October 9, 2013

October 9, 2013
How to Find the Right Doctor

Welcome to another day in my life. Today is Wednesday and we have almost made it thru the middle of another work week. 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? That is what I am going to blog about today and tomorrow.

Finding the right doctor isn't easy and it shouldn't be. When you put your life in someone else's hands, you need to feel confident that this is an individual with enough smarts, qualifications, and skills to give you the care you deserve. You should shop for a doctor the same way you interview a lawyer or an accountant. You could be starting one of the most important professional relationships you ever have. People know more about how to buy a car than they do about selecting a doctor. It's not so much a matter of labeling a doctor as "good" or "bad" you want to go beyond just weeding out physicians who have gotten themselves into professional or legal hot water. It's about comfort level; whether a particular doctor is good for you. Smart questions and a little healthy skepticism can help you find Dr. Right.

Evaluating a Doctor: What to Consider

What kind of care are you looking for? A primary care doctor helps keep you healthy, provides a home base for all your medical needs, and is your go to when you're sick. A specialist has a deeper but narrower skill set, and may serve only a short term purpose, like diagnosing a problem or designing a treatment regimen. Experts suggest starting with a primary care doctor who can then help direct you to the most appropriate specialist or sub-specialist (think cardiologist for a possible heart problem or a cardiac electrophysiologist for a heart rhythm problem), should the need arise.

Having roughly determined the general category of physician, the next step is to ask yourself what blend of experience and personality traits are important to you so that you and the doctor will be a good fit. It's a mix that obviously depends on the relationship you will have with the doctor. If it's long term, such as one with a primary care doctor or with a specialist who sees you for an ongoing condition, personality and demeanor will carry more weight than if it's a one or two time encounter with a specialist or surgeon.

You'll want to be alert for warning flags, which are more likely to be cautionary yellow than stop now red. Where a doctor went to medical school and did his residency training are good to know. (Resources like U.S. News's Top Medical Schools shed light on program quality.) But how much emphasis to place on a doctor's schooling is contentious. Some medical experts believe that the best medical schools produce better doctors by being more selective and training the future physicians more rigorously. Others say education is only a consideration if it raises one of those yellow flags. Some people go out of the country as a roundabout way to get a medical degree. Is that person less competent, or is there a reason why [he] couldn't get into a U.S. medical school? Maybe not, but it's another question to ask. And if the doctor isn't willing to answer, that says something.

Once the candidates are narrowed down to a manageable number, Google is your friend. Most doctors have at least some degree of online presence that can give you valuable insights. You can tell how transparent a doctor is based on how friendly his site is. What kind of communicator does he appear to be? Does it seem like he's available via E-mail? Any research papers he's authored and displays might give you an idea of special interests and strengths, too. But a website is just one evaluation tool, not a deal breaker. A doctor who doesn't have one could be the one you want.

If a doctor's gender makes a difference to you, there may be more to think about than just personal preference: Studies have found that female doctors may do a better job than their male peers of providing basic preventive services to both men and women. Evidence suggests that women do prefer care from female doctors, particularly if they need screening tests for breast, cervical, or colon cancer. (Male patients are more open to a physician of either gender.)

As for age, older doctors obviously have more experience to bring to the examining table and younger ones may be more savvy about advances and more open to new techniques, but that doesn't readily translate to conclusions about which ones are likelier to be better doctors. It's your call.

It's smart and completely within your rights to set up an introductory phone call with any doctor you're considering. Most doctors will make time to do this, experts say. Does he or she sound like someone you could relate to? People sometimes think this is a binary decision you gather information, you pick one of the doctors, and then all the dominoes fall into place. Choosing a doctor is step one. Working with [him or her] is the rest of the process. A few leading questions can shed light on a doctor's decision making style, and whether she works with patients to design a treatment plan or whether she feels strongly that she's the doctor and what she says goes. For example: Can I weigh in when I have ideas about my care? Neither approach is right or wrong.

Finding the Best Primary Care

Everyone needs a doctor trained in treating and managing the usual run of medical problems, from colds to migraines, as well as chronic conditions like diabetes and high blood pressure. He will assess your symptoms and, if necessary, direct you to the right specialist. If he's doing his job correctly, he'll also coordinate your care, communicating with other doctors you see and making sure nothing slips through the cracks. Internists, who treat adults ages 18 and over, are the broadest category of primary care providers. Some women choose their gynecologist as their primary care doctor. Geriatricians specialize in older people. Family practitioners see both children and adults; in small towns, their services often include obstetrics and minor surgery. Pediatricians, of course, treat kids. Besides M.D.'s, nurse practitioners and physician assistants are reasonable options for healthy patients who are interested in wellness care and counseling.

Most often, patients look for a primary care physician by asking family and friends for suggestions, and experts say that's fine for starters. But finding out why your brother or aunt likes the doctor is critical. One of my family members chose a doctor based on a friend's recommendation. Then she found out that her friend preferred a patriarchal figure who gives orders. That relationship did not work out.

Online resources claiming inside information on physicians are abundant, but most simply list easily attainable contact information and facts about the physician's medical education, board certification, and possible disciplinary actions. U.S. News's Top Doctors, a compendium of more than 27,000 physicians nationwide, can identify doctors recommended by their peers based on their clinical skills, including how well they relate to patients, and other qualifications such as education, training, hospital appointments, and administrative posts. Top Doctors is linked up with the U.S. News Best Hospitals rankings so you can see which physicians are at the nation's best hospitals, and narrow the field by specialty or location.

There also are websites like HealthGrades.com or RateMDs.com where patients can post reviews of their doctors. Proceed with caution. A typical primary care provider may have several thousand patients, and very few doctors on such sites are rated by more than a tiny handful. A lot of doctors don't have a representative set of ratings. If you see a doctor with two or three ratings, they're likely going to be very negative or very positive, and I'm not sure how accurate that is.

Tomorrow I will finish blogging on this topic and I hope you have a beary safe and great Wednesday!

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

big bear hug,

Daddy Dab