A generation or two ago, people relied on General Practitioners (GPs) for all their medical needs, from treating colds, hayfever and backaches to setting broken arms and delivering babies. The kindly, competent GP knew the medical histories of every member of a patient’s family because he treated them all. A quaint, outdated concept? Maybe not. Enter the Primary Care Physician (PCP). Find out what constitutes primary care and why you and your family should have a PCP. Also, learn what questions you should keep in mind when choosing the doctor that best suits your needs.
Health care in the United States today is largely defined by specialty care, with an endless number of high-tech procedures. This system is expensive and centers around curing disease, not preventing it. But now employers in both the private and public sectors are nudging workers into managed care, which stresses preventive medicine in order to save on expensive treatments later on. Concurrently, Americans are taking more responsibility for their health by improving their diets and by exercising. That’s where a primary care physician comes in.
Major Role of the Primary Care Physician
Primary care physicians see their patients regularly to keep close tabs on their health and their use of specialty care. By educating you about measures that will keep serious medical problems from occurring in the first place, they practice preventive rather than crisis medicine.
Since primary care physicians see individuals and, perhaps, their entire families over an extended period of time, they become familiar with the physical, psychological and lifestyle factors that might impact their patients’ health. So in addition to finding out about your medical history, primary care physicians need to know a great deal about your life. Do you smoke? Are you happy? Is your job frustrating? How much do you exercise? Is your marriage solid?
When doctors have all this information, they can suggest ways to improve your health. They also know what is normal for you and can better understand medical problems that arise in relation to your general health, rather than as isolated events. Additionally, because they are trained in a number of different disciplines, a primary care physician can try to treat you before sending you to a specialist, saving you considerable time and money. Once referred to a specialist, your PCP can keep track of your care so that you are not subjected to unnecessary duplication of diagnostic procedures or the prescription of medications that are dangerously incompatible with one another.
By doing all this, a good primary care physician can help you manage your health care. This has become controversial, however, since managed care plans frequently use primary care physicians as managers. Primary care physicians are sometimes called gatekeepers because when you need specialized attention, the managed care plan usually requires that your PCP refer you to appropriate doctors and maintain an overview by monitoring medications and keeping a record of your treatments.
Three Kinds of Primary Care
If you’re thinking about finding a primary care physician, don’t wait until you get sick. The relationship you develop with this health professional can be the key to keeping illness at bay, and it is your best entry point into the rest of the medical system.
When looking for a primary care physician keep in mind that out of 24 different specialties in medicine, only the following three are considered primary care:
Family practice (general practice). A family practitioner is a physician who specializes in general family care. Doctors in this specialty are trained in several basic medical disciplines including internal medicine, pediatrics, obstetrics, gynecology, general surgery and psychiatry. These physicians can treat everyone in your family.
Internal medicine. An internist is a physician who diagnosis and “medically” treats (without surgery) disease in adults. Internists may have a subspecialty which focuses on: a specific part of the body, such as heart, lungs; a specific disease, like diabetes, or arthritis; or a particular age group, such as adolescent or geriatric medicine.
Pediatrics. Pediatricians care for and treat children from birth through the teens. They commonly have subspecialties, such as pediatric cardiology, gastroenterology, perinatal medicine, or surgery.
Ways to Find a Primary Care Doctor
Your first step is to gather names. Here are a variety of sources to try:
· Physicians. If you have recently moved to a new location, ask your former physician for a referral. You can also ask other doctors you respect and see regularly, such as a gynecologist or pediatrician.
· Friends, relatives or business associates. Referrals from people you know are usually based on trust and confidence, which is certainly in your favor. Remember, though, that your contacts’ opinions may be largely based on how they click with the physician’s personality and style. Only a visit with the doctor will reveal if these qualities suit you.
· Hospitals. Reputable hospitals usually offer a referral service that can provide you with the names of staff doctors who meet certain criteria you may be seeking, such as specialty, gender, experience and location. However, the referral service cannot vouch for the physician’s quality of care.
· Your local medical society. Local Medical Societies often offer directories of their membership, but like hospitals, they cannot vouch for quality.
· Managed care plan. If you belong to a managed care plan, find out what doctors are affiliated with it. Ask what information is available on the doctor’s background and services.
· Health Pages’ listings. See our exclusive comparative charts for information on local Family and General practitioners, Internists and Pediatricians, including their training, office services and fees.
Considerations in Making a Choice
Once you’ve gathered some names, use these guidelines to help you check out prospective doctors.
· Professional credentials. Certainly any physician you consider should have graduated from an accredited medical school, but not necessarily a large, “big-name” institution. As a general rule, though, the most highly qualified physicians have completed their residencies in major medical centers.
One of the best ways to evaluate doctors is to be sure they’re board certified. That means a doctor has completed a prescribed period of residency in a specialty, has passed oral and written examinations and has handled a minimum number of cases. Board certification is no guarantee of quality, but the American Board of Medical Specialties (ABMS) notes that doctors who’ve passed their boards have met standards above and beyond those required to get a medical license. To find out if a doctor is board certified, call the ABMS (800-776-2378).
· Professional affiliations. Your ideal doctor is probably affiliated with a large, well-equipped hospital, either as a staff member or as an attending physician, a title that carries with it admitting privileges. Without such an appointment, you’ll have to see another doctor if you go into the hospital. A teaching position at a medical school is further indication that a doctor is both well trained and up-to-date.
Information on a doctor’s training and affiliations can be found in the Directory of Medical Specialists, which is available in large libraries. You can also gather information about professional qualifications and practice arrangements by asking the doctor’s office staff (see “Questions To Ask About The Doctor’s Practice”)
practice arrangements and location. Years ago, virtually all doctors were “solo practitioners” – they had private practices and when they were unavailable, usually had another doctor respond to their patients’ calls. Today you may choose a solo practitioner or a group practice, in which two or more doctors in the same specialty or different specialties share the same office. One advantage of this is that they can cover for each other for weekends and vacations. Also, take into account the doctor’s location and office hours since, if these aren’t convenient, you may put off regular visits.
· Personal manner. Often referred to as “bedside manner,” a doctor’s interpersonal skills and ability to communicate are very important. Consider a 1993 survey of 2,500 women and 1,000 men conducted by Louis Harris and Associates for The Commonwealth Fund, a New York City philanthropy. The poll found that 41 percent of women and 27 percent of men said they had changed physicians because they were dissatisfied with their care. What’s more, 25 percent of women and 12 percent of men said they felt they’d been talked down to by their doctors. About 17 percent of women and seven percent of men had been told that a medical condition was “all in their head”.
In addition to being a good communicator, a doctor should treat you like a partner in your own health care by explaining procedures, test results and medications and by answering your questions. You may also prefer a doctor who shares your cultural background, religion and/or views on ethical issues such as abortion and life- support measures. To evaluate a doctor’s personal manner, you will have to schedule an initial visit (see “Signs That Say ‘This Is The One.”)
Make the Most of Your Visit
You can indicate your desire to be a decision-making partner in your medical care by participating fully when you have an office visit.
· Be prepared. On your first visit, bring a summary of your medical history, including childhood diseases, chronic illnesses, hospitalizations, medications and a health history of your parents. Also bring reports of recent diagnostic tests, such as x-rays and blood workups (which you can request from your other doctors).
· Tell the doctor everything about your health and illness. The doctor cannot accurately diagnose or prescribe effective treatment if you withhold information. What you tell your doctor is confidential.
· Ask precise questions. The best way to get advice that relates to you, as opposed to the population in general, is to be specific: “How do I…” or “What is the best way for me to…”
· Take notes. Many patients can’t remember their discussions with a doctor once they’ve left the office. A forgotten bit of information or recommendation could change the course of your treatment.
· You and your doctor are a team. Many patients sabotage their treatments by failing to follow the doctor’s instructions. Skipping doses of medication, or indulging in food and drinks that are prohibited can jeopardize your health. On the other hand, if a treatment regimen doesn’t seem to be working or is making you feel worse, don’t hesitate to call the doctor so that appropriate changes can be made. In this new age of medical care, the old-school “Doctor knows best” attitudeis fading fast. It’s being replaced by a relationship in which the informed patient and doctor make decisions together.
Most doctors are competent and trustworthy. But, as in other professions, there are some who don’t measure up. The problem is that most people don’t bother to find out if their doctor has had any legal or professional difficulties. Physicians who have been disciplined for unprofessional practice and/or behavior and who have malpractice payment reports on file are listed in the National Practitioner Data Bank. Hospitals are required to check all of their doctors with the Data Bank every two years. Even though advocacy groups have pushed for access to the Data Bank, it’s still not available to consumers. But you can check out doctors through these sources:
· According to the Federation of State Medical Boards, the total number of serious disciplinary actions against doctors across the country was 3,375 in 1995 -that’s about 0.5 percent of all doctors. To find out if a particular doctor has been disciplined by your state, call the agency that licenses physicians in your state. Call the Federation of State Medical Boards for the number to call in your area (817-868-4000).
· 10,289 Questionable Doctors, published by the Public Citizens’ Health Research Group in Washington, D.C., is in many public libraries, or you can order a state supplement by calling 202-833-3000.
Once you have narrowed your choice of primary care doctors down to one or two, call their offices and ask the office manager, receptionist or nurse the following questions:
- What should I expect on the first visit? An initial visit should involve a complete medical history and a head-to-toe examination of skin, eyes, ears, tongue, mouth, glands, heartbeat and breasts. These basic tests should also be included: blood pressure, an electrocardiogram (EKG), a chest x-ray, a rectal exam and blood tests.
- What if the doctor has a subspecialty? Ask if he or she is a general practitioner, an internist or a family practitioner. An internist with a subspecialty in cardiology may be your best choice if you have a chronic heart condition.
- What are the doctorís hospital affiliations? Find out if the doctor is affiliated with at least one hospital in your area.
- What are the fees and billing procedures? Ask if you are required to pay at the time of your visit and what form of payment (check, credit card) is acceptable. Sometimes the office staff will process insurance forms for you and wait for payment from the insurance company.
- Who covers for the practice when the doctor is absent? You may never get to meet this back-up physician but it is wise to check up on the credentials anyway.
- Does the doctor provide time for telephone consultations? Any doctor who “does not talk to patients on the phone”, should not be your doctor.
- Does the doctor make house calls? Believe it or not, some still do – a plus if you have an elderly or handicapped person at home.
Signs That Say “This is The One”
Knowing when you have met a doctor you can trust is really a gut reaction. Here are a few tip-offs that indicate you have found “Dr. Right”.
- The doctor’s office staff is courteous and helpful.
- You are seen by the doctor within a reasonable time of your appointment or you are given a good explanation for the delay.
- Telephone calls are not accepted during the consultation so the doctor can focus on you (unless it is an emergency).
- You are not rushed through the visit assembly-line style.
- The doctor treats you like a responsible, intelligent person.
- The physician listens to you, does not interrupt when you describe symptoms and encourages you to air your concerns about treatment.
- The doctor is well-informed about preventive health measures, such as nutrition, exercise and the widely recommended use of screening tests.
- The pros and cons of medical procedures and therapies and the implications of test results are thoroughly and clearly explained.
- You are encouraged to call with questions concerning your treatment, such as the proper way to take your medication.