People choose their doctor for a host of reasons, some logical, some not. The first and second posts on this topic cover such things as online ratings and bedside manner. In this third post, I’ll review several more points to consider as you make your choice of care provider. Once again, we’ll look at a few ways NOT to choose a doctor.
Don’t choose a doctor based solely on your interactions with the office personnel. The front office staff – which includes desk, phone, and insurance clerks, as well as the practice manager – is the first stop once you are in a doctor’s office. They are often the ones who set the tone for your encounter. If they are friendly, the feeling is welcoming. If not, the atmosphere is chilly and can induce a certain amount of anxiety (on top the anxiety you may already feel). But friendliness does not guarantee competence, nor does efficiency guarantee good care. Conversely, a gruff or churlish desk clerk is not necessarily a reflection of the doctor you’re seeing.
By the nature of the business, there is often a disconnection between the front office staff and the doctors themselves. The front office has its own set of rules to follow, and sometimes, in an effort to protect doctors from what seem to be intrusive or unreasonable requests from people, they think of themselves as defenders of the castle. As a result, they may sometimes forget why they are there — to help you, the patient.
I once heard from a friend who needed a biopsy that the doctor’s office she was referred to had lost her chart not once, but twice. When they did find the chart and called to schedule an appointment, they offered her the “first available” opening, which was 2 weeks later. That is the policy of the schedulers in that office, at a hospital that advertises its “compassionate care.” But she had already been waiting 4 weeks from the time she was referred. In many cases, such a delay might not be troublesome, but mention the word “biopsy” to a patient and the anxiety escalates astronomically. To refuse to bend the “first available” rule for this patient on top of losing her chart was unforgivable. Chances are, however, that the physician she was supposed to see likely never knew about this situation because it was all handled by the front desk. (You might surmise, however, that the physician would be the focus of blame.) Fortunately, the patient was able to schedule an immediate appointment with a physician at another practice.
In another case, a friend who had been treated in the emergency department of a local hospital on a Saturday called her regular physician’s office on Monday to schedule a follow-up appointment. She too was told the “first available” was 2 weeks away, even though she had been instructed in the emergency department to get immediate follow-up the next week. Fortunately, the patient knew the native language of her bilingual physician. So she wrote a fax in that language, knowing that the front desk staff would not be able to read it and would pass the fax directly to the doctor. The trick worked, and she soon got a call from the physician, who arranged an appointment the next day.
When it comes to the doctors themselves, don’t rule out a physician who comes from outside the U.S.and has an accent. About 25% of physicians practicing today in the U.S. have come from elsewhere, and many of them are working in places many American-trained doctors don’t want to work: Appalachia, rural towns and cities, and the Veteran’s Administration, for example. Despite the current notion of “American exceptionalism,” there are many other countries with training programs that equal those in the U.S. and there is clear evidence that care provided by doctors from these programs equals and sometimes surpasses that of American physicians. This includes physicians who come from less developed countries. Because their countries can’t afford the technology available in the U.S., they emphasize direct interaction with patients, specifically assessment through the H&P (history and physical exam), not sole reliance on expensive technology. In addition, all foreign-trained physicians must pass the same licensing requirements as American-trained doctors, as well as a proficiency exam in English.
And finally, don’t pick a physician based on how nice the office looks, or how easy it is to park there. Appearance and ease of access are great for creating a comfortable experience, but they are no guarantee of competence, either the doctor’s or the staff’s.
As is true in every aspect of life, image does not always reflect reality and what you see is not necessarily what you get. Those trendy fixtures and fine art on the wall of an office may create a soothing atmosphere, and certainly, you want to be in a clean, orderly, and pleasant facility. But do granite countertops ensure that your internist or the specialist knows the correct dosage of the drug you are getting? (And how do you suppose the facility covers the cost of those trendy countertops?)
According to Marty Makary, in his book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, a disturbing majority of people choose health facilities according to ease of access, notably the parking lot. It’s a treat if the parking lot is easy to navigate and adjoins the entrance to the office, but a convenient strip of asphalt is no way to choose your health care.
In these last few posts, I’ve defined quite a few criteria about how NOT to choose a doctor. Next time, we’ll talk about the criteria to focus on when choosing the best doctor for your situation.