Complimentary Story
February 2024Once upon a time local doctors served several generations of a family, from births to final illnesses. But gone are the days when people stayed in one town their entire lives. Whether you are the one who is moving or your doctor is the one relocating, eventually most people will need to find a new physician. Finding the physician who fits your needs and personality will impact your future healthcare.
I would argue that, given the rigors of medical education, many physicians are competent. I suspect a few bad ones do get through. (Yes, the person who graduates at the bottom of the class still qualifies as a doctor.) Although most are competent, that doesn’t mean that all of them are a good fit for a given patient. We all come into a relationship with preconceived ideas of who the other person is. Sometimes we are correct, sometimes not. So how do we figure out if this new physician is right for us? What questions should we be asking?
I think it is important to start with what we should not be asking in this new relationship, just to get that on the table. Starting with certain questions will likely make the physician defensive or suspicious. In employment law, certain personal questions are considered illegal. To most people in normal conversations, these are routine topics of discussion and a great way to get to know someone, but questions in this category have protected status. Most physicians have had some role in the hiring process and have been instructed to be careful with their own questions, so they are alert to these topics. While the new patient does not intend to discriminate or intrude, some people are quite private or sensitive, so it’s best not to start off on the wrong foot.
What illegal questions am I referring to? Asking about marital status is one of those questions. The presence of a ring may or may not indicate marital status, but the absence of a ring may merely be an aid in proper hand hygiene. Any questions about children are off the table as well. Church affiliation may be important to many, but it is not an opening topic. As harmless as questions about recreational activities may seem, that can also be a sensitive topic. These questions, and others like them, are considered highly personal, and not everyone is ready to discuss them. We physicians are especially sensitive to personal questions, as we all have had patients cross boundary lines and get overly familiar, mistaking professional medical care for a more intimate relationship. Sometimes these boundary lines are obvious and sometimes they are not. In the job interview process, once the prospective employee mentions something, then it is entirely okay to ask questions in that specific area. The same applies here, to a point.
So why does a physician get to ask you these same questions if you can’t ask them of the physician? Your answers to these questions can be influential in making a diagnosis or assessing your risk for future problems.
The questions you ask should be questions that are important to your health and your worldview. By asking the questions in a way that focuses on you, you will be able to get a hint, or more, of how your new physician will treat you and of his or her worldview. Stick to professional questions on a first visit. For the most part, the answers to these may be part of a physician’s profile on their clinic’s website and you won’t necessarily need to dig into them during your visit. Indeed, many of the topics in the preceding paragraph may be addressed in their profile as well, and are therefore fair game.
“Where did you go to medical school?” Educational background is generally a good question, if you have knowledge of the reputations of various schools. Some medical schools have a better reputation than others, but a student is going to get out of medical school and residency what he or she puts into it.
“How long have you practiced in your specialty?” New residency graduates may have the latest knowledge, but have had little opportunity to have applied it in a patient care setting, while older physicians have had a chance to apply their knowledge and have the wisdom to know how to use it. Only you can decide where along this spectrum you want your physician to be.
“Do you have any special fields of interest in medicine?” This question can garner insight into the physician’s strongest areas of current knowledge. Doctors generally have special interests and are happy to talk about them and how they may relate to your specific situation.
“Do you have experience with a specific condition? If not, whom do you refer to?” As much as doctors want to be able to take care of everything, some conditions are just beyond what can be accomplished in our specific setting. It is helpful to know what the plan is when you run into issues with which the doctor will need outside help.
“What is your policy about having others in the room?” This can apply to any number of family/friend combinations. Sometimes one needs a second set of eyes and ears to have the best recall and understanding of the office visit. It may also speak to the doctor’s views on some of the larger social issues of the day.
“How many things can we talk about during a visit?” At one time, I never would have thought I would have to answer this question, but today it bears asking. Current billing practices and clinic time constraints have gotten out of control. For instance, clinics push the annual free physical paid for by insurance, but the “free” part is pretty limited. Ask anything and you move into “Preventative Plus” territory, a higher billing category. If you come in for a visit other than that annual exam, you may still be allowed only one subject at a time. More visits, more money, more time consumed. There are, of course, practical limitations to the time one can spend in the office and the number of issues that can be resolved. Strict rules about time and content are hard to follow. Discovering the doctor’s policy will save frustration later.
“How strongly do you promote preventative services?” Maybe you (the patient) don’t want a particular test, or for that matter, any screening tests or vaccines. How are they going to handle that? Will you be asked about it every visit? Will the clinic have someone calling you or sending you endless reminder letters? The current reimbursement model from insurance companies pays clinics for completing a high percentage of the screening tests and vaccines that they deem important. More than likely, at a large clinic you will be pushed to get all the recommended items completed.
“What is your approach to disease management?” Physicians can default to a very aggressive approach to disease management. Sometimes aggressive disease management is not in the best interest of the patient, but will the physician respect that position? Or the converse, if the patient wants to do everything possible even when it won’t make a difference, how will that request be treated?
On subsequent visits, continue to think through healthcare issues and prepare questions in advance. Regarding medications, if a medication needs to be prescribed, what is it for? What are the side effects? Every medication has a relatively short list of well-known side effects to watch out for. Are there other options for treating this condition? If the prescription is for a branded product, is there a generic alternative? Surgeries? Lifestyle? Supplements? There are always options. Some may not be very good options, but there are options, and you should be made aware of them.
If you have health goals, how can the physician help assist you in achieving those? Many clinics have access to dietitians and therapists of various sorts. They may have nurses who can help navigate various potentially beneficial services. Fewer clinics will have professionals with the knowledge to help with supplements or other care models, but they may have a referral list of trusted individuals.
“What is the best way to communicate with the practice?” This is another question that I didn’t think I would ever have to ask. Communication used to be pretty simple, but now getting through to someone is difficult: Phone trees. Time on hold. Messages passed from receptionist to one nurse to another nurse, and your question possibly never even reaching the doctor. Or, you are forced to make an appointment just to ask a simple question. Your care can be compromised when it takes too long to talk to the person who can help you.
For the time being, if you need health care, you will need to interact with a large clinic at some point in that journey. I would encourage you to find a small clinic, independent if possible. They are more likely to have physicians who will respect your individual decisions and support your journey as you wish. Their incentives are more focused around you, instead of on corporate policy. Small clinics are making a comeback as more physicians wake up and see what they have become and what their clinics are doing to them and their patients. These corporate policies are not what motivated most of us to enter the profession. Thankfully there is an awakening going on that will only benefit all of us.
GenesisPrimaryCare.com
