Guest blogger Beth Austin shares her professional and personal advice on choosing the right doctor. She is the principal of Crescendo Consulting Group.
I’ve spent a lot of time in my professional life knee-deep in articles on healthcare quality and medical information, as well as working with local doctors, hospitals, and health-focused, not-for-profit agencies. As part of this work, I often share information and resources with others to help them choose a doctor. I’ve also spent a lot of time wondering whether anything I knew or said ever made a difference to anyone, or whether people always end up picking the specialist their PCP recommends or just geolocating the practice closest to their house. Does anyone even pay attention to their health or healthcare unless there’s a problem?
Recently, I received an unexpected medical diagnosis (although I suppose most of them are unexpected). It was of the frightening and potentially life-changing variety where you blow through your health plan deductible and out-of-pocket max faster than you can say “hospital johnny.” Suddenly I felt as if I were being put to the test – an almost surreal, multiple choice exam where the wrong answer could have significant consequences. I would soon be faced with important decisions – and would learn first-hand whether anything I knew actually mattered. I’ll share with you a few tips based on my experience, but first, a couple of caveats.
Big Caveat Number One: It’s personal. A big lesson learned for me is that there is no single “right answer.” Choices about treatment approaches or where one receives care can be affected significantly by one’s personal life circumstances. There is a whole truckload of psychological, spiritual, and simply practical aspects that need to be considered. If you know someone going through this, provide guidance and insight, but don’t judge.
Big Caveat Number Two: It’s not always easy. Even if you think you know the right answer, speaking up or acting on your knowledge is sometimes challenging for a myriad of reasons. The subject matter is intimidating, you’re exhausted, you’re stressed, and you’re afraid of making the wrong decision… more great reasons not to pass judgment on others (or yourself).
Now, for what it’s worth, here’s what I learned from my experience:
- Learn how to be a patient. This may sound unnecessary, because all you have to do is show up for appointments, right? Wrong. Being actively involved in understanding and making decisions about your care can make a big difference in the outcome. For more information about this, see Jessie Gruman’s work. For other resources and tools, you can visit sites such as AHRQ, the US Department of Health and Human Services, or respected organizations specific to your condition (just to name a few).
- Write it down. With a brief acknowledgement of my Type A personality, I think this is one of the most important things you can do. Shortly after receiving my diagnosis I made a list of everything I needed to do and what information I needed to get. You should also write down questions as you think of them or symptoms as they occur (if relevant). As a practical matter, you’ll probably want to write down most everything because you’ll be lucky to be clear-headed enough to remember your own phone number at a certain point.
- Use the buddy system. I know you’re an intelligent person, but this simply isn’t the time to “wing it.” Bring a family member or friend with you to all appointments. Give him/her a copy of that list of questions you wrote down so you don’t forget to ask any of them. Ask him/her to write down all the answers. Get his/her impression of the visit and exchange ideas. S/he can also act as your advocate when you cannot.
- Know where you’re getting your care. Does the doctor or hospital you’re considering using specialize in your condition? How do they perform on quality reports? If you don’t know the answers to these questions, find out.
- Know your condition. Obtain as much relevant information about your condition as you can. Understand your diagnosis, the risk factors, and possible treatment approaches.
- Too much of a good thing is, well, sometimes a bad thing. It is critically important that you be an involved, informed participant in your care, but you also want to do your best to limit yourself to research and behaviors that are relevant and helpful. I know it can be a challenge to find the right balance between being empowered and overloading yourself with unhelpful, unnecessarily frightening, and/or inaccurate information, but it’s very important.
- Reach out. Now is not the time to be shy. Although it’s often difficult to talk about personal health information, a support network is a vital part of making good decisions. In addition to your friends/family, reach out to people who also have your condition (most are very willing to talk about it). Dig deep into your network if needed. Just being able to “talk out loud” to someone can help the decision making process. Use any resource available to you — even if you’re not sure you need it – such as local support groups. You’ll find help in unexpected places.
- Listen to your doctors. The “s” on the end is important. Unless you have an imminently life-threatening situation and time is of the essence, you will want to talk to more than one doctor in some shape or form. Ask your primary care doctor for guidance. Obtain recommendations from more than one doctor if possible. You may want to get a second opinion on treatment.
- Listen to yourself. This one is the most important. In the end you’ll need to filter all the information you received from friends, family, others with your condition, doctors, quality reports, and other sources — which will likely be conflicting in some regard. Ultimately, you will need to find a process for evaluating all the information and making a choice about which you can feel confident. Trust your judgment.
Final Exam
For me, the doctor-choosing multiple choice test ended up looking something like this:
Which doctor would you choose?
- An experienced, qualified doctor whose style and approach you really like and works at a hospital that has a national accreditation in your condition.
- A doctor who is widely recognized as the best in the area for this condition and works at a hospital that performs well on quality reports, but is not credentialed in your condition.
- A doctor at a tertiary medical center that is nationally and internationally recognized for providing care for your condition and is two hours away from where you live.
Remember that this is a personal decision, and for that reason I won’t tell you which doctor I chose because it is not necessarily the “right” answer — just the right answer for me. The biggest point is to know that you have a choice and to use some sort of informed decision making process. And, overall, I’m really glad I paid attention before it became a matter of life and death.
I think the article misses the single most important point in choosing a doctor today.
Choose an independent physician in solo or group practice, not an employed physician – whether employed by a medical group or a hospital system. Even better, choose a physician who is not contracted with an insurer.
Employed physicians usually receive a salary but, in addition, get a (usually) substantial portion of their pay based on “productivity.” Now, ultimately, all physicians are paid based on their productivity, but the word has a special sense in employee situations. The incentive that is always present for the doctor to “do something” is there, but in the case of an employee that pressure is amplified, and may be so to the detriment of the patient.
Many employment models pay bonuses to their employed practitioners (MDs or advanced practice nurses) based on some threshold of productivity. In other words, if the practitioner doesn’t perform or prescribe enough diagnostic or therapeutic procedures, then s/he won’t get the bonus.
These payment models increase patient and system costs, expose patients to increased risk, and rarely contribute anything to the quality of care the patients receive.
Finding a non-participating physician (i.e. those who don’t contract with insurers) is difficult, and in many parts of the country there are none to be found. But patients lucky enough to find them receive care that is lower cost, more personalized and higher quality.
Non-contract physicians, rather than relying on a high flow rate of patients arriving via an unsurers provider list, and accepting poor payment for that convenience, instead build their practices on the basis of word of mouth and local advertising, and by providing the patients a level of service commensurate with that form of growth. They spend more time with patients, get to know them better, and do so at a cost which is lower than what the contract physicians charge.
By removing the insurer from the exam room, they allow a frank, valuable discussion of the disease at hand without being compelled to interject the insurers payment policies into the discussion. Insurers will continue to reimburse the patient for their care, but pat the money directly to the patient rather than delivering a steeply reduced amount to the physician.
Using a non-contracted physician brings medicine back to what it ought to be – a relationship solely between a patient and his or her chosen physician.
This seems like a lot of work! What’s the trick to being an informed patient before it becomes death-defying?
Great question, Daniela. It starts with realizing that a lot of healthcare depends on our own decisions and action, and that there are real differences between care providers. So you get to think: What do I want? And who provides it?
You don’t have to “boil the ocean,” i.e. solve the whole subject all at once. It starts with getting started and thinking appropriately.
In my view, it’s really not different from being an “engaged consumer” in other areas. Do you choose a car or TV based on reading you’ve done? Are you particular about getting what you want when you get your hair cut?
The prolog of my book describes how I was an engaged / activated / empowered consumer of health services decades before I heard about patient empowerment or engagement. Just be a thoughtful consumer, aware of your wants, ask for what you want, and let things unfold.