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What’s Important in Choosing a Doctor?

    • What kind of doctor do you need?

    • Both Birnbaum and Brayer suggest you consider a primary care physician (PCP) for the bulk of your medical care. That typically means a physician trained in Family Medicine or Internal Medicine for overall care. You might also need a Pediatrician for children up to age 18, or an OB/GYN physician for women in their reproductive years.

      If you have an HMO health plan, you likely already have a PCP to coordinate your care. But Drs. Birnbaum and Brayer say PCPs provide benefits, no matter what health plan you have.

      Why? A primary care physician is a specialist in comprehensive medicine, says Dr. Brayer. Their specialty is caring for the whole patient, always taking in the big picture.

      A PCP is also trained in preventive care – screenings, immunizations, discussions of health issues. This need for regular preventive care continues through every stage of life, notes Dr. Birnbaum.

      A primary care doctor not only guides you in the best preventive care, they will help you deal with illnesses that might arise, and manage chronic diseases. A PCP will guide you toward the correct specialty physician, if you have a need. By coordinating care, your PCP can help you avoid duplicate tests or inappropriate visits to the Emergency Room.

      Dr. Birnbaum notes that your care may also be provided by a nurse practitioner (NP) or physician assistant (PA). These health care professionals work in collaboration with your physician.

    • Health care that’s personal for YOU

    • The biggest benefit of having a primary care physician, say Birnbaum and Brayer, is that they come to know YOU. If you see a PCP for your care over time, he or she comes to understand not only your physical body and its unique needs, but your values, attitude, fears and your own philosophy about how you will use medical care. This is vital to a partnership that helps your doctor help you. Are you cautious and want to be guided in all medical decisions? Are you willing to consider alternative treatments? Over time, your PCP comes to know what matters most to you, and understands the type of communication you need to feel confident in your medical treatment.

    • Guidance for referrals to specialists

    • If your health coverage is an HMO plan, you are probably familiar with the need to have a PCP guide your referral for specialty care. But even if your plan is a PPO that lets you choose specialty care without a doctor’s referral, there are good reasons to seek your PCP’s guidance.

      Consider this example by Dr. Birnbaum: You develop a sore knee, notice a mole on your upper back, and have an ongoing cough. If you decide to refer yourself to specialists – an orthopedic physician or rheumatologist for the knee; a dermatologist to look at the mole; and an allergist or pulmonologist to listen to your cough – you could end up spending a good deal of time and money on these conditions, since many of the newer health plans have high deductibles you must pay yourself before full coverage kicks in. PCPs can handle a wide range of health issues and perform minor procedures in their offices. They are also trained to provide effective preliminary diagnosis and – knowing you as they do – help you decide on the right specialist for the next level of care. No one knows your body as well as you do, so a trusting relationship with your PCP will help you make your decisions about specialty care.

    • But which Primary Care Physician?

    • For basic adult primary care, the choices are a Family Medicine or Internal Medicine physician. What’s the difference?

      Family Medicine physicians typically care for the entire family – from newborn babies to grandmothers and grandfathers. If it’s important to you to have the entire family seen by one doctor, Family Medicine is a logical choice. Of course, a single adult can also choose a Family Medicine physician for all his or her care.

      Internal Medicine physicians typically do not see children under 18. Internal Medicine doctors are also more oriented, by training, to hospital medicine and more severe diseases.

    • What about a Pediatrician for my child?

    • Pediatricians are trained to care for children, from birth through about age 18. Dr. Birnbaum says it’s important to note that a Family Medicine doctor can also care for healthy children, from birth throughout their growing years, including the recommended well baby checkups. If your child has a chronic disease, is at risk for certain diseases, or was born prematurely, a Pediatrician is probably the best choice for you. The Pediatrician can serve in the role of overall care provider and help with referrals to other pediatric specialists. As your child reaches his or her teen years, it can be a good time to seek out a Family Medicine or Internal Medicine doctor for their care as adults.

    • What about an OB/GYN for a woman’s basic care?

    • Dr. Birnbaum notes that the OB/GYN who cares for a woman through pregnancy and birth is likely to continue that relationship during her reproductive years. Healthy young women often don’t need much medical care other than their regular Pap smears and physical exams. An OB/GYN can meet that need. If a woman prefers to get all her care in one place, a family doctor or internist can also provide Pap smears, as well as pelvic and breast exams.

      OB/GYNs generally don’t provide immunizations or other preventive screening exams, so having a Family Medicine or Internal Medicine physician as well could be useful. Also, as a woman ages, she may develop chronic conditions like high blood pressure or diabetes that are usually not in the scope of an OB/GYN specialist’s care. In these cases, having a PCP also makes good sense.

    • OK, now which doctor do you choose?

    • After choosing the specialty that fits your needs, you need to choose the doctor who will provide your care. At this point, it’s all about getting personal. Ask yourself these important questions:

      • Do you want a doctor whose office is near your home, or your work? How far are you willing to travel when you need to see a doctor?
      • Do you have a hospital you would prefer to use for any surgeries or hospitalizations? Find out if the doctor you are considering has privileges there.
      • Do you feel more comfortable with a physician of the same gender as you, or does that matter?
      • Would you prefer a doctor who shares your cultural heritage or speaks your native language?
      • Are you a telephone or email person? Many doctors now offer online options to communicate, schedule appointments and pay bills. If that will make your life much easier, find a “connected doctor.”
      • Do you need extended or weekend hours to meet your busy schedule? Find out if a doctor offers that.
      • Most importantly, know your own philosophy of health and wellness – and choose a doctor who shares that philosophy. Use of medications, frequency of testing, full-on care or wait-and-see – both patients and doctors vary in their philosophies. No one is “wrong” but it’s important that you match.
      • Understand who provides back-up if your doctor is unavailable.
      • Ask around – if a doctor is recommended by friends, co workers and family, that’s always a good sign.
      • Does the doctor take your insurance? If none of the doctors you wish to see accepts your health plan, consider changing your plan.

    • Don’t be afraid to change doctors

    • Remember that your health care is extremely personal and extremely important. No one is happy in a doctor-patient relationship where there is a mismatch of styles or personalities. Do not be afraid to change to a new doctor, says Dr. Birnbaum.

      She also notes that you – the patient – hold a responsibility in making this relationship work. Your doctor can only come to understand your point of view if you share it. While we are likely past the days when patients fully surrendered their medical decision-making to their doctors, we also have a responsibility to listen to the experts we have sought out for their training and skill.

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