

Suppose you need hospital care at some point, as most people do even if it's only for a routine outpatient procedure. If you're young and healthy, the hospital a doctor is affiliated with might not matter much, but if you have a problematic medical history or you're moving into old age, it could be significant. Would you prefer to be close to home, or are you open to a better hospital farther away, if that's where your doctor has admitting privileges? If you have knee problems, for example, a hospital that does a high volume of joint replacements and has a good track record would be a candidate. You can find out any doctor's hospital affiliations by calling his office or by asking the hospital, which has a database of affiliated primary care physicians and specialists.

Calling the office will also give you a chance to avoid discovering after the fact that it's run like a car that desperately needs a tuneup or like a restaurant with a surly wait staff. Spending five minutes on the phone with the receptionist will tell you how far in advance you need to make appointments, the length of a typical office visit, and whether the doctor usually sticks to the appointment schedule or is two hours behind by noon. If you hear that the doctor is very busy and doesn't keep to his schedule well, and if you're someone who needs to come in and be seen without a long wait, you'll know right away that it won't be a good fit. Some doctors understand that their patients' time is important, and some even offer gifts or money back for enduring excessive wait time. While that's by no means the norm, an office that doesn't value timeliness or efficiency may be a deal breaker.

How the office is organized will affect your convenience, too. You'll want to know whether lab work or X-rays can be done in the office, or if you'll need to go elsewhere. If the doctor is totally booked, can you see someone else in the practice? Are Saturday hours available? What time does the practice open and close, and how will those hours jibe with your schedule? Is he available via E-mail, as an increasing number of physicians are?

Finding a Specialist

Over time, most people will need care that's more specialized than a primary care doctor can provide, either for a difficult chronic problem (like osteoarthritis or intractable pain) or because of a condition or test results that demand immediate attention (like a suspicious mammogram or blood in the urine).

Primary care doctors generally make reasonable referrals, so the specialist your doctor recommends should be the default choice if you don't want to keep hunting. But a doctor isn't a good fit simply because he's endorsed by another physician. A better tactic would be to ask your primary care doctor for the names of two specialists, and why he might recommend one over the other. Is it based on convenience or reputation? Especially when the referral could be for a serious medical problem, you can get right to the bottom-line opinion by asking: Would you go to him? Would you send your mother to him? Posing another question or two will tell you whether the specialist communicates well with primary care doctors; if so, your care will likely be better coordinated. Say to the doctor, 'When you send people to this person, does he or she keep in touch with you?". And ask what other patients have said about the doctor.

Experts consider board certification one of the best indicators of competency and training. A study published in the Archives of Internal Medicine in 2010, for example, described a "robust relationship" between board certification and quality of care. It isn't hard to understand why. A board certified specialist has gone through a rigorous residency followed by more training in the specialty and finally testing and peer evaluation (plus periodic recertification). A doctor's board status can be checked at CertificationMatters.org. The American Board of Medical Specialties recognizes more than 150 specialties and subspecialties, including family practice, internal medicine, surgery, cardiology, and orthopedics.

Sometimes you'll need to move fast. Need further testing to determine whether a spot on your skin is cancerous? A second opinion before beginning an experimental treatment? Been told surgery is a must? In all cases, it's most important to find out about the doctor's experience with patients like you.

The more often a doctor performs a procedure, the better he gets and the lower the chance of calamity. It follows that the more cases he sees like yours, the likelier the results will be good. Finding out is surprisingly simple, and good doctors wish more patients would make the effort. You only need to ask directly how many patients like you the doctor has seen over a recent period and how they fared. If you're discussing heart bypass surgery, for example, what you want to know is the number of these procedures the specialist has performed in the past 12 or 24 months on patients in your age group in similar physical and medical condition and the death and complication rates for those patients. To put the answers in perspective, ask if there are national benchmarks to use as comparison.

Deaths are almost unknown in some procedures, such as hip and knee replacements, so an impressively low figure may be misleading. For those, what counts is the percentage of patients who returned to a good quality of life, and again, for patients like you how long that typically took.

Vague responses ("Oh, my patients have very few complications") or figures that worry you are yellow flags. As for a doctor who brushes off your questions, that's one of those rare red flags that should make you politely end the conversation. You're never obligated to proceed with a specific doctor. Everybody is different in what they're looking for. Trust your instincts coupled with the legwork you've done, they will guide you. The bottom line, experts agree: Taking control of your care is worth the extra effort.

Hope these tips help find the right doctor for you and that you have a beary safe and great Thursday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab