Finding the Right Physician

KEEPING THE SAME physician can prove more difficult than expected. During over 30 years that I've had MS, I've had numerous changes in my physicians, including my internist, urologist, and neurologist.

It is difficult to face the loss of health care providers you trust and rely on, but life does indeed go on. We tend to put physicians in a special category, but in reality they are subject to the same passage of time and life transitions as the general population. Choosing a new physician is a difficult decision that involves patience and emotional energy.

When faced with the decision to find a new physician, consider the following steps:

1. Decide if you need a specialist, internist, or family practice physician. A specialist deals with specific parts of the body. For example, a neurologist deals with the neurological components of the body. Neurologists may further specialize in specific neurological diseases such as MS or Alzheimer's disease.

A family practice physician is concerned with the total health care of the individual and the family and is trained to diagnose and treat a wide variety of ailments in patients of all ages. The family physician receives a broad range of training that includes the elderly. Special emphasis is placed on prevention and the primary care of entire families, utilizing consultations and community resources when appropriate.

An internal medicine physician is a personal physician who provides long-term comprehensive care in the office and the hospital, managing both common and complex illnesses of adolescents, adults, and the elderly.

Internists are trained in the diagnosis and treatment of cancer and infections, as well as diseases affecting the heart, blood, kidney, joints, and digestive, respiratory, and vascular systems. They are also trained in the essentials of primary-care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health, and effective treatment of common problems of the ears, skin, nervous system, and reproductive organs.

Some physicians in the U.S. choose to become doctors of osteopathy (DO). Similar to the MD degree, students receive osteopathie degrees after four years of study at osteopathie colleges. Osteopathie training emphasizes traditional diagnostic and therapeutic procedures, as well as the relationship of body systems and holistic patient care.

Your internist or family physician may refer you to a specialist. Ask who he/she would see if they needed a specialist for a particular reason.

2. Does your insurance plan limit you to specific physicians?

Review your insurance plan list in making your decision if applicable. Many insurance plan lists are out of date so call the insurance plan or check with the physician's office to confirm that he/she will accept your insurance. The majority of Americans are in HMOs (health maintenance organizations) and PPOs (preferred provider organizations) so they are limited to specific doctors and hospitals.

3. If you have Medicare, ask if the physician takes assignment (physician agrees to accept payment from Medicare as payment in full). Sometimes you will end up paying the difference between what the doctor charges and what Medicare covers. Some doctors will only accept patients who have Medicare supplement plans that pay the difference between what Medicare pays and what the doctor charges.

4. Is the age, gender, or experience of the physician important to you?

Do you prefer a female or male physician? Maybe someone older or younger than you?

How many years since medical school has the physician been working in a specific field of medicine? You may want a physician who has a lot of experience or you may be willing to work with a physician who has just graduated from medical school. The average amount of experience since medical school for physicians in family practice is 21 years. If you are having surgery or a complex procedure done, you may want to ask how many similar operations or procedures the physician has done and what is his/her success rate.

5. Can you understand what the physician is saying? If you are not fluent in English, then find a bilingual physician who speaks your first language. Otherwise, you may need to bring along a bilingual family member or interpreter to explain what he/she is saying and ask the questions you have.

6. Ask friends, relatives, or others if they have a physician they would recommend. A support group is a good way to find out about physicians who deal with MS. Why do they like the physician? Plus, if your past physician was in a practice with other physicians, he/she may recommend a partner to you. This approach worked well for me: When my physician retired, he personally knew a number of appropriate physicians but recommended one in particular who can meet my needs the best.

7. Consider location. Is the physician's office located at a place convenient for you and accessible for a wheelchair or scooter that you may be using? Is the office near public transportation or affordable parking? For some, receiving the best care outweighs issues related to convenience.

7. What are the hours of operation? Are the hours scheduled during the entire week or only one or two days a week? How will you contact the physician for an emergency after office hours? Is the physician in private practice or a member of a group practice? Group practice may mean that another physician will cover for yours when he/she is not available to see you now.

8. Has the physician dealt with other disabled individuals with your disease? Can the examining table be adjusted for individual needs? Some electric tables can be lowered so individuals with limited mobility are able to get on the table.

9. What hospitals are associated with the physician? Most physicians can only admit patients to certain hospitals with which he/she is affiliated. Are these hospitals ones you would want to be admitted to?

10. Does the physician have a license to practice medicine in your state? Physicians may hold one or more licenses to practice medicine in 54 U.S. licensing jurisdictions. A physician license demonstrates that the physician is licensed to practice general medicine and surgery by a state medical board of examiners after passing a state or national license examination. Each state has its own procedures to license a physician and sets its own standards for all physicians in that state. Contact the medical board of examiners in your state(s) to confirm that a physician is licensed and has no restrictions.

11. Is the physician board-certified? Each medical specialty has a national board responsible for setting standards that physicians must meet in order to be certified. Board-certified members have completed several years of training beyond medical school, have practiced for a designated number of years in that specialty, and have passed examinations in their specialty.

Therefore, board certification is generally a good indicator of knowledge and professionalism. (Approximately 58% of physicians in family practice are not board-certified.) Once certified, physicians must attend continuing medical education programs throughout their careers in order to remain certified. Some physicians are board-certified in more than one area.

12. Check for professional misconduct. Physicians' professional misconduct is collected from the state medical boards. You can contact your state's medical association for further information. be sure to check for sanctions, which are disciplinary actions ranging from default on a student loan to patient abuse.

13. Call a selected physician to find out how far in advance you must schedule an appointment. Some physicians aren't accepting new patients; a number of physicians I wanted to see were booked five months ahead of time. If you cannot wait, you may need to make an appointment with someone else.

14. Beware of costs for medical care. These include co-payments (amounts you pay for office visits or hospital services which must be paid at the time of the service). Also consider any procedure or medication for which you must have prior authorization. Financial details can be very confusing so review your insurance plan information and contact customer service for your insurance plan to clarify any possible payment. If you make a mistake, you are responsible for any payments due to the physician or hospital.

In conclusion, you should consider many factors when selecting a physician. To lessen your stress, you should work towards having an internist or family practitioner in place before an emergency situation occurs.