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THE LIFESTYLE MAGAZINE FOR THE RIO GRANDE VALLEY
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How to Choose A Doctor?

If you are new to an area or have a new health problem that requires a new physician it can be very stressful.

The good news is that for a physician to be in practice he has already passed many thresholds of qualification. To maintain a license to practice medicine a physician must have graduated from an accredited medical school and undergone a recognized form of residency training after medical school.  The great majority of physicians today especially of younger physicians will be board certified in their field of expertise. This means that they have taken written and oral examinations, demonstrated competence in their practice, and been recommended by fellow physicians in the same specialty. Medical licenses are regularly reviewed and evaluated so that the vast majority of physicians in practice today are more than competent to provide care. Most states have websites where you can check on a physician’s current licensing.

The Role of Insurance in Choosing a Doctor

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For most types of specialties there is usually more than one doctor from which you can choose in a community.  Unfortunately, just because a doctor specializes in certain area does not mean your insurance company will accept him.  When care is received in an elective way, that is to say it is not an emergency which is different than saying medically necessary, from a physician that is not participating with your insurance provider you may be liable for significantly higher medical bills than if you chose to go with a physician that was approved by your insurance company.  Before going to any new physician for a non-emergency it is important that you personally confirm with your insurance provider that the new physician is a provider and make sure you understand what will be covered and what co-pays will be your responsibility. Even though many doctor’s offices mean well, relying upon the good will of the physician’s office to help you negotiate with an insurance company after you have seen a non-participating physician can lead to a financial nightmare.

Sometimes it occurs that the only physician with the expertise to treat your problem in a community will not be a participating physician.  For non-emergency care it is still important for you to discuss this situation with your insurance company before you see the new physician. Often, the insurance company will want a letter or phone call from a local participating physician explaining why you require specific care from a non-participating physician.  In addition, the new physician’s office should be willing to stipulate to a temporary agreement for your care with your insurance company before you commence care with the new physician.  If you initiate non-emergency care before getting this agreement you may be abrogating any responsibility at all for your insurance company to pay any costs for your care.

A very common scenario that occurs is that the closest physician of a particular specialty that is participating in your insurance plan may be quite a distance away or be so busy that he or she may not have any appointments for weeks.  Here again, it is important for the patient to get a referral letter to the insurance company stating medical reasons which would make it more prudent to see the non-participating physician then the distant physician . Many states regulate insurance so that insurance providers have procedures for exactly these types of situations. In addition, it is wise for the patient to review their medical insurance policy which will usually contain provisos for these special situations.

Word of Mouth

Your neighbors, co-workers, family, and friends may be very useful information sources about a doctor’s practice. Doctors have different personalities and different styles of running their practice that may appeal more to one person or another.  Some people may like a chatty doctor who runs a perennially late office because he spends too much time with patients while others prefer a punctual just the facts type of physician.

The way the office staff deals with patients is very important.  A great doctor with an unfriendly or rude medical office staff can lead many patients to seek care some place else.

by Tony Barclay
Editor’s note: Tony Barclay is a retired physician & Harvard graduate who likes to write medical and scientific issues.This article is presented for general information and should not be taken as medical advice.

 



Referral from Other Physicians

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Doctors practice in community of physicians. Their economic existence especially for specialists often depends upon the referral of patients from other doctors. Except for the case when physicians are employed by the same entity such as a hospital, university, or non-profit corporation, doctors cannot receive kickbacks or benefit financially from referrals.  Physicians in certain types of insurance programs like HMO (health maintenance organizations) may be penalized for excessive referrals to specialists. Physicians should always reveal to the patient if they have a potential financial incentive for a referral. It is very important to understand that this does not mean the referral is inappropriate or wrong but just shows appropriate transparency from which you can make a decision.

Primary care doctors who get repeated negative feedback from their patients will usually stop referring patients to that specialist. So in the absence of financial association you are actually benefiting from this experience and should always consider the advice of your primary care physician as being worthwhile.

Local Doctor vs. a University Affiliated Specialist

Today people often have the option the receive care locally from a well respected specialist or travel a variable distance to seek care at university medical center affiliated teaching hospital. Should a person if he or she is able always go to the university program?

Physicians like anyone else are best at what they do most often.  Some types of surgeries or treatments may be rarely if ever done in a community setting.  University medical centers that have a special experience in treating these types of problems will clearly be more superior to that you can receive in a local setting. This is true for very few medical conditions, in fact, for the most common of medical conditions care in local hospitals is usually equivalent to national standards.

On the other hand, care in a university medical center that is distant from your home may not be in your best interest.  For example, if you have a routine surgery that could have been reasonably done in your community and instead you went 400 miles away there are significant problems that could develop.  Although many medical concerns can be dealt with over the phone, sometimes the physician simply must see the patient to assess the problem. Calling a university surgeon 400 miles away at 4 am about wound drainage will lead to a difficult situation versus if you had the surgery locally where you could see the doctor in his office that morning.

Similarly, the pace and personal style of private practice physicians and university physicians tends to be quite different.  Local physicians are often in competitive practice environments and tend to have a more “hands on” approach than the university faculty member who has an army of resident doctors and medical students.

Sometimes people with multiple medical problems or chronic conditions like diabetes think they should receive care in a far away medical center. Actually, for many of them this may be the worst thing to do, because the physicians, who know them best such as their long standing diabetes specialists, will be better able to help them in the local hospital assisting the new specialist than if they go to a far away medical center.

Finally, remember that the patient must be an advocate for him or herself. Do not be afraid to ask questions about your condition, discuss alternatives, and ask for details about expected payments.  Always make written notes before you go to the doctor for the physician and his staff about any questions you have.  If you do not feel comfortable about the care you are receiving speak frankly about it with your physician.  Physicians cannot read their patient’s minds. If you still have doubts about what is best for you do not hesitate to seek a second opinion. 


 
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