How to Choose a Doctor

[TromboneAl]

In another thread I discussed switching to a new primary care physician. I have a list of doctors in the Blue Cross network, so now I need to figure out how to evaluate them and decide which to go with.

Asking friends who their doc is would be good. I guess interviews are out.

Any suggestions?

 

[Rich_by_the_Bay]

I am getting more drawn to small groups (under say 10 to 20 docs in your specialty) due to the protective effect of more peer interactions, surveillance to meet quality assurance goals and guidelines. A solo or small group physician can veer pretty far off the mark before getting noticed.

I advise speaking to the nurses at the local emergency room to see if the same names keep coming up. No harm talking with neighbors. Pharmacists are a good resource, too.

Full disclosure: I have mostly practiced in group settings, academic centers. Though I did a decade of part-time private practice back in the 80s.

 

[Moemg]

I agree with Rich that you are safer with a group practice . They police each other and will get rid of somebody who is hurting the group's reputation. I would also look for an internist rather than an GP . If Lena or you know any nurse's they can usually find out who is good .

 

[HFWR]

I use an extensive list of criteria to choose my medical providers...

 

[Free To Canoe]

I use an extensive list of criteria to choose my medical providers...

I wonder if they give Senior Discounts?

 

[Purron]

I look to Washingtonian Magazine's "Top Doctor" list issued each year. It's a survey of area doctors asking them who they'd see or send their loved ones too. Been issued for years now. Know that doesn't help you Al, but are there similiar lists in your area? Or doctor referral services?

 

[Free To Canoe]

I was paying medical bills this morning and the nature and type of these charges caused me to think that my current doctor is someone to manage, not my ally in the health care arena. Perhaps I am losing perspective. From this thread, I realize that I will need to look in the "big city" for better selection that is not availble out here in the rural areas.

 

[Rich_by_the_Bay]

I look to Washingtonian Magazine's "Top Doctor" list

Unfortunately those surveys are misleading and financially motivated, IMHO. I have been on the list every year since 1980, including one or two years where I had left that state a year before. If you make the list you get endless solicitations for leather bound volumes, plaques (just $29.99). And your name gets distributed/sold via mailing lists to countless others.

That's not to say that many good doctors are on the list but I would look to other sources.

Glad you found a good match, nonetheless.

 

[Purron]

Unfortunately those surveys are misleading and financially motivated, IMHO. I have been on the list every year since 1980, including one or two years where I had left that state a year before. If you make the list you get endless solicitations for leather bound volumes, plaques (just $29.99). And your name gets distributed/sold via mailing lists to countless others.

That's not to say that many good doctors are on the list but I would look to other sources.

Glad you found a good match, nonetheless.

I might have a little faith since in this stuff you're on the list! But geez Rich, where do we turn find a good source of info on docs? Just another thing that makes me feel clueless and helpless in regards to choosing a health care provider. More so since my mom's going through some health issues right now. Who do you trust?

 

[obgyn65]

+1. I would also do a quick search online, for example by NPI number here NPI Number Lookup - Get Doctors NPI Number in the NPI Registery or check the State Boards online for any past disciplinary actions.

I advise speaking to the nurses at the local emergency room to see if the same names keep coming up. No harm talking with neighbors. Pharmacists are a good resource, too.

 

[Rich_by_the_Bay]

I might have a little faith since in this stuff you're on the list! But geez Rich, where do we turn find a good source of info on docs??

It's tough but frankly, most of the MDs I know (95%) are honest, compassionate and competent. Exposing their practice to a group of peers (group practice, I mean) is another plus.

But notwithstanding the horror stories, by trusting your instinct and doing due diligence you should do fine in your search.

 

[Purron]

It's tough but frankly, most of the MDs I know (95%) are honest, compassionate and competent. Exposing their practice to a group of peers (group practice, I mean) is another plus.

But notwithstanding the horror stories, by trusting your instinct and doing due diligence you should do fine in your search.

Thanks Rich. This gives me some comfort.

 

[LightningDawg]

sometimes looking at healthgrades.com is useful.
If lots of patients give bad reviews, then I would be wary.

 

[Silver]

For the past 20 years I have seen a nurse practitioner for my primary care needs. I have needed to make changes a few times due to relocations, but I will only establish with a primary care physician if they have at least one nurse practitioner. The initial visit has always been with the physician, and then I make all future appointments with the nurse practitioner.

Many group practices employ nurse practitioners in the group, and they can be great to work with from a patient's point of view.

 

[ItDontMeanAThing]

Had multiple selection criteria. Looked at quality of where they did their undergrad, med school, intern / residency. At least 5 years since the end of their residency. Longer time with current group / solo practice / hmo / etc. the better.

During initial visit with new doctor I watched like a hawk for any treatment of me as a bag of meat and water with symptoms. Did he interrupt me, discount what I was saying, give terse answers to questions and in general handle me like he was being paid based mostly on throughput? I can understand that docs react in those ways to people who ramble, are disorganized, and go on and on and on. My spoken English is organized, brief, clear and to the point, so if a doc is reacting in those ways to me he's too efficient for me.

After about 10 years of selecting docs I modified my selection process to ranking men on my pre-visit criteria below the women who had equal merit. This was because in general I had rejected way more men then women based on their communication during the first visit.

 

[DblDoc]

I advise speaking to the nurses at the local emergency room to see if the same names keep coming up.

I have seen this advice several times before. I'm not sure it is valid anymore given the switch to Hospitalists. When Internists and FP doctors were admitting their own patients to the hospital the ER nurses interacted with them a lot and could quickly separate the good ones from the bad. In our current system the only interaction they have with a primary care doctor is with their own provider.

I agree with you about the "Top Doctor" polls. We get bombarded from the hospital administration to vote in these so they can toot their horn when the list comes out.

DD

 

[GregLee]

Affiliations with hospitals or university medical schools might be a good sign. I don't have a primary care doctor, other than my oncologist (who is still giving me followup exams for a case of cancer 5 years back). Do I need one? I think my oncologist is competent, since he has some credential in internal medicine.

 

[eytonxav]

I think there would be a lot more great physicians around if they were not so ham strung in having to deal with the insurance companies, high malpractince insurance and taking on too many patients so that they can make a buck. That said, I think the comment about going with a practice makes sense, as well as checking out whether any disciplinary actions have been filed.

 

[Rich_by_the_Bay]

I have seen this advice several times before. I'm not sure it is valid anymore given the switch to Hospitalists.

Good point -- it depends on the local community situation.

 

[JakeBrake]

Since my long time primary care doctor retired several years ago, I have been going to the nearest walk-in clinic. My medigap insurance is with United Healthcare. All the doctors at the clinic have two stars in UHC's doctor finder. That's as good as it gets with UHC. Since I have been going to the clinic (about 10 years) there has been no turnover in doctors. I think I have seen all the doctors at the clinic a couple of times.

The clinic does not make appointments. I go in and wait until I am called. I don't wait any longer this way than I did with an appointment with my old doctor. The doctors at the clinic can refer me to a specialist or admit me to a hospital if necessary. The clinic is associated with a particular local hospital. So, I suppose they would admit me to that hospital, which is fine with me

The clinic does not take Medicare assignment. I have to pay the Medicare rate (which is much less than the "list price" rate) The clinic files the claim with Medicare and UHC and I am reimbursed by Medicare and/or UHC.

My old doctor had gone to the hospitalist system. So, when I needed a doctor the worst he was not there except to submit consultation bills.

 

[haha]

Many of the larger multi-specialty clinics in and around Seattle have added Walk-In clinics to their offerings, usually operating 8am-8pm or so. In addition, some of them offer "Urgent Care", which has longer hours but is still cheaper than a 24 hour emergency offering. I assume if you show up at Urgent Care really sick they send you to a hospital ER.

Most serious trauma in Seattle Area and even beyond winds up by ambulance or helicopter at Harborview Hospital.

ha

 

[simple girl]

I posted on facebook to my local friends, asking for recommendations. I wanted someone who would really LISTEN to me and not rush me during my exam. Those qualities are what I posted on my request on Facebook. Two people recommended the same doc. I saw him recently and was very impressed. He really seemed to care about me as a person. Yes, I had to wait a long time past my appointment time to see him. However, he spent at least a FULL 15 to 20 minutes talking to me, at least. Much more attentive than any other doc I've ever been to.

 

[TromboneAl]

I wanted someone who would really LISTEN to me and not rush me during my exam. Those qualities are what I posted on my request on Facebook.

This is what initially attracted me to my current doc. He really sat down and listened, paid attention, and got to know me. I was amazed, since I'd been used to assembly line care in the past.

But after 10 years, I've realized that that quality is useless if he's not a good doctor.

-------------

Here's another example of something he said. You tell me if it's bonkers or not:

I had gotten an A1C test at a health fare, and showed him the results. He said "That test is totally useless, because there's no point in having a test if there's nothing you can do based on the results."

I agree with the general principle, but don't think it applies to the A1C. So, am I crazy or is he?

 

[HFWR]

This is what initially attracted me to my current doc. He really sat down and listened, paid attention, and got to know me. I was amazed, since I'd been used to assembly line care in the past.

But after 10 years, I've realized that that quality is useless if he's not a good doctor.

-------------

Here's another example of something he said. You tell me if it's bonkers or not:

I had gotten an A1C test at a health fare, and showed him the results. He said "That test is totally useless, because there's no point in having a test if there's nothing you can do based on the results."

I agree with the general principle, but don't think it applies to the A1C. So, am I crazy or is he?

I had mentioned to my doc that I had been reading about the paleo/low-carb diet, hoping to get his take on it, since I'm on niacin and simvastatin. Instead, he proceeded to draw a "plate", and show me that two portions of starch, with a low-fat meat, a vegetable, and low-fat milk, was the suggested "diet:. Haven't bothered with that subject again...

 

[haha]

Here's another example of something he said. You tell me if it's bonkers or not:

I had gotten an A1C test at a health fare, and showed him the results. He said "That test is totally useless, because there's no point in having a test if there's nothing you can do based on the results."

I agree with the general principle, but don't think it applies to the A1C. So, am I crazy or is he?

Well, it just seems to be two different ways of looking at things.

I have brought my fbs and ppbs way down, since first finding that I had an issue some years back.

But my LDL has gone up, I suppose from the same diet that brings down the blood sugar. So it doesn't always work the way the guru's say.

Ha