(The following post is an excerpt from The Myths of Modern Medicine: The Alarming Truth About American Health Care by John Leifer)
Imagine navigating the Amazon without a guide. Though the health care system isn’t rife with venomous snakes and flesh-eating fish, there are a great many hazards that can make the experience tortuous, expensive, and even deadly. Your tour guide, the one who keeps you out of harm’s way, is your primary care physician (PCP). He or she has drawn the map for your journey, enlisted others to help you surmount obstacles, and carefully tracked your progress. When you need someone with specialized knowledge, your PCP should know the best resources to call upon for help. When an unexpected complication arises, he knows how to course-correct.
It’s doubtful that you will find the Indiana Jones of primary care. What you will find, with a dedicated search, is a highly competent and compassionate physician who is dedicated to your family’s health. You can improve your odds of finding the right PCP through a well-organized search process that includes some or all of the following elements:
Your search starts here:
- Decide whether it is important for your physician to adhere to a certain demographic profile:
- Does it matter whether your physician is male or female?
- Do you want your physician to fall within a certain age range?
- Do you have any feelings relative to the ethnicity of your physician?
- As we’ve discussed, physicians undergo varying levels and types of education and training. It is important to identify what level of training and credentials are important to you:
- Are you seeking a physician who has trained at a traditional medical school, or are you equally comfortable with someone who has undergone osteopathic training? There are subtle philosophical differences between the traditions that still exist today. You may find one more appealing than the other.
- How important is it that your physician be American trained? An increasing number of primary care physicians are foreign medical graduates. Their training may be impeccable, but it is a factor worthy of your consideration.
- Will you be more comfortable with a family practice physician (who integrates care for patients of both genders and every age, and advocates for the patient in a complex health care system[i]) or with an internal medicine physician (who provides long-term, comprehensive care, managing both common and complex illness of adolescents, adults, and the elderly[ii])? If you select a family practice physician, what range of services are you comfortable receiving from this physician before being referred to a specialist (e.g., would you allow your FP to perform a colonoscopy or would you expect to be referred to a gastroenterologist? What about delivering your baby?)
- Do you value certain training institutions more than others, be it for medical school, osteopathic school, or residency? Would you, for instance, have higher confidence in an internist who trained at the Mayo Clinic?
- Is your physician board-certified or board-eligible by either the American Academy of Family Practice (AAFP) or the American Board of Internal Medicine?
- How will you determine whether your physician possesses the requisite experience, knowledge, and wisdom to manage your care optimally?
- How many years has your physician been in practice?
- How long has he or she been in their current practice?
- What does your physician do to stay current on medical advancements? Can you discern whether they are a “life-long learner?”
- Can you obtain informed opinions from other physicians about your PCP?
- Have you been introduced to any of your PCP’s partners—particularly the primary physician providing coverage when your physician is off or unavailable?
- What have you heard from friends and family about this physician? They may have limited ability to discern his or her clinical skills, but they may provide wonderful insight into the physician’s bedside manner.
- Your physician’s sphere of influence:
- Are you comfortable with the hospital(s) with which your PCP is aligned? Since chances are you won’t see him or her if hospitalized (hospitalists increasingly act as the primary care provider within the confines of the hospital), you should give this issue serious consideration.
- Is your physician independent or employed by the hospital? If they are employed, all the more reason to be comfortable with that facility or system, since it may pressure your physician to use the resources of that system.
- Your PCP may have a relatively tight-knit group of referral sources who are also tied to one or more hospitals. Are you familiar with some of the key specialists upon whom your PCP relies, and are you comfortable with these groups based upon your limited knowledge about them?
- Is the physician’s philosophy of care congruent with your beliefs and values?
- Under what circumstances would your physician consider it essential to see you the same day?
- Does the physician welcome you as a collaborator in your care or does he or she prefer that you defer to their judgment?
- Is the physician relaxed and thorough when addressing your questions or concerns?
- How does the physician manage your fear or anxiety? Is it with compassion or is he or she dismissive?
- How will your physician actively coordinate your care when multiple specialists may be involved?
- Does your physician have a particular bias toward medications in general or specific categories of drugs?
- How much importance does your physician place on wellness and prevention versus intervention? How do they demonstrate their commitment to wellness?
- How much importance does your physician place on well-being or emotional health? How do they demonstrate their commitment to this element of our lives?
- Does your physician practice within a medical home?
- Does your physician’s staff include advance practice nurses and nurse educators who can play an important role in your health?
- What is your physician’s perspective on end-of-life care?
- How confident are you that your physician will recommend treatment regimens based on the latest medical science?
- Does he practice evidence-based medicine?
- Does he utilize an electronic medical record?
- Are there standard protocols of care integrated into the record that your doctor relies upon?
- Can you discern any other important information about your physician from trustworthy third-party data sources?
You can glean some of this information by scheduling an appointment to meet your potential new PCP and conduct an “interview.”
With perseverance complemented with a little luck, you will end up with the guide you need. Remember, though, even the best of guides are human. Your job is not to place blind trust in any single individual within the health care system, but to use your discernment to know when to be deferential and when to seek more information. A good primary care physician will not be offended or threatened by your questions, but rather respect your stewardship of your own health.
If you are worried about asking your doctors tough questions, get over it. As Charles Inlander advises, “The bottom line is that you have to walk in with an arsenal of questions to be able to pick a primary care doctor or specialist.”[iii] When we began, I indicated that selecting the right PCP is a formidable task. If you’ve done the homework, you are in agreement that the effort is well worth the time.
Otis Brawley, MD, offered similar advice when I asked him how a consumer could find the “right” physician—be it a PCP or specialist: “I think that people should interview doctors. If someone has a chronic disease, this may be the most important interview of their life. Think of it as a hiring decision.”[iv]
[i] American Academy of Family Physicians, last modified 2013, http://www.aafp.org/home.html.
[ii] Intermountain Health Care, last modified 2013, http://intermountainhealthcare.org/providers/specialties.html.
[iv] Otis Brawley, MD (Chief Medical and Scientific Officer, American Cancer Society) in discussion with the author, August 16, 2013.