Friday, June 5, 2015

How to Pick a New Primary Care Provider (PCP)

I want you to think about your choice of Primary Care Physician (PCP) as one that is vital to your health and happiness- similar to your choice of church or school and just short of your choice of spouse.
Your choice of PCP can determine life or death because the PCP is your gateway to healthcare. Primary care physicians are on the front line and treat disorders varying from depression and anxiety to high blood pressure and cholesterol. They are usually the first to suspect stroke and heart disease and often will be the ones who discover cancer and other life-threatening diseases.

If you look in the Yellow Pages or at an internet search for a Primary Care Physician (PCP), you will quickly be overwhelmed by the multitude of names, locations, and specialty options (Family Practice, Internal Medicine, Pediatrics, OB/Gyn, etc.). The medical landscape in your region will likely determine which specialty is more prevalent (Family Practice vs Internal Medicine) or even available (Pediatrics and OB/Gyn) to you. You then will need to make a difficult choice that could determine your future and affect your health.

Word of mouth has been and will continue to be one of the best sources for your choice of PCP. Family, friends, coworkers, and inquisitive bystanders are usually quick to give you a reference and make a recommendation. Be aware that these opinions are just that, OPINIONS.

The following article attempts to illustrate the qualities to look for and those to avoid when choosing a PCP. Remember that your choice of PCP is an extremely important decision as that doctor is often the first to diagnose your medical illnesses, is the one who will refer you to specialists who can save your life, and may also be the one who admits you to the hospital when critically ill. As you can imagine, this can be a daunting decision and has many facets and wrinkles. This article is intended to be an overview and will not be able to cover all potential dilemmas.

To start, I am going to describe the qualities that I deem to be important when making this choice:

Look for these Gems

First, although physician demographics (age, gender, race, religion, etc) are important when deciding about your next PCP, I think that personality should be one of the most important qualities that you investigate when picking. It is widely known that not all doctors have great personalities, however I think it is important for you to find a compatible personality type in your prospective doctor. Once again, word of mouth and websites like DoctorRated are vital when deciding whether a doctor's personality is a good fit for you. One other often-underutilized strategy is to schedule a new patient visit with a prospective PCP in order to get a feel for their personality. Most insurance plans then afford a patient a chance at a second opinion if you are not comfortable with the first doctor.

Second, a doctor's knowledge and ability to translate this knowledge for the patient is paramount when picking a PCP as this is the way you will be educated and informed about your medical issues. A smart doctor is not just book smart, well read, and up-to-date on current studies and literature, he/she should also be able to harbor that knowledge and release it to the patient in a form that is understandable and logical. Too often, I hear patients tell me that they think their PCP is "very bright” or even "brilliant” but state that "[the doctor] talks over my head.” DoctorRated will be the best resource for determining which PCPs will be able to translate his/her knowledge into a meaningful conversation with you.

Third, training and experience are the foundations that doctors use for making complex decisions about patients. When researching which PCP to choose, a patient must keep these two qualities in mind. Far too often, I hear friends discuss young doctors and discount them due to their lack of experience. Although this snub can be warranted, be aware that older doctors trained in an era when technology was not as advanced necessitating that they keep up with newer literature and techniques. There is no better source for determining which doctors have the best training and experience than a website which asks doctors and their peers to rate this quality.

Finally, there are several special circumstances that should affect how you pick the perfect PCP. I think it is vital that you pre-determine you preferred hospital and emergency room. In so doing, you need to be aware of which hospital your prospective PCP prefers. If you were to choose a PCP who does not work at or with your preferred hospital, this can cause a lack of communication that will affect your health in a detrimental way.

You also should be aware of how your prospective PCP interacts or communicates with other doctors, specifically specialists. Medicine is a social field just like construction and banking. Primary care physicians develop a set of referring doctors for different disease states just like a general contractor has his/her own set of plumbers, electricians, and carpenters. Communication between doctors is a necessity in order to coordinate care and get the best healthcare outcomes. If your PCP is not a good communicator, your health can suffer.

Also be aware that a PCP's personality will often mirror that of the doctors to which he/she refers. Unfortunately, if you are unhappy with your PCP, you will likely be unhappy with the specialist to which your PCP refers you. Once again, the choice of PCP is instrumental in your healthcare lifecycle.

Finally, if you have a relationship with a hospital in your area that is unwavering and nonnegotiable, you need to make sure that the PCP that you choose maintains a similar relationship. Most PCPs now defer hospital care to others, namely hospitalists, so that they can maintain their office-based practice. When discussing or investigating this detail, make sure you understand who will take care of you in the event that your PCP does not admit to the hospital. My experience has been that most PCPs will have a relationship with an admitting hospital doctor, the question is if the admitting hospital doctor is of the same quality as your PCP. You can obtain this information by either calling your hospital or calling the prospective PCP's office.

Don't Get Bogged Down in the Details

I often hear patients describing their choice of PCP based on certain personal qualities or logistics of the office system. Wait times, office staff/environment, location/convenience, and friendship are often mentioned as important. I am going to explain below why these should not be at the top of the list when making your choice.

Friendship with a physician surely can be a benefit to the patient when it comes to obtaining access to the doctor and simplifying communication. However, I suspect that the benefits of these patient-physician relationships end here. More commonly, I see patients treated inaccurately and inappropriately over the phone or after a cursory office visit with a friend/physician because the friendship muddies the decision-making process. I do not think this is the case for all friend/physician relationships, however I point it out so that you ensure that this does not happen to you. Healthcare is like business and financial services in this way- be very careful when you go into business with a friend, let your friend manage your money, or choose your friend to be your PCP.

As with hospitals and ERs, patients will often pick a PCP because his/her office is convenient to work or home. Although location certainly can make seeing a PCP easier, I would not sacrifice quality for convenience.

A doctor's office staff undoubtedly can make or break the patient/doctor relationship. Rude or unfriendly office staff, nurses, doctors, and doctor's partners can make for a very troubled relationship. There is nothing worse than a doctor whose nurse does not return calls, follow up on tests, and/or inform patients about results. At the same time, the office environment including the waiting room, furniture, cleanliness, security/privacy, and parking all contribute to the overall patient experience. Although I do not feel that these factors trump doctor quality, they can sway a patient to change PCPs if the patient feels that another physician offers similar quality without these hassles.

The same mentality goes for wait times. Extended wait times seem like a waste of your time. Most patients disdain waiting on their doctor and will change to another less "busy” doctor due to this. What they do not know is that "busy” doctors are usually busy because they either are more skilled, more personable, or more liked by their patients than their competitors in the area. Doctors who are not busy can be that way for a similar but opposite reason. I will put it another way- would you rather wait to see a highly qualified PCP who you get along with well or go to a subpar doc who will get you in and out quickly? It just takes one life-threatening diagnosis to know that a couple of extra minutes once or twice a year is worth your time.

Although the above article cannot cover all details when choosing the perfect PCP, I have laid out a groundwork for you to make this decision easier. Not all of the advice will pertain to you so use it as you deem fit. The following is a list of the top 5 recommendations when choosing a PCP:

1. Your choice of PCP can determine life or death because the PCP is your gateway to healthcare.

2. Word of mouth has been and will continue to be one of the best sources for your choice of PCP. Websites like DoctorRated can also delineate these issues.

3. Personality, knowledge, training and experience, and communication skills (between PCP and specialists) are vital in choosing a perfect PCP.

4. Wait times, location/convenience, office staff/environment, patient/physician friendship should almost never be a major determinant of which PCP you choose.

5. Research all of your area's PCPs by asking your doctors/friends/family and review ratings on DoctorRated and other websites.

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