CHOOSING A PRIMARY HEALTH CARE PHYSICIAN

Your primary health care physician's role is to oversee your healthcare, including recommending preventive care, referring you to specialists, requesting diagnostic tests and treatments, and making sure that your questions and concerns are addressed. So it's important to select a physician you trust and in whom you have confidence. Ideally, the time to establish a relationship with your PCP is when you are well, not when you are sick or injured and need medical help in a hurry. Even if your choice is limited to physicians within your health plan network, using the steps outlined below will help ensure that the PCP you select is one who meets your requirements and provides quality health care.

Who Provides Primary Health Care?

Although your health plan may limit your choice of PCP, you are usually allowed to choose from one of the following four specialties. Board certification is offered for each specialty, so look for this credential as you begin your search for a primary care physician.

• Family Practice Physician: Trained to deal with the overall health care of individuals and their families; may have extensive experience in managing a particular condition, such as diabetes.
• Internist: Treats adult illnesses and provides general health care. May specialize in treating heart, lung, blood, or other disorders.
• Gynecologist: Specializes in treating women's health problems; whether or not you're allowed to choose a gynecologist as your PCP depends on the health plan and state you live in.
• Pediatrician: Treats infants, children, and teenagers.

Step 1: Assess Your Needs

• What is your health and health care status?
  Do you have a chronic illness, such as diabetes or hypertension? If so, you'll want to find a PCP with extensive experience treating patients with your condition.
• Does your family history suggest the need for a particular type of physician?
• Is it important that your physician emphasize lifestyle changes, such as diet and exercise?
• Would you prefer a physician of the same gender, age, race, or religion?
• Will this physician also take care of your family members?

Step 2: Gather Information

What do you want to know about your physician and how do you find this information?

• Health Plans - Call your member service representative, or visit the health plan's website.
• State medical licensing boards - For the number to call in your area, look in your phone book under "State Government Offices -- Medical Board."
• Visit the American Medical Association's website at http://www.ama-assn.org to find credential information about licensed physicians or try http://www.healthgrades.com.

• American Board of Medical Specialties (ABMS)- Call 1-800-776-2378 or visit their website at http://www.certifieddoctor.org

• Sanctions information is available for many states at http://www.healthgrades.com and at http://www.docboard.org
• Call your state medical board and request information on past and pending disciplinary actions.
• Check court records in your local county clerk's office to learn if any malpractice lawsuits have been filed.
• The Public Citizen's Questionable Doctors guide, available in many public libraries, lists 16,638 MD's who have been disciplined by federal agencies.

• Ask friends, family members, and coworkers for personal recommendations.
• Talk to physicians, nurses, and other healthcare workers whose opinions you trust.
• Best Doctors (www.bestdoctors.com) will give you the names of two physicians in your area who have been recommended by other doctors in their database for a small

Step 3: Ask Questions

Before choosing a PCP, call the physician's office and conduct a telephone interview. It's likely that you won't be able to speak with the physician directly, but an office manager, nurse, or medical assistant should be able to answer the majority of your questions. Some offices might also allow you to conduct a "get-acquainted" visit with the physician, so ask if this is an option. You'll want to ask questions about access, office practices, and the physician's background.

• Access
  - Are you accepting new patients?
  - What are the standards for wait time and visit length regarding routine and urgent appointments?
  - How many patients are seen per day? (25-30 should be the maximum number)
  - Is my health insurance plan accepted?
  - What hours and days are patients seen?
  - How do I reach the physician in an emergency?
  - Who takes care of patients after hours and when the physician is gone?
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• The Physician
  - Is the physician board certified? What is his/her specialty?
  - How extensive is the physician's experience with my health condition?
  - What is the physician's policy regarding prescribing medications over the phone?
  - Does the physician make house calls or give telephone advice?
  - What continuing education courses has the physician taken over the past few years? This can give you a flavor of the physician's interests and areas of expertise.
  - How long has he/she been in practice?
  - What is the doctor's philosophy on integrating complementary therapies, such as acupuncture and chiropractic?
• Office Practices
  - Is this a solo or group practice? Will I see the same physician at each visit?
  - What should I expect on my initial visit?
  - Are living wills and durable powers of attorney honored?
  - What are the fees and billing procedures; do office staff process insurance claims?
  - How is the physician paid by my insurance plan (capitation, fee-for-service, etc.)?

Once you've chosen a primary health care physician, schedule an appointment so you can meet with him or her to review your medical history and address any medical concerns. If you are in general good health, you may want to schedule a physical examination with your new PCP, especially if your health plan covers this service. During and after the appointment, ask yourself the following questions:

• Does the physician take time to explain everything about your condition and treatment?
• Do you feel comfortable talking with this physician?
• Are you treated courteously or do you feel rushed or dismissed?
• Does the physician's personal style match your own preferences?
• Are you encouraged to call with questions about your treatment or changes in your health?
• Is the office staff courteous and helpful and is the office location convenient?

Choosing a physician can be an overwhelming process unless you know where to start. But finding the right doctor for your healthcare needs can help to ensure greater continuity of care, better communication among your healthcare providers, and even peace of mind for you and your family.

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