Choosing a Family Doctor

Of the 1.1 billion medical visits Americans make each year, almost half are to primary care doctors. They are on the frontlines of medicine, doing everything from diagnosing strep throat and setting broken bones, to treating chronic diseases like diabetes, asthma, and high blood pressure. They also help patients make certain lifestyle changes, like following a healthy diet, getting more exercise, and quitting smoking.

Your physician becomes familiar with your family, often getting to know each of you as individuals. "One big distinction for family doctors is that they don't just treat diseases or organs, we treat people," says Michael Fleming, MD, former president of the American Academy of Family Physicians who's been a practicing family physician for 25 years, seeing both rural and urban patients in Shreveport, Louisiana. "A family physician who doesn't like people is in the wrong profession."

They also need to be prepared to tackle complex problems. "When I walk in the door, most of the patients I see don't have just one problem, they have several problems," Fleming says. "I rarely see a patient with just a sore throat. What I see is a hypertensive diabetic with heart failure who has a sore throat. So one of the things we excel at -- why people are drawn to this specialty -- is being able to handle that complexity."

How do I find a good family doctor?

It's best to do the research when you're not under pressure. Don't wait until illness strikes to look for a doctor. You may not have enough time to decide on the best place to get care.

It's a good idea to start by gathering the basic information about your insurance, and making some general decisions about your care. For example:

-- What kind of health insurance do you have? Is it a managed-care plan that requires you to see only doctors in the plans network? Can you afford to pay out-of-pocket for a doctor who is not a member of your plans network?

-- Do you need a family doctor with a particular background or medical specialty?

-- Does your doctor have privileges at the hospital where you would prefer to be treated?

-- How far are you willing to travel for appointments?

-- Do you need convenient parking, or is the office accessible by public transportation?

-- Do you need a doctor who has evening or weekend office hours?

-- Do you prefer a male or female doctor?

Once you've answered these questions, the next step is to find two or three candidates that you'd like to interview.

How do I go about finding a doctor?

You may want to start by contacting the local or state chapter of the American Academy of Family Physicians for a list of family doctors in your area. You can also go to the American Medical Association's Web site and use the "DoctorFinder" service to find doctors (listed by specialty) who practice near you.

If you belong to a managed-care plan -- such as an HMO or preferred provider -- you will probably have to choose from a list of primary care physicians who contract with the insurance plan. (Your choices may be further limited to the doctors who are accepting new patients.) Although both methods will give you a pool of doctors, you'll still need a way to choose the right doctor for you.

"You can't underestimate the importance of word of mouth" in finding a good family doctor, says Fleming. "Talk with people in your community and find out who their family doctor is and why they go to him or her."

Also, ask other doctors or hospital nurses for their recommendations -- and in particular, ask whom they would take their mother, father, or children to. Some hospitals offer physician-referral services. You can also ask other health-care providers, such as your pharmacist, dentist, or eye doctor, about doctors they know and recommend. You may want to talk with your family, friends, coworkers, neighbors, or people you know through community groups. Some communities even have parenting Web sites through the local university, which encourage their members to recommend (or warn against) certain clinics or specific doctors.

What questions should I ask?

Once you have a list of doctors, you can call their offices to get more answers to your questions and concerns. Some doctors can schedule time for interviews with prospective patients, either in person or over the telephone (make sure he/she knows you are selecting a new doctor) although fewer and fewer physicians are able to take the time. Once you're there for your appointment, note whether the office staff is courteous and how much time you have to spend in the waiting room.

This is also a good time to let your prospective doctor know that you're interested in a partnership and in building a trusting relationship. There are questions you should ask the staff and questions you should reserve for the doctor. Some offices have brochures; some have Web sites where some of these concerns will be answered. Among the questions you should ask the doctor's staff:

-- Is the doctor accepting new patients?

-- At which hospitals does the doctor treat patients?

-- Does the doctor accept my insurance coverage? Will the office take credit cards?

-- Are there any additional fees for other services (such as filling out health documents or letters)? How are co-payments handled?

-- When is the doctor available? What are the office hours?

-- How long does it usually take to get a routine appointment?

-- How quickly can I get an appointment if I have an emergency? What about nights or weekends? Home visits?

-- Does the doctor or staff speak the language I'm most comfortable using? If not, can you provide a translator?

-- At what point can I cancel an appointment and not be charged a fee?

-- Will a doctor, nurse, or physician's assistant give advice over the telephone? Will they answer e-mail concerning health questions?

-- Does the office send reminders about routine screenings (Pap smears, for example)?

-- Where do patients go for lab work?

Questions to ask the doctor during a visit or phone interview:

-- What medical school did you graduate from?

-- Are you board-certified in family practice?

(Board-certified doctors have had three or more years of extra training after medical school to become specialists in a particular field of medicine, and must pass a rigorous examination in that specialty. Family physicians have to be retested every seven years to maintain their board certification. Family doctors are certified by either the American Board of Family Practice or the American Osteopathic Board of Family Practice.)

-- What is your philosophy of care? Are you treatment-oriented or prevention-oriented?

-- How aggressive are you in ordering tests and prescribing medication?

-- Who covers for you when you're out of town? How can I learn more?

If you want to do some extra digging, you can also investigate a doctor's training, background, and quality of care -- including whether the doctor has a history of legal or disciplinary actions, or if there are any currently pending. According to the federal government's Agency for Healthcare Research and Quality, you can:

-- Find out if a consumer or other group has rated doctors in the area where you live. (You'll also want to find out the basis for these ratings.)

-- Find information on doctors in some states by going to the Web site http://www.docboard.org. (This Web site is run by a group of state medical board directors.)

-- Call the American Board of Medical Specialties (847-491-9091) to learn whether a doctor is board-certified. The board's Web site is http://www.abms.org.

-- Call the American Medical Association at 800-621-8335 for information on a doctor's training, specialties, and board certification. This information can also be found on the AMA's Web site under the "DoctorFinder" feature (http://webapps.ama-assn.org/doctorfinder/home.html).

How can I tell if I've chosen the right family doctor?

If the answers to your questions satisfy you -- and the doctor is board-certified and well-qualified -- then you're on your way to finding the right family doctor. But it's also important to consider how well a doctors personal style and communication skills match yours.

"You want a family physician that you can develop a trusting relationship with," says Fleming. "(This person has) to be skilled in communication -- listening, understanding, and being able to place the patient's present situation in the context of their family and environment. Conversely, they also have to be able to talk with the patient in a way the patient understands, taking into account their emotional, cultural, and educational backgrounds."

Make sure to consider personal rapport and compatibility when you're with your doctor. Ask yourself, how easy is it to talk with this doctor? Are you interrupted before you've had a chance to explain your problems? A good doctor will treat you with respect, be patient, encourage you to ask questions, and listen to your concerns. A good family doctor should also take interest in you as a person, and consider both your physical and emotional needs.

Before making any decisions about medical treatment, you should feel fully informed. The doctor should explain all diagnoses, treatment options, and likely outcomes in a way you understand, and should discuss your preferences.

Trust your reactions and feelings when deciding whether a particular family doctor is right for you. You may want to give the relationship some time to develop, or you may know without question that you need to move on. Don't be afraid to decide a doctor is not right for you and your family, and keep searching.

References

Interview with Michael Fleming, M.D., president, American Academy of Family Physicians

Choosing a doctor. Agency for Healthcare Research and Quality.

Choosing a physician to meet your needs. Wellspan Health.

Choosing a doctor. National Institute on Aging.

Centers for Disease Control. Ambulatory Medical Care Utilization Estimates for 2004. June 2006.

American Academy of Family Physicians. Officers, Directors, Vice Presidents.

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