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How to choose a doctor

Last updated: March 2013

Getting started

Choosing a doctor is one of the most important things you will do in your life. You will trust this person for his or her expertise, advice and to administer treatment that may save your life.

And remember that choosing a physician is just that; a choice. You need to be happy with your doctor and the treatment-on the medical level and a personal level-that you receive. Whether you're looking for a primary care physician or a specialist, it pays to do as much research as you can to ensure that you find the right match.
 

Get a referral

Try to avoid picking a doctor at random from your health plan's list or out of the phone book. In a Consumer Reports survey, people who found their physicians through someone they trusted—a friend, a family member, or another doctor--had the most favorable experiences. (We found a similar phenomenon in a survey of consumers who visited mental-health professionals.)

If you're picking a doctor to care for a specific condition, ask about how often he or she treats cases similar to yours. Patients we surveyed who took this step were more satisfied with their care. You can also ask the doctor about specialty board certification, which requires advanced training and the passing of rigorous tests.

Generalist or specialist?

Everybody needs a doctor who performs routine health exams and can treat common, everyday problems like the flu and muscle sprains. Such primary-care doctors— typically a family-practice physician or general internist—should also coordinate and oversee any care you get from specialists for severe or complicated problems, such as cancer or heart disease.

Some people, however, may want to get their primary-care from a physician with special expertise or training. For example, people older than 65 or so may want to seek out a geriatrician, especially if they have multiple age-related problems, such as hearing loss, cognitive decline, and urinary incontinence.

Women going through a difficult menopause or considering having a child may opt to use an obstetrician/gynecologist as their primary-care giver. And people with certain chronic disorders that require frequent monitoring and medication adjustment could consider doctors with special training in those problems; for example, someone with diabetes may consider an endocrinologist, and an individual with rheumatoid arthritis may prefer a rheumatologist. Before you select a specialized physician for your primary-care, however, make certain that he or she will perform the more general tasks required of a primary-care physician.

Historically, doctors who specialize in the types of care the Institute of Medicine recommended--family doctors, pediatricians, and internists--earn much less for interacting with patients than specialists who do procedures that take the same amount of time. This pay gap has persisted, for economic and political reasons, despite repeated efforts to reduce it. New medical school graduates, often saddled with six-figure student loans, are increasingly opting to forsake primary-care for the bigger paycheck they can earn as specialists. This is even more reason for exhaustive due diligence when searching for a caregiver.

Seeking a surgeon

You may find yourself in search of a qualified surgeon for any number of medical procedures, from simple minimally-invasive scopes to major life-saving surgeries. Ask your primary-care doctor to recommend a surgeon, if necessary from the list of doctors approved by your insurance company. For complicated or unusual problems, ask for the name of a recognized expert or search the medical literature to find someone who has published major articles about your problem. Then contact that physician and ask him or her to recommend someone in your locale.

Finally, talk with the prospective surgeon and ask how many operations of the type you need he or she has performed. Studies suggest that experience leads to higher success and lower complication rates. When deciding on a surgeon, remember that caseload may be more important than a surgeon's age. An analysis of Medicare data for nearly 461,000 patients found that while surgeons over age 60 with low surgical volumes had higher patient mortality rates on some procedures, those who continued to maintain high surgical caseloads had comparable outcome with surgeons ages 41 to 50.

Also ask if the surgeon can provide references from patients willing to speak with you. Find out which hospitals the doctor admits patients to, and check their quality. Better hospitals tend to attract better doctors.

How to check credentials

Doctors, like schoolchildren, are increasingly being put to the test. Experts have developed practice guidelines detailing how physicians should address everything from basic preventive care to complex chronic conditions such as congestive heart failure and diabetes. Researchers are even starting to measure how well doctors manage their practices, gathering data, for example, on how quickly patients can get an appointment and how long they are kept waiting once they have one.

Gordon Moore, M.D., a Rochester, N.Y., physician who has researched what makes primary health care effective, says he would like to see "all this information listed right there in the waiting room for everyone to see, so that patients can make wise consumer choices and know how good their doctor is at treating the health problem they're concerned about." While this may become a reality some day, for now finding the right doctor for you involves cobbling together information from a variety of sources, including your own observations and interactions with your doctor.

Health-care quality organizations- notably the nonprofit National Committee for Quality Assurance (NCQA) now gather data on how well doctors in managed-health-care plans follow practice guidelines. Then they use the results to grade those organizations. (To see how your health plan and others in your area fare, go to www.healthchoices.org.) Experts hope that eventually the grades will extend all the way down to practice groups and even individual physicians.

Some health-insurance plans provide information for members on the educational and professional background and specialty certification of participating physicians, so you should start there. Also consult these general websites:

Administrators in Medicine Information on licensing and disciplinary actions taken against doctors in 18 states; links to state medical boards of remaining states.

American Board of Medical Specialties Board certification means the person has completed an approved residency program and passed a detailed written exam in at least one of 24 specialty areas, such as family practice, internal medicine, or obstetrics and gynecology.

American Medical Association DoctorFinder  Comprehensive information, including educational history, board certification, and hospital admitting privileges, for the 40 percent of doctors who belong to the AMA.

Questions to ask

When choosing a doctor, you'll need to ask a lot of questions. But not all of those questions should be directed at a prospective physician. In fact, you'll want to ask yourself a handful of questions before you even pick up the phone to call a doctor. Assuming you've done the research on the doctor's credentials and specialties, you're going to want to get answer to questions that have more to do with personal preference and best practices than medical training.

Questions to ask yourself

Is your doctor's age a factor? The years of patient experience accumulated by older physicians can be a significant advantage. Some research suggests that patients tend to prefer the bedside manner of older doctors. A physician with many years of experience may also have better clinical judgment, which could translate into improved ability to diagnose and manage complex health problems. But a study published in a February 2005 issue of the Annals of Internal Medicine reported the seemingly counterintuitive finding that, overall, the more experience a physician has, the worse his or her care becomes.

In general, if your priority is someone familiar with current evidenced-based standards of care, you may want to opt for a younger physician. And if you have multiple, complex health problems, or put a premium on bedside manner, you may lean toward an older one.

Male or female? Some research suggests that women prefer getting care from female doctors; that's particularly true for screening tests for breast, cervical, and colon cancer. Other research hints that female physicians may do a better job than male ones in providing basic preventive services to both women and men. So if you're particularly concerned about preventive health care, consider seeing a female doctor-especially if you're a woman yourself.

Are you looking for a collaborative partner or a trusted leader? The caricature of the average primary-care doctor has gradually shifted from the father figure who makes medical decisions for you to a technician who lays out an array of treatment options for you to choose from with hardly a word of guidance.

The reality, of course, is that a good doctor has always been someone whose judgment you trust but who is also willing to take your preferences into account and to admit when the medical evidence is uncertain. And most physicians combine both characteristics, at least to some extent. Still, doctors do tend to lean toward either relying mainly on their professional judgment or using a shared decision-making model that involves actively educating patients and seeking their input.

Questions to ask a potential doctor

How long will I have to wait for an appointment? Look for practices that offer "open-access" scheduling, in which doctors typically leave part of each day's schedule unbooked so they can offer some same-day appointments.

Do they keep paper or electronic medical records? Computer-based record-keeping is considered a major step toward improving the quality and efficiency of medical care. But only about one-quarter of Canadian and U.S. doctors surveyed recently said they currently use electronic records, compared with 8 out of 10 or more in Australia, the Netherlands, New Zealand, and the United Kingdom.

Do they take questions by e-mail? Though searching for health information is one of the most popular uses of the Internet, less than 10 percent of patients communicate with their doctors by e-mail. That relatively small number may be due, in part, to many doctors' reluctance to hand out their e-mail addresses, for fear both of liability implications and of being overwhelmed by "cyberchondriacs."

E-mail "conversation" is great for non-emergency matters: problems or advice about a chronic disease, an appointment, test results, clarification of some item that came up during an office encounter, an overlooked question, a medication side effect, or any question requiring only a yes or no answer. And it's a direct link to your doctor, without a telephone intermediary such as a nurse or assistant and can supplement your time with you.

When to get a second opinion

Unfortunately, doctors, even your own trusted physician, can miss a diagnosis, especially nowadays, when they may be under pressure to see many patients in a short time. Studies indicate that more than 20 percent of patients in emergency rooms or intensive-care units are diagnosed incorrectly, and the problem undoubtedly extends to doctors' offices, too.

So it pays to research any diagnosis you receive to learn what questions to ask, whether you need additional tests, and when to seek a second opinion. Obese individuals diagnosed with asthma, for example, should ask whether their breathing problems might actually stem from their excess weight. Here are several other situations, nearly all of them common, where you may need to consider a possibly overlooked problem.

In general, avoid surgery unless the problem threatens your health or disrupts your activities, less aggressive treatments have failed, other causes have been ruled out, tests show that surgery would help, and there's little hope of spontaneous recovery. And get a second opinion if you have the slightest doubt about whether you need the procedure.

   

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