One of the very best resources of free help and financial assistance in the U.S. Get help navigating your health insurance, accessing treatments, appealing insurance denials, and connecting to care through the Patient Advocate Foundation, or call 800-532-5274. Go to https://apatientsplace.wordpress.com/help-guidance/ for hundreds of links to free help with your healthcare.
By W. Kolber, MHA
The relationship that you have with your primary doctor is possibly the biggest factor in determining the quality of healthcare you get in the U.S. Without the “right” primary care doctor you are left without what may be your best advocate. You can find “Dr. Right” with effort, and it’s well worth it. Just, don’t expect it to be easy.
The “right” doctor for you will;
- Listen to you.
- Treat you with respect.
- Communicate in a way that works for you.
- Help coordinate your healthcare needs and doctors.
- Be available when you need her/him.
- Be aware of what matters to you.
- Be in your health insurance network; if you are insured.
Remember, the “right” doctor for you may not be the right doctor for someone else. Finding the right doctor involves putting together information from many different sources.
- Your insurance provider.
- Your personal observations when you visit.
- Other doctors and health care professionals.
- Friends and family.
- The Internet.
- Other patients.
This article guides you through the process, helps you evaluate the information you get from others, and tells you the questions to ask.
The first decision you should make is who will be your primary care physician.
In an ideal situation this is the doctor who will help you make the right choices based on your medical situation and your preferences. If you are in an HMO, your primary physician will be required to manage your referrals to specialists. Even if you’re not in an HMO you will want your primary doctor to do the following;
- Know who you are.
- Know what you want.
- Coordinate your healthcare.
- Explain things you don’t understand.
- Connect you with other providers and services.
- Advise you about anything on your mind related to your health.
- Be accessible when you need help.
Now that you know what your doctor should do, consider the qualities you want. A few key qualities to consider include;
- years of experience.
- education background; including their residency.
- male or female.
- convenience of practice; location and hours.
- after hours access to help.
- communication methods; phone, email, text, etc.
- designation as a medical home.
The “medical home” practice model is a team-based model. The doctors who follow the principles of the patient-centered medical home model take the lead for each patient’s medical team, while the team collectively takes responsibility for providing the patient’s health care needs. In 2007, several of the leading medical organizations, including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association released the “Joint Principles of the Patient-Centered Medical Home.“
The principles are:
- Each patient has an ongoing relationship with a personal doctor trained to be the primary contact. That doctor provides continuous and comprehensive care.
- A personal doctor leads a team of individuals at the practice who collectively take responsibility for the ongoing care of each patient.
- A personal doctor is responsible for providing all the patient’s health care needs, or taking responsibility for appropriately arranging care with other qualified professionals.
- Care is coordinated and/or integrated across all providers including specialists, hospitals, home health agencies, nursing homes, etc.
- Quality and safety are enhanced through care plans, evidence-based medicine, clinical decision-support tools, performance measurement, active participation of patients in decision-making, information technology, and quality improvement activities.
- Patients have open access to care via email, flexible scheduling, convenient hours, telehealth, quick and effective communication, and other means.
- Payments should reflect the value of the work that is done both inside and outside of the face-to-face visit.
Identify three to five doctors in your insurance network that meet your criteria by using your health insurance Provider Directory. Find the type of doctor that meet your needs. The most common primary physicians are Family Practice, Internal Medicine, General Practice, and in some cases for women OB/GYN. If you don’t know how to access the Provider Directory call your health insurance customer service number.
Review the qualifications of each physician. The medical credentials such as the medical school a doctor went too, and where they did their residency often indicate how well a doctor performed during their early training. A doctor’s credentials may also show you if a doctor has achieved a level of expertise and knowledge that the Medical Board that oversees their specialty feels qualifies that doctor for certification.
Often these basic qualifications can be checked in your health insurance provider’s handbook or on their web site as a part of the listings for the doctors who are in their network. There are also many web sites that offer this information about doctors. Some of the leading websites for physician ratings and reviews can be found at www.aPatientsPlace,com. One of the best sources outside of your insurance provider is the professional medical association that licenses, certifies, and supports the doctor’s practice specialty. Another great source is the www.healthfinder.gov web site..
You can check if your doctor is Board Certified at the web site www.abms.org. There is no cost to register, and you can look up as many as five doctors each day. Board certification means that the doctor has completed an approved residency program and passed a detailed written exam in at least one of 24 specialty areas, such as family practice, internal medicine, or obstetrics and gynecology. Most doctors must renew their certification every five or ten years. Sometimes older doctors do not need to renew their certifications due to rules that cover experienced doctors. If the doctor is not board certified, find a different doctor.
Another simple way to find a doctor’s basic qualifications and a little about their practice at the same time, is to call their office and ask their staff.
If the doctor or their staff is hesitant to answer your questions, if their phones are not answered quickly, or you are put on hold for more than a few minutes, you should think about how you would feel if you were their patient and the same things were happening to you.
Tip: Start building a relationship with your doctor ASAP. Consider that a typical primary care physician may have 2,000 to 3,000 patients, and they may see as many as 30 patients on busy days. “
Contact the practice by phone.
Here are some questions to ask the practice administrator or the receptionist during your initial phone call…
- Is the doctor taking new patients?
- Do you accept my insurance?
- How long does it usually take to get an appointment?
- How long does the doctor usually spend with each patient during an appointment?
- Can I get a same day appointment in an emergency, or if I am in pain?
- What are the office hours?
If the practice receptionist has the time, additional questions that you might ask include;
- Who will see me when the doctor is not available if I have a problem, question, or concern?
- Is the doctor part of a group practice? Where can I get more information about the other doctors?
- Which hospitals does the doctor use?
- What is your cancellation policy?
- Is lab work done in the office, or at an off-site facility?
- Do you help patients with their insurance claims?
Check for Criminal Conduct. You can look this up on the web at www.fsmb.org. That site lists each individual state’s medical board site. There you can search under professional misconduct to see if your doctor has been listed. You might be surprised by what you find. You might also consider checking the federal government’s Open Payments database to see if their doctors receive payments from drug makers or medical device manufacturers.
Check the Doctor’s Reputation. There are several ways to check a doctor’s reputation. Remember though, that another patient’s experience, or a list of “top doctors” may not be based solely on facts. Information from patients, other health professionals, and subjective sources should be confirmed by at least two other sources if possible. Here are some ways to find more about your doctor’s reputation:
- Ask the doctor’s current patients. When you are waiting to see the doctor, talk to a few other patients in the waiting room. Tell them that you are a new patient, and ask them what they like most and least about the doctor and practice.
- You can also learn about a doctor’s reputation from other health care professionals.
- If you prefer, you can look online at the growing number of web sites that publish information from patients and health care professionals about their experiences with specific doctors. The web site Yelp is one such example. A more complete list can be found at www.aPatientsPlace.com.
- You can also search for “patient chat rooms” or “patient referrals” in your local area using your favorite Internet search engine. Sometimes, local magazines and web sites even publish lists of your area’s “best doctors.” Although, being listed as a top doctor in a publication or on a website does not necessarily mean that they are a good doctor.
The best doctor to work with will be open and honest about his or her limitations. A doctor’s attitude towards patients who would like a second opinion does not provide insight about the reputation of the doctor. It does show a lot about their comfort for recognizing that their patients are at the center of the health care system. Good doctors will welcome another opinion. If they are unwilling or resistant to refer their patients to other specialists this may be a sign of arrogance, or caring more about their ego than the well-being of the patient.
Some hospitals and health providers have phone or online doctor referral services. Usually you can find out if your hospital or health system has such a service simply by calling their main number or going to their web site.
Tip: Do not call 800 numbers at the local hospital as your only source during your search for a doctor. Many hospitals and health systems use these services to influence you to choose the doctors who drive the most revenue to the hospital, or to help a new practice add patients, or increase the use of a new treatment.
Ask for Referrals. Since the early days of medicine, referrals have been one of the primary ways that people learned of doctors who might help them. Referrals from someone you trust gives you the advantage of learning from someone else’s experience. The most likely sources for referrals are health care professional, nurses, your family, a friend, a neighbor, or a co-worker. Consider though, that the experience of the person referring the doctor to you may not be similar to what you experience.
Tip: The fact that the person giving you a referral had a positive experience, or that they have been using the same doctor for many years does not mean that they are getting good care, or that you will.
There are also web sites that are set up by other health care professionals to help people find doctors. Examples are http://www.FindADoc.com and SurgeonRatings.org. There are also social networking sites like Yelp that let users post and read comments about local doctors and practices. One of the challenges with online reviews is that you can’t always be certain that the reviews are authentic, or that they aren’t written by friends. Not to mention that patient reviews are often only written by people who either hate or love their doctors.
Consider Ratings. Health insurance companies have been rating the performance of doctors for years, but consumers seem to prefer the opinion of their peers over a company that might have a financial interest in their ratings. Information and ratings from insurance providers and hospitals may also be influenced by the financial goals of the organization. Some experts feel that ratings tend to influence patients to see the least expensive instead of the best doctors. However, if your insurance provider web site tells you how many procedures a doctor has done or other facts about the doctor that can be very helpful information.
Tip: Patient chat rooms and discussion groups can be an excellent source of referrals and information for everything from doctors to nursing homes to therapists. There are many patient chat rooms available at www.aPatientsPlace.com.
Schedule an “Interview” Appointment. Meet and talk to every doctor, or at least their Practice Manager before trusting them with your treatment and/or care. Most practices have set aside a few time slots for new patients to come in and speak with the doctors. You might want to think through some of the following questions before scheduling an interview appointment.
- Where is the practice located?
- Will it be easy for you to get there?
- Is it accessible by public transportation?
- Is there ample parking?
- Which hospital(s) does the doctor use?
- Are you comfortable with the possibility of being treated at one of these institutions should the need arise?
- Where are routine x-rays and laboratory studies performed? Can these be done in-office, or will you have to go to an outside laboratory?
- How long must you wait for an appointment after you call? Can you be seen on the same day if you have an urgent need?
- Is the office staff friendly and courteous?
- If you call with a question about your care, does a doctor or nurse return your call promptly?
- Who covers for the doctor when he/she is away?
- Whom should you call if you have a problem after-hours?
- If the doctor works in a group, are you comfortable with being seen by one of the practice partners?
- Does the doctor frequently refer patients to other specialists, or does he/she prefer to manage the majority of your care?
- Does the office process insurance claims, or must you pay up-front for services and file the claims yourself?
- How long will you have to wait for an appointment? Look for practices that offer “open-access” scheduling, in which doctors typically leave part of each day’s schedule un-booked so they can offer some same-day appointments.
- Do they keep paper or electronic medical records? Computer-based record-keeping is considered a major step toward improving the quality and efficiency of medical care. But not all doctors use electronic records.
- Do they take questions by secure e-mail or text? E-mail “conversation” is great for problems or advice about a chronic disease, an appointment, test results, clarification of some item that came up during an office encounter, an overlooked question, a medication side effect, or any question requiring only a yes or no answer. And it’s a direct link to your doctor, without a telephone intermediary such as a nurse or assistant and can supplement your time with you.
During your initial appointment, you want to consider if the doctor …
- Communicates openly and honestly.
- Encourages you to ask questions.
- Listens to your opinions and concerns.
- Answers your questions.
- Is not defensive.
- Has experience treating your medical condition successfully.
- Will spend the right amount of time with you.
- Respects your preferences.
- Explains things in way that you are comfortable with.
You should always work with a Board-Certified doctor. This means that they have completed residency training in a specific field following graduation from medical school, and they have passed a competency examination in that field.
- Contact your insurance provider to discuss your options, and get an updated copy of your insurance plan benefits.
- Check each doctor’s qualifications.
- Make sure the doctor accepts your insurance. Why pay yourself if there is an excellent doctor in your insurance provider’s network?
- Disregard advertisements.
- When your doctor refers you to a specialist, always ask for two different recommendations.
- Don’t wait in an office for more than an hour. Having to wait for hours may mean the doctor is under-staffed.
- If you have no insurance or only have Medicaid, go to a clinic at a university medical center.
Here’s a link to additional information on working with doctors.
Making your way through complex medical systems, doctors appointments, and treatments can be overwhelming. Medicare beneficiaries can get free help with care coordination, medication management, explanation of a diagnosis or treatment, and connections to resources through the Medicare Quality Improvement Organization. Just complete the brief form on their home page. If you need additional assistance finding help for your health care journey, complete the contact form at aPatientsPlace.com.
1. Be involved in all parts of your healthcare.
2. Ask questions whenever you are unsure of anything related to your healthcare.
3. Find out how much you will be expected to pay before appointments, tests, and treatments are started.
4. Request copies of your test results, doctor’s notes, and medical record when you check in for any appointment, test or treatment.
5. Always find out how much successful experience your health providers have at diagnosing and treating your specific condition.
6. Keep and organize copies of your medical records, test results, and interactions with all of your health providers.
7. Learn as much as you can about your illness and providers from trustworthy sources.
8. Contact your insurance provider as much as is needed to understand your coverage, your insurance provider’s guidelines, and your financial responsibilities.
9. Negotiate fees with doctors and treatment providers whenever possible.
10. Review your bills for mistakes, or have someone do it for you; its free.
11. Consult an experienced specialist after a serious diagnosis.
Get free help navigating your health insurance, appealing insurance denials, and accessing care through the Patient Advocate Foundation, or call 800-532-5274. Go to https://apatientsplace.wordpress.com/help-guidance/ for hundreds of links to free help with your healthcare.
- Be involved in all parts of your healthcare.
- Ask questions whenever you are unsure of anything related to your healthcare.
- Whenever possible, find out how much you will be expected to pay before appointments, tests, and treatments are started.
- Request copies of your test results, doctor’s notes, and medical record when you check in for any appointment, test or treatment.
- Always find out how much successful experience your health providers have at diagnosing and treating your specific condition.
- Keep and organize copies of your medical records, test results, and interactions with all of your healthcare providers.
- Learn as much as you can about your illness and providers from trustworthy sources.
- Contact your insurance provider as much as needed to understand your coverage, your insurance provider’s guidelines, and your financial responsibilities.
- Negotiate fees with doctors and treatment providers whenever possible.
- Review your bills for mistakes.
- Consult an experienced specialist after a serious diagnosis.