Monday, April 1, 2013

How to Choose the Right Doctor

So much attention today is paid to the rising costs of our medical care, premiums and what our insurance does and does not cover. Often over looked in the process is who is the person delivering the care.  Under what criteria should we select a physician?

Sometimes, we're restricted in who we can visit based upon our insurance limitations. However, when we do have flexibility, the majority of patients are still ill equipped to objectively choose the best physician available. Most decisions result from emotional and highly subjective considerations. Does he have a good personality?  We think, if my friend likes him, he's probably a good physician. Or, if he's been in practice for a long time, so he must be good, because the more experienced a doctor has the better he is. Perhaps he was simply recommended by another physician. While some of these may be valid reasons for physician selection, they are not based on the criteria that relate to overall quality of care issues.

Here's a few specific ways to begin the search for the doctor who best meets your needs.  
  • Check the physician's basic credentials.  This provides a baseline for the type of training a physician received.  Many states offer physician profiling websites which detail the physician's education, training and specialty board certifications.  Or try DocFinder for its easy to use search engine. DocFinder remains the only database that combines all licensing jurisdictions by state licensing boards and remains free of charge to the public. In addition to physician profile information from states that have passed physician profile laws, the website contains the licensing background and disciplinary information of physicians and other health care practitioners. The American Board of Medical Specialties allows you to check Board Certification on their site, as well as any disciplinary action taken against the physician, including malpractice/liability issues.
  • Check field specific expertise or procedures.  This is important especially when selecting a surgeon or sub-specialist like an oncologist.  It is entirely appropriate to ask the physician how many procedures, such as the one for which you are seeking help, he has performed.  The phrase "more is better" is probably appropriate in this case.  An orthopedic surgeon who has performed 1000 hip replacements is probably better than the one who has done 100.  However, there is a caveat.  Surgeons with less experience may have been more recently trained in newer and better techniques.  They may be using more state of the art surgical procedures.  Older surgeons, for example, may not have been trained or feel comfortable in minimally invasive robotic surgery. Younger surgeons are trained in these techniques and may not be as proficient in the traditional open surgical procedures.  A recent Consumer Reports story said "When deciding on a surgeon, remember that caseload may be more important than a surgeon's age. An analysis of Medicare data for nearly 461,000 patients found that while surgeons over age 60 with low surgical volumes had higher patient mortality rates on some procedures, those who continued to maintain high surgical caseloads had comparable outcome with surgeons ages 41 to 50."
  • Another aspect of physician selection relates to seeking a second opinion.  You should always seek a second opinion when surgery is recommended or a particular treatment or procedure is proposed, such as cancer treatment.  Mistakes are often made in diagnosis which leads to inappropriate treatment.  It's invaluable to hear another opinion. A recent Wall Street Journal article by Holly Finn talks about second opinions:  A 2010 Gallup poll found that 70% of Americans are so respectful of their doctor's advice that they never get a second opinion or do additional research. We apply more scrutiny to choosing bluejeans, buying flat-screen TVs or ordering lunch. A good doctor will welcome you seeking a second opinion from another physician.  You cannot be concerned about hurting your doctor's feelings by going for a second opinion.  If you are close to a major teaching hospital medical center, take advantage of your access to the very best in your area. If you cannot seek out a teaching hospital environment, then the experience and credentialing criteria suggested above should be utilized to select a second opinion.  Always remember, if your second opinion physician is different from your first, then you should seek a third opinion.  You should have at least two opinions that are the same or similar to make an educated decision.
  • The Human element.  No matter how skilled your doctor may appear if you do not feel comfortable talking to him or relating, this could lead to unexpected stress and frustrating communication down the road. Do not take for granted the importance of a rapport with your physician.  
  • Insurance participation. You should always ask if the physician participates with your insurance plan.  This can have significant cost implications.  If he or she participates/accepts assignment, then the physician agrees to accept as payment in full the amount approved by the insurance company.  On the other hand, if he is out of network, and therefore does not accept the assignment, then he can charge you the difference between the approved amount and the approved amount.  In the case of Medicare, a doctor who does not accept Medicare Assignment can only charge 15% above the Medicare approved amount. Often times you can negotiate a preset reduced percentage ahead of time with the physician if they're aware your insurance will not cover the treatment.
  • Hospital affiliation.  It may be helpful to verify the hospital(s) in which the physician has admitting privileges.  Hospital services and and quality vary from one to the other.  You may want to inquire about re-admission rates for the patients, infection rates, mortality rates by diagnosis or admission type.  Many state health departments require hospitals to report on various infection rates. Centers for Medicare and Medicaid Services has published the infection rates on its Hospital Compare website, where the government already publishes data about patient satisfaction and some other types of medical errors in order to help consumers choose quality hospitals.  Not all hospitals are created equal.  

While the above recommendation are not an all inclusive list, at least you have some additional guidance to now select a doctor with more confidence and objectivity.

Stay Informed. Stay Positive. Stay Healthy.
The Patient's Advocate
Any additional questions or concerns please call:
1-800-400-4066 and ask for Harvey.