Choosing the Right Doctor

By William K. Summers, MD
© 2000-William K. Summers, MD

HMO's are collapsing like a house of cards. Many have abandoned their Medicare programs. Poor reimbursement by the federal government and 90,000 pages of new regulations dealing with HMO Medicare is said to be the cause. And the bureaucrats are accusing the HMO's of profiteering; but how does one profit with 90,000 pages of regulations?

Perhaps it is just as well. One of the major sacrifices of the new medical world has been the right to choose your own physician. We were limited to those "preferred" providers. This term implies that nurse practitioners are equal to physicians. Pharmacists are equal to nurse practitioners. Pharmacist's assistants are equal to pharmacists. The pharmacist's assistant's secretaries then must be the same as a doctor. All providers were equal. It turns out that the term "preferred" meant that the provider would accept ever-decreasing payments for service. Given enough time, only nurse practitioner assistants would be "preferred".

Now that HMOs are melting down, we again have the burden of selecting our own doctors. I took a brief survey asking, "How would you pick a doctor?" The answers: "I look at my HMO hand book." "I would go to the emergency room." "Someone who has their Boards in their specialty." "Who cares?"

Next was the question was, "How would you pick a doctor for your mother?" The answers: "The doctor has to be an expert in his field?" "I would ask a friend." "I know a doctor (nurse, pharmacist, etc). I would ask them." And one person said, "Who cares?"

Your primary physician should be a matter of great concern. Medicine is an art with the veneer of science. Outcomes depend upon how artfully the science is practiced. Outcomes depend upon how well your personal medical team works together for you. As "birds of a feather flock together", good doctors tend to associate and refer to each other. One doctor may be an excellent scientist; but he and his team might not work well for your personal needs.

Criteria I suggest for choosing a physician is represented by the acronym "PEER HAIR":

P   Positiveness - A doctor should give hope, not false despair. Positive doctors will often work well with other health care professionals. They are team players.

E   Educated - This does not mean passing their specialty Boards. Studies show there is no measurable patient outcome difference between fully-trained physicians and those doctors who passed a Board exam. Educated means they trained at a good medical school. More importantly, they continue their education. Educated doctors learn from their patients. They graciously accept your internet research. Educated doctors try to educate you, the patient, about your problem. Incidentally, the word "doctor" is Latin for "teacher".

E   Experienced - Book learning can carry a doctor only so far. There is no substitution for spending enough time "practicing" medicine. Experience leads to confidence. Confidence means the doctor will act with minimal hesitancy. In medicine, hesitancy can cost lives.

R   Responsive - Do they listen to you? Do they answer your questions? Do they act on your complaints? Will they act contrary to the HMO denial?

H   Honesty - Will your doctor admit when he does not know the answer to a problem? Is your doctor comfortable turning to a book to look up an answer? Or will they pretend they know everything? Will your doctor tell you if he handles capitated healthcare contracts? This is where the HMO pays the primary doctor a fixed price. If that doctor sends the patient to a specialist or orders a test, it is taken out of his fixed price.

A   Aggressive - Does your doctor order tests to make a diagnosis? Are several office visits required to establish the diagnosis? Minimizing tests and office visits may delay the proper diagnosis and proper treatment. Sometimes a brief hospitalization to establish diagnosis is the cheapest and best care.

I   Integrity - Does your doctor do the right thing when no one is looking? Does he send you for that test that he knows is correct, knowing that it will mean extra paper work from the insurance company? Does he admit you to the hospital because you need to be there on Friday night when pre-approval is not likely? Or does he wait until the insurance reviewers return to their offices at 9:00 am Monday morning?

R   Reputation - What is the doctor's reputation? It is the summation of the above.

So, where do you find super-doc? Ask your friends. Contact your local medical society. Look in the Yellow Pages. Do research on the WEB. With general criteria in mind, you will know whom to pick when you find them.

To Your Health!!