So, You Need a New Doctor? Here’s What to Do
Last week we addressed all those maladies that affect us, especially as we age. This week we share how to find experts for those and bigger challenges.
It was so easy in the old days when we were growing up to go to one doctor who handled all ailments and illnesses. He was the family physician who often knew us personally and was available 24/7. Many had treated our parents and even made house calls.
This type of doctor was showcased in movies and on TV. There was Dr. Richard Kildare, Dr. Marcus Welby, Dr. Ben Casey or Dr. Doug Ross to tend to our health-care problems, a one-stop shop to handle what ailed us.
These days, as the population has surged and doctors are more specialized, one doctor no longer will suffice. Especially as we age, we have more doctors on our speed dials and some specialists and problems we didn't even know existed.
Move to a new city or town and it's among the most challenging assignments to face, along with finding a hair stylist and salon, grocery store and gym. We spend lots of time ferreting those out, so why not even more when it comes to our bodies and our health?
After a friend asked Barbara what questions she should ask when she met with a new doctor because her internist was retiring, Barbara tapped Margaret and said help me come up with the list to give her. We did and used it in our last book, Not Dead Yet in the chapter, "Ills, Pills, and Spills."
When another friend of Barbara's asked what's the difference between going to an internist or family practice physician, because she had moved and was assembling a new medical team, we weren't sure. We looked up the specialty and learned from an online source that family medicine is a specialty within primary care that provides continuing and comprehensive care for an individual and family across all ages, genders, diseases and parts of the body.
We also asked Madison, Wis., family physician, Dr. Jim Davis, for his expertise and he had this to say. "A family doctor takes care of the full spectrum of patients from newborn care through childhood and adulthood. Many family doctors also do prenatal and obstetrical care. General Internists are trained only on the care of adults which was a popular specialty through 1990's. Over the last 20 years, a significant number of internists go on to specialty care in areas such as rheumatology, cardiology, etc. The biggest problem in medical care is the lack of access to primary care (which are what family physicians and general internists provide) due to underfunded family medicine training and increasing specialization of internists. Everyone talks about primary care, yet no one finds it."
In fact, Barbara chose this type of physician for her general care when her former internist retired, although at the time she wasn't aware of the difference. She liked what she had heard about him from a physician's assistant who had worked with him. That was a good enough reason to try, she felt, after she googled him and learned about his training.
However, when it comes to what to ask and what credentials they should have, we have a good, even if not definitive idea what we want. We do know that we prefer to have a physician that's in proximity to where we live. Margaret concurs and prefers women doctors as a rule.
First, we need to know that the doctor who's a possibility is taking new patients and accepts our insurance. Not all do. Some will not take insurance but may accept Medicare and supplemental policies.
We prefer doctors for major problems who are associated with a major medical center and teaching hospital, so they're on the cutting edge of treatments. We've been told that those who aren't may be as much as 10 years behind in research and knowledge.
When Barbara broke her dominant right hand and was considering surgery in her small town, a physician friend advised, "You'll probably be okay, but I don't deal in probably. Come to my hospital (with teaching program in a larger city). She did and also knew from researching about the doctor that he had performed the necessary surgery day in and out. She got a good result. Less good was his bedside manner but she felt that didn't matter in this case since she hoped that the surgery would involve one or maximum two surgeries, plus multiple visits.
We also want doctors with excellent training. We check out various health-care sites to read their curriculum vitae for where they went to medical school, where they interned or did their residency, what fellowships they went through that relate to our problems and any extra training they have. We care far less about the college since that was so long ago, and they might have majored in history or poetry and then decided to go into medicine. It's also a good idea to check their age; it's disappointing to find a doctor who one year later tells you they're retiring.
Barbara knew from needing another surgery that it was important not just to go to a doctor schooled in the part of the body she had to deal with especially after she learned it could be a possible cancer issue. So, she consulted with an oncology surgeon. (Fortunately, it wasn’t cancerous.) "You want your first surgery to be the best," more than one doctor told her and don't want her to have to go back on the operating table." More good advice.
Margaret followed this when a dermatologist noticed a suspicious mark on her cheek, the result of sun damage. The doctor did a biopsy that came back negative. He wanted to dig deeper but before Margaret said, "Okay," she got a second opinion from a woman who was recommended to her and is a cosmetic dermatologist. She did a different type of biopsy and that too came back negative.
Then, when she went for a freckle check recently, the female dermatologist did another biopsy. This time it came back suspicious. She recommended that Margaret start using a topical cream for six weeks to see if the problem is alleviated. It's likely she'll have to have it removed. She plans to collect the names of a couple of good dermatologists with plastic surgery credentials.
We suggest asking other doctors you go to for recommendations. They can offer excellent choices as Barbara's family practitioner did for a new gynecologist. Ask them to be brutally honest, even if they won't be too negative about another doctor. At least they will steer you to the best.
You might also ask some friends, but we say you need to take their advice with a grain of salt since they may care more about bedside manners than we do.
On the other hand, we care about how easy or hard it is to get into see a certain doctor. Margaret had to use pull when she first came to New York City to get into a good internist. We don't want to have to wait months, especially if it is life threatening or very serious.
The upfront office staff is important too. We like if the office manager or PA listens to our concerns and gets back to us promptly regarding how soon we can get in and also with results from tests if we don't understand what's on the patient portal, if we use one. And we don't want to read negative results posted on the portal in medical jargon that we don't understand. We want someone in the office first to call us and gently explain the information and put it in the right context. Sorta hold our hand virtually.
Sometimes, even after we've done so much leg work, we need to make changes or get a second or third opinion. We'll start off and the relationship will seem perfect, and then go downhill. Maybe the chemistry isn't right. Perhaps, the doctor is too busy for our needs, decides to switch to a concierge-type practice, which doesn't take our medical insurance, or dismisses our concerns or questions when we meet.
Yes, arrogance and condensation occur in all professions, including medicine. "Do no harm" may be mostly about physical harm but our psyches also need some pampering and care. Whatever is the reason, we may want to start over and find someone new. But if you hear that a certain doctor is one of the best in his field, but lacks bedside manner, we say go for excellence. This isn't a prom date-but that's us. Eventually, practice can make perfect or at least give us a good start to getting the best care we can.