Choosing A Primary Care Doctor and Getting the Best Specialist Care

Excerpted from
Special Treatment : Ten Ways to Get the Same Special Health Care Your Doctor Gets
By Kevin J. Soden, M.D., M.P.H., Kevin J. Soden, M.D., M.P.H.

Women: Are They Being Shortchanged When It Comes To Primary Care?

What we're going to say here will be controversial and we know it. Women are often shortchanged when it comes to the kind of primary medical care they receive. We know what most of you are thinking: "They can't be serious. They just don't know what they're talking about." Well, we are serious and we do know what we're talking about... and what we do know is that many women are not getting the total medical care that they deserve. We hope we've got your attention now.

A great many women operate under the assumption that if they see their OB-GYN doctors (mainly their gynecologist) every year, they are getting all the medical care they need. That is just not the case. A gynecologist is great if you're only interested in female problems or just what happens below your waist. The problem is that the number one killer of women is cardiovascular disease, and most OB-GYN doctors don't have the time in a routine ob-gyn visit to diagnose and treat cardiovascular disease and the risk factors associated with it.

We strongly believe that if women choose to see their OB-GYN for care of many female-related problems, then they definitely must have a second physician, such as a family practice specialist or an internal medicine specialist, provide the rest of their care. If not, too many problems may be overlooked or not addressed proactively.

The bottom line: We don't care where women get their care. We just want to make sure they get all their health care issues addressed. Right now too many women are being shortchanged in their medical care and that's what we'd like to see changed.

Choosing the Right Doctor for Your Child

Children are not just little adults. Children's medical needs and issues are definitely different Like adults, children do have different problems and needs based upon a particular stage in their life. Babies are different from children, who are different from teens. Pediatricians and family practice specialists deliver the majority of care to children of all ages. So, what should a parent do to pick a doctor for their child? Outside of evaluating the basic medical skills of the doctor you are considering, there are some other questions you should consider asking. We advise doing the same thing you do when picking a doctor for yourself: conduct an interview with your child's potential doctor.

The environment of any doctor's office can provide huge insights into whether or not you want that doctor caring for your child. Are there separate waiting rooms to keep sick children away from well children or adults? Is the waiting room clean and kid friendly? Is the office staff polite and considerate on the phone and in person? If other parents are in the waiting room, what kind of comments do they make about the doctor? Are they happy with the doctor?

Here are a few other things to consider in meeting your child's special needs:

What are the office hours? Do they meet your schedule needs? If the office is only open a few days a week, then the doctor may not be available when you need him.

Is emergency or after-hours coverage available at all times? You shouldn't be left out in the cold when you need your doctor the most. If the doctor isn't personally available, then who will be covering for her? Does she have someone who understands children covering her calls? If an internist is covering calls for your doctor, how is that going to help your sick child?

Do nurses or other skilled professionals handle calls after hours? You don't necessarily have to speak to a doctor right away, but you do need to speak to an experienced medical professional who can help guide you to the best next steps. Oftentimes, an experienced nurse can handle almost all the problems that occur after hours. If there is no one who knows children answering calls after hours, then you need to look elsewhere for a doctor to care for your children.

Is there access to specialist care if needed? Not all areas of the country have access to pediatric specialists of various kinds. Hopefully, you'll never need this service, but it's good to know where you can get it if you do.

Here are some other things to ask yourself during the actual interview with a doctor:

• Does the doctor see the parents as partners in the care of their child?

• Does the doctor's personality fit well with your child's?

• Is the doctor a good listener?

• Are you, as a parent, comfortable asking questions to the doctor?

• Is the doctor concerned about preventive care?

• Does the doctor use antibiotics for every cold or respiratory infection or is she more judicious in their use?

Your child's perception of doctors can be shaped for years by his early experiences with the physician you choose. Do your homework. Take the time to research the best doctor for your child.

Finding a Specialist

Sometimes, despite our best efforts to stay healthy, we get into trouble with a difficult, unusual, or serious medical problem that requires the special training and expertise of a medical specialist. Maybe it's knee replacement surgery, a rare blood disorder, cancer, or heart bypass surgery. Whatever the reason, locating a physician for a specific health need can sometimes be as daunting as the procedures you might face. Where's the best place to start to find a specialist?

The first person to ask when looking for a medical specialist is your primary care doctor. Believe it or not, finding a specialist may be easier than picking your primary care doctor. Why? Because in most cases, you've already got the help of the medical person you trust most... your primary care physician.

When you are told that you will need to see a specialist for care, the one question to ask your doctor is, "If you were sick like I am, what doctor would you personally see?" Whoever that person is, get your doctor to get you in to see them for your specialty care-even if it's not in the same town. You need to make it clear that all you want is the best care for your particular medical problem, no matter where it is or what hospital it might be. I Here's a good example of what we mean. Your PCP tells you that you have a cancer in your colon and you need surgery. Doctors know that there are fewer complications and better surgical outcomes when colorectal surgeons perform this type of surgery instead of general surgeons. There are many reasons for this, as we'll explain in Chapter 5. They would see the specialist surgeon even if it meant traveling elsewhere for surgery or going to a different hospital.

Next, if there is a particular hospital that you'd like to use, call or get on their Web site and find out what specialists are available in your area of need. Such sites can provide you names of potential candidates. While you have hospital personnel on the phone, ask them about what they've heard about these specialists. What you hear sometimes can be surprising and informative.

Third, go to the American Board of Medical Specialties (ABMS) Web site and look up the doctor's name to make sure he or she is board certified. The site provides information about certification and recertification.

Finally, if you have time, go to interview the specialist much as you would your primary care specialist. Oftentimes, you may not have the luxury of time to conduct interviews because your medical problem requires more immediate action. In these cases, we say trust your doctor. Rarely do you go wrong when you do, especially if she recommends the doctor she would see personally.

Before going to the appointment with the specialist, make sure to gather together all your X rays, blood work, and appropriate medical records and bring them with you. Why? Well, believe it or not, records can get lost when being transferred from one place to another. It's just like when you're drying clothes and two socks go in but mysteriously only one sock comes out when the dryer stops. A doctor's office can be just as mysterious. Records get misplaced on a desk or stuck in a corner. X rays get put in someone else's file. If you take charge and get them yourself, you'll make sure that your specialist has all the information that he or she needs to begin your medical evaluation.

After your consultation with the specialist, ask her to send a note with her findings, diagnosis, and treatment suggestions to your primary care physician. It will provide assurance that your primary physician has all the information he needs to provide the best continuing care for you.