In my work as an elder care advocate I am often asked to recommend a physician and frequently hear the challenges families face with finding the right physician for their needs. Until my late twenties I did not have a primary care physician (PCP) who I saw on a regular basis. I religiously kept my well women visits with my Ob-Gyn, but never with a PCP. I was one of those women who never got sick, lived at the gym, and had a youthful metabolism that allowed me to love my skinny black dress and ice cream. Why did I need a primary care physician? Well…pregnancy, life, and maturity changed all that!
As an Occupational Therapist I knew plenty of doctors and interacted with physicians on a regular basis. But when I found myself seeking a primary care physician I really was not looking forward to it. For many reasons, both professional and personal, I did not want to be bothered. When push came to shove, I figured my health is one of my most important assets and I wanted to hire the right person to help me manage it; so I approached it like a job interview.
The first step I took was talking with friends and family about local doctors they recommend. I got a couple of names and reviewed their profiles using the physician referral hotlines at the local hospital. The physician referral operator told me information about their medical schools, their residences, provided information about their group medical practices, and she informed me of the insurance plans the doctors accepted. Of the physicians I checked out I chose one and made an appointment with him. The office staff was kind, the waiting and examining rooms appeared clean, and he had a cordial beside manner even when he told me that at 30 I need not worry about my occasional heart palpitations although a massive heart attack killed my dad at age 38 when I was two weeks old. I calmly stated my disagreement and engaged in a brief bantering which amounted to no real alternative causes except coffee, soda, or chocolate (which I didn't consume at all or very little) or stress (who isn't). After that, I didn’t say another word but the voice in my head screamed “You are SO Fired!”
I shared this experience with a close family member with similar expectations and personality as my own. He recommended his doctor who I have been with ever since and have recommended several people seeking his brand of interaction and medical management.
In hindsight I realize that I, like many patients, had initially made the assumption that a doctor recommended by someone I know will be the right doctor for me. While friends and family are a good place to start, be forewarned that "House, M.D." might be your girlfriend’s cup of tea but "Trapper John, M.D." might be just what you need. The reality is that finding a “good” doctor and finding the right doctor for you is not necessarily the same thing.
There are medical circumstances when having a doctor well versed in your medical condition and its treatment is all that matters. There are other times when building a relationship with a competent and engaging medical professional is what you seek. From my primary care physician I needed that type of relationship. I was able to seek and find it when I solidified in my mind the kind of doctor-patient interaction I needed. The success of a doctor-patient relationship is dependent upon a reciprocating ability to freely express concerns and be heard. I needed a teacher; someone who was willing to answer my questions, was open to explaining his/her assessment, and presented research-based alternative explanations and solutions. That works for me.
As an elder care consultant the advice I provide seniors and their caregivers when searching for a primary care physician is to first equip themselves with a sound knowledge of their own expectations, learning styles, life-stage philosophies, personality types, and communication preferences. It is unfair to you and your doctor to ask that either of you conform to fundamentally divergent philosophies and expectations. This knowledge should help you screen referrals from friends, family, and professionals, and should inform the questions asked during your interview(s) before you commit to a first appointment with a new primary care physician.
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Great information and I'm glad you provided a distinction between general and questions for gerontology.
July 2, 2008 - 10:44amThis Comment
What thorough information. And you're right, just because a friend makes a recommendation on a doctor, one's specific health conditions and philosophies are important. Personally, I have never interviewed a doctor, but did have one who I felt subjected me to unnecessary tests and like you, in my mind was thinking "No thanks." What type of questions would you recommend asking a doctor during an interview? With their busy schedules, how much time should an interview take?
July 1, 2008 - 9:10pmThis Comment
Tina,
A brief but productive interview with a physician is a mutually beneficial way to get to know each other and establish boundaries for a collaborative relationship at the onset. The worst that can happen is that you realize before the commitment that the realtionship won't work.
As to the time issue: Physicians usually have office time and some days with blocks of office time. If briefly meeting your doctor before you commit to a first appointment is important and he/she does not have time perhaps this in itself is indicative that you have divergent expectations.
Questions should relate to your expectations and preferences,your specific acute and ongoing medical needs and occurences that have frustrated you in the past to inquire about how your new doctor has handled similar situations.
The basics might include:
* How have you managed patients who are frustrated with long waits in the waiting room? Fellow patients in the waiting room can answer if this is an issue but you might also get insight into the practice's perspective on having to wait and learn about growth and staffing patterns. Most people are forgiving of infrequent extended waits; but with regularity it can jeopardize the relationship/patronage.
* Are patients required to cycle through all partners in the practice? At what frequency? What are the allowed exceptions, if any?
If you are seeking a specialist in Gerontology specifics might include:
* What percentage of your current patient caseload is seniors?
* What is your philosophy on the treatment and management of confusion in seniors? What alternative/non-medical interventions have you recommended with success?
* If your elderly patients need rehabilitation in a nursing rehab center do you follow their care at the rehab center? At what facilities do you have priveleges?
* How much time does an appointment allow for patient questions and education? How do you prefer patients communicate their questions: give them to the nurse upon arrival, ask them during/after the appointment, or a combination of the two?
The idea is to be reasonable but also to be honest and upfront about your expectations. What do you have to lose?
July 2, 2008 - 9:18amThis Comment