The “right” doctor for you will treat you with respect, communicate in a way that works for you, coordinate all of your healthcare needs and doctors, be available when you need her/him, and be aware of what matters to you. They may not be the “right” doctor for someone else.
Finding the right doctor involves putting together information from many different sources, including your insurance provider, personal observations, doctors, friends, family, the Internet, and other patients. This section will guide you through the process and discuss the sources you might use to make your decisions. You will also learn how to evaluate the information you get from those sources, and what questions to ask doctors when you are deciding who is best for you.
Choosing a Primary Care Physician
Tip: The first decision you should make is who will be your primary 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 know who you ae and what you want, coordinate your healthcare, explain things you don’t understand, connect you with other providers and services, and advise you about your choices and their consequences.
First consider the qualities you want in your top doctor. A few key qualities to consider include;
The “medical home” practice model is a team-based model. The doctors who follow the principles of the medical home 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 Doctors, and American Osteopathic Association released the “Joint Principles of the Patient-Centered Medical Home.” The principles are:
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…
If the practice receptionist has the time, additional questions that you might ask include;
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. The Open Payments database can be accessed at https://www.cms.gov/openpayments/.
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:
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 your primary doctor, a nurse that you know, 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 www.DoctorScorecard.com. There are also social networking sites like http://www.Yelp.comthat 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.
During your initial appointment, you want to consider if the doctor …
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.
Additional information on finding specialists and working with doctors is available at https://apatientsplace.com/
By Helen M. French, BSN, ADN/RN, an operating room nurse to whom ALL life is precious.
BREAST CANCER SURGERY: PLEASE, take note of several critical suggestions, I have for any “woman or man” who is having a “breast/s biopsy”: As simply as I can state the “surgical aspect/s”: If a biopsy is being done just on ONE breast, suggest/request that your “surgeon” ONLY does the “BIOPSY” and then waits for a “permanent” tissue result, which will only take the lab 2 or 3 days. It is my opinion, that a “frozen” biopsy, i.e. a quick lab result, which usually takes about 45 minutes, has more of a chance of producing a “false positive”. The “argument”, that is often exposed, is that YOU will have to come back for a second procedure, etc etc, BUT, in my opinion, as an operating room RN, who has “circulated and/or scrubbed” on many breast cancer cases and mastectomies, I believe that it is worth the hassle. It is very possible that the “first” specimen i.e. the one under going a “frozen” test, could be incorrectly read/diagnosed by the lab tech/pathologist or even “mixed up” with someone else’s breast biopsy/tissue. Please ,also remind your surgeon that the “specimen”, whether IT is going to the lab as a “frozen” or one that has been placed into a jar of “formalin per the doctor’s orders, while in the OR room, that IT is CLEARLY marked with “ones name/with middle initial, date of birth, medical number as well as their “surgeon’s name”, along with the actual date of the procedure and the “location of the specimen”; IF the “OR” is using their hospital labels, the information on the label still has to be correct. # Secondly, CONFIRM with YOUR OR RN Circulator and with your surgeon, before surgery the “correct” breast IF just ONE is being operated on. Even though, the OR RN Circulator, the surgeon and the entire OR team is to “verbally confirm the “correct site” of any surgical procedure, before making any incision, if I was the patient, I would mark the “correct” breast with an ink pen that does not wash off. # Thirdly, a very critical issue, but not the end, IF IF IF one is having a biopsy on both breasts, I stand by my “preceding remarks”, BUT, also mention to the surgeon before hand, to make sure that “TWO” mayo trays are “set up/being used” by the “scrub person”!!! I.E. ONE “mayo tray” for the “right breast” and ONE “mayo tray for the “left breast”. NEVER should just ONE “mayo tray”, on which, the scissors, forceps, mono-polar cautery, sponges, etc are on, ever be used on “both”. IF, there are cancer cells in any of the specimens taken, cancerous cells can be transferred over to the “side” which has NO cancerous cells. (I.E. pic is a generic image of breast cancer cells); Dear Facebook readers, be safe, blessings, frenchie i.e.
A key District court decision against United Behavioral Health (UBH), a subsidiary of the country’s largest insurer United Healthcare and the country’s largest behavioral health provider, noted that UBH created internal policies that illegally denied treatment to thousands of patients, and put profits over patients. The case will now move into the remedy phase where penalties will be determined. United Health Group is expected to appeal.
If we continue to put profit over health, the U.S. health system will continue its slide towards becoming a second rate health system that delivers quality care only to those with the highest income. The only way out is through the consumer. Washington is too embroiled in a political tug of war, insurance and health providers only see financial pressures growing due to rising costs and an ageing population, and medical records providers try to hold on to their market share by blocking the data sharing that is critical to achieving quality outcomes.
As a patient in the U.S. health care system you will face many obstacles to getting safe, quality, and affordable health care. To overcome them, you must advocate for yourself and lead your health care team. You’ll get a big assist from many primary and specialty care practices transitioning into medical homes and providing patient-centered care.
You are the core of your health. You make the most of the choices that impact your health. You certainly feel or suspect that something may be wrong long before anyone else. You decide when and how to engage with the health care system.
Pretty much everyone agrees that helping patients understand and engage in their own health, well being, and health care is an important part of a safe, cost-effective, and high performing U.S. health system.
It makes no sense that despite the evidence that patients are still facing significant barriers to getting their own medical information., leading health care organizations, including the White House, U.S. Department of Health and Human Services (HHS), The Centers for Medicare and Medicaid Service (CMS), and leading payers sit on their hands when providers do not remove barriers and provide patients easy and affordable access to their own medical information.
The solutions are not hard or technological. Today, with only a few exceptions, medical records are kept electronically, and the cost to transmit data is almost nothing.
Access would be opened and barriers lowered if these leading organizations would simply publicizing organizations not complying, reducing reimbursement payments, and assessing penalties for non-compliance.
Unfortunately for every American, the White House, Congress, HHS, CMS, and large commercial health insurance companies, have not taken much leadership in solving this long-standing problem. Sure, they’ll offer hundreds of millions of taxpayer dollars for health providers to convert to electronic medical records, and even announce new initiatives with great names, like “MyHealthEData,” intended to “trigger innovation, advance research to cure disease, and provide evidence-based treatment guidelines.” God forbid they actually helped Americans get the cost and medical information they must have to manage their own health.
Fortunately, even without leadership form these healthcare powers, some consumer driven organization like Apple or Amazon will eventually figure out how to give control of our medical records back to consumers and monetize providing consumers a simple, secure, and unobstructed digital service for collecting, storing, retrieving, and distributing their own health records.
Take these steps when you get an unexpected or expensive medical bill.
These options include;
There are also free medical bill review and advocacy services available.
#CMS Overhaul of #Medicare ACOs which was announced by Secretary Verma today is well worth review. Buried in today’s rule is the flexibility for risk-based ACOs to offer new incentives to beneficiaries for taking steps to achieve good health and expand telehealth services. This is very encouraging to those who believe that patient decisions must be factored into payment models to ensure that risk is aligned with the factors that determine health outcomes. CMS next step should be to allow beneficiary rates to be adjusted up or down based on the beneficiaries adherence to guidelines and best practices known to improve quality and lower cost. Access the CMS post at; https://www.cms.gov/blog/pathways-success-overhaul-medicares-aco-program
Emergency rooms are expensive places to get non-emergency treatment. There are affordable ways to get good medical care, even if your uninsured and/or unemployed. We’ll discuss several options later in this article. If you do find yourself in a hospital emergency room go to the hospital’s billing office a soon as your released and discuss your situation with a service representative. Many hospitals give charitable care to patients who truly can not afford to pay.
The Patient Advocate Foundation helps patients with chronic, life threatening, and debilitating diseases access care and treatment. Case managers and their Financial Aid Fund staff are available to talk to you from 8:30 am to 4:00 pm on weekdays. They are closed on weekends and most holidays. The phone number is (800) 532-5274. They help over 100,000 patients every year. There is also a long list of patient helplines available at aPatientsPlace.com. The helplines are organized by category, most popular, and disease.
Find a Free Clinic
If you’re not having an emergency, consider finding a free clinic. You can get both primary and specialty care at most clinics. There are over 1,400 clinics across the U.S. that provide free health care in their community. Here’s the link to find a free clinic.
Low Cost Medication
NeedyMeds.org is a non-profit organization that will help you find programs to pay for your medication. An alphabetical list and phone numbers for more than 100 organizations that provide financial help is available at aPatientsPlace.com.
Patients do not pay to participate in studies that test new treatments in development. You can search for clinical trials related to your disease at Clinicaltrials.gov. There are more than 290,000 public and private research studies in the U.S. and around the world currently listed as of Dec. 2018.
Medicaid is a federal and state health insurance program for people with limited income.
Eligibility is determined by each state. Go to https://benefits.gov and click on “Healthcare and Medical Assistance.” Choose your state and category “Medicare and Medicaid” to learn about eligibility and how to apply.
Children’s Health Insurance Program (CHIP) provides health coverage for children in families with incomes too high to qualify for Medicaid, but who can’t afford private insurance. Call 877-543-7669 to find out if you qualify and to apply.
Money Saving Benefit Programs
According to the Cleveland Clinic and a large body of research, lifestyle is the key to diabetes self-management. I see many posts on social media and in patient groups that mention diet or exercise as a solution to reverse diabetes. While both diet and exercise are important parts to the solution, it’s important to understand that scientific research confirms that while you can manage diabetes, it can not be reversed.
To successfully manage your diabetes you’ll need to develop, execute, track, and refine a diabetes management plan (DMP). This should be done with leadership and partnership from your primary care physician (PCP), and coordinated with any specialists and clinicians that you are working with; such as an endocrinologist.
Your plan should include nutrition, physical activity, stress, and medication management. The nutrition part of your plan should be developed and managed with input from a dietitian.
In order to be successful your DMP must be realistic. It must fit with your current lifestyle and your circumstances. Your DMP should also be documented in your medical record so you can stay on plan even if you change physicians, relocate, or find yourself with out insurance.
There are 8 behaviors that you should include in your DMP. They are;
You physician and his/her staff should be experienced and comfortable helping you develop a diabetes management plan (DMP) and discussing it with you during and in-between appointments. Follow up with your PCP and/or the practice staff should be frequent and agreed to by you and your physician. If you are at a high risk for non-compliance your physician’s staff should help by directing you to local support services.
Tip: Medicare pays for 10 hours of diabetes education. An additional 3 hours of medical nutrition therapy is also available to patients. After the first year, 2 hours of additional training are available each year.
Start by working with your PCP and a registered dietitian to create a weekly meal plan. This should include eating a balanced diet with a variety of foods, including fruits, vegetables, whole grain foods, low-fat dairy products, and lean meat, poultry, fish, or meat alternatives.
Your meal plan should include a focus on the right amount of carbohydrates to control your blood sugar. This should be done in collaboration with a dietitian. Your meal plan should offer lower fat options and limit saturated fats, and it should emphasize using sugar in moderation. Other inclusions in your meal plan are 20-35 grams of fiber per day. Vegetables, beans, and whole grain foods are good sources. Drinking water throughout each day, avoiding high fat foods, and using less salt are also part of a good meal plan.
If you have type 1 diabetes your insulin dose can be adjusted based on level of carbohydrates in your meal.
You can help control your blood sugar, slow the progression of your diabetes, improve your overall health, manage your weight, boost your brain activity, and help manage stress through physical activity. The type of physical activity that’s right for you should be discussed with your PCP, added to your DMP, and tracked for your use.
Tip: Life will get in the way on some days. It’s OK to miss a planned exercise or skip a day or two when you’re not feeling up to it. The keys to success are to;
Blood Sugar Monitoring
How often you should test your blood sugar level depends on the type of diabetes you have and your diabetes management plan (DMP). According to the Mayo Clinic If you have type 1 diabetes it’s common to test before snacks, meals, and bet time, before and after exercise, and sometimes during the night.[i] Some people treated with insulin may use a continuous glucose monitor (CGM). CGMs rely on a sensor placed under your skin to read your blood sugar levels. Some work automatically, and others require you to run a receiver over the sensor.
If you have type 2 diabetes, you will likely be testing less. The actual amount will depend on if you are taking insulin, and the type and amount of insulin you’re taking. If you’re taking multiple injections each day, testing is often recommended before meals and at bedtime. If you’re using a long-lasting insulin you may only test a few times daily before meals. If you are managing your diabetes without any insulin, you may not need to test your blood sugar every day.
In all cases, you should work with your doctor to identify what’s best for you, and set targets based on your personal circumstances. The factors your doctor use will usually include;
Tip: Medicare pays for monitors, test strips, lancets, testing supplies, and glucose control solution. Consult with your physician for limitations.
If you have type 1 diabetes you are likely to take medication for the rest of your life. Yet, it is estimated that 20% to 30% of patients do not take their medications as advised by their doctors. If you experience negative side effects from your medication tell you doctor. In most cases there are other options.
Diabetes is both chronic and progressive. Since managing diabetes requires daily attention, you are solving problems related to your activity, diet, and stress. Learning how to respond to changes in your blood sugar and different situations requires you to find solutions that work for you. It’s important to note that over time this can also take a mental and emotional toll on you.
Having skills to maneuver difficult or potentially embarrassing situations will help you to stay positive and engaged with your DBM. If you feel like you are failing, you are much more likely to let your disease dictate your life.
You can take preventive actions to minimize your risk of letting your disease make you feel lousy or incapacitate you. Following your DMP, having regular exams with you doctor(s), checking your blood pressure, and checking things like your feet, eyes, teeth, cholesterol, and other lab tests are all parts of your DMP that should be discussed with your doctors.
Barriers to Success
Many patients are not comfortable making decision about their care because they have relied on their clinicians to tell them what to do. The problem with that strategy if you are trying to manage your diabetes is that your daily decisions often have even a bigger impact on your success managing your disease than anything that happens in your doctor’s office. If you do not have affordable access to drugs, you are not satisfied with your clinicians, or you are unsure about any aspect of your care you should seek help from your doctors, insurers, community services, local area providers, and online support groups. Connections to resources and help with every aspect of your diabetes management plan can be found at https://aPatientsPlace.com.
[i] Mayo Clinic. Blood sugar testing: Why, when and how. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628