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CARECOUNSEL TIPS

CHOOSING A SPECIALIST

People who are basically well receive most of their personal health care from a primary care physician (PCP). However, if you become seriously ill or injured, you may need to be treated by a specialist. If you have a chronic illness, such as diabetes or heart disease, you may have a PCP who is also board certified in a specialty relating to your illness. Typically, your PCP will refer you to the specialist. Depending on the type of health insurance plan to which you belong and the urgency of your condition, you may be involved in the selection process. Choosing a specialist is very similar to choosing a PCP. You want someone in whom you have confidence, someone who meets your requirements, and finally, someone who provides quality personal health care.

Definitions

Primary Care Physician (PCP) - Manages an individual's personal health care for minor, uncomplicated illnesses and injuries, promotes wellness and detects health problems through education and screening, and coordinates specialist care and services.

Specialist - A physician with advanced education and training in a medical specialty. A licensed physician can practice in any specialty, but those who are board certified have met certain requirements. The American Board of Medical Specialties recognizes 25 specialties, including:

Allergy/Immunology	Anesthesiology	Colon/Rectal Surgery	Dermatology
Emergency Medicine	Family Practice	Internal Medicine	Medical Genetics
Neurological Surgery	Neurology	Nuclear Medicine	Obstetrics/Gynecology
Ophthalmology	Orthopedics	Otolaryngology	Pathology
Pediatrics	Physiatry	Plastic Surgery	Preventive Medicine
Psychiatry	Radiology	Surgery	Thoracic Surgery
Urology

Step 1: Gather Basic Information

Medical Education, Training, and Experience

Personal Health Insurance Plans - Call your member service representative, or visit the 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" of your state.
American Medical Association at http://www.ama-assn.org

Board Certification

American Board of Medical Specialties (ABMS)- Call 1-800-776-2378 or visit their website at www.abms.org
Official ABMS Directory of Board Certified Medical Specialists (available at many public libraries

Complaints or Disciplinary Actions

Sanction information for many states is available at http://www.docboard.org
Call your state medical board and request information on past and pending disciplinary actions.
Check court records in the county clerk's office to find recent malpractice lawsuit filings.
The Public Citizen's Questionable Doctors guide available in many public libraries lists 16,638 MD's who have been disciplined by federal agencies.

Recommendations and Resources to Help You Find a Specialist

Friends, family, and coworkers.
Physicians, nurses, and other personal healthcare workers you trust.
County and state medical societies; depending on the organization, they may give you a preferential recommendation, or provide several names of physicians who are members of their society.

Best Doctors at http://www.bestdoctors.com can help you locate a specialist who can treat your condition using their database of physicians recommended by other specialists. Call them at 1- 888-DOCTORS for fee information.
Visit http://www.healthgrades.com for information on specialists' training, experience and sanction information.
Hospitals; you can call a hospital or medical center and ask for the names of specialists on staff. This is especially helpful if you contact a hospital with a good reputation for treating your particular condition, or one that is affiliated with an academic medical center.

Step 2: Ask Questions Before the Visi

Prior to scheduling an initial appointment, you can gather basic information by speaking with a staff member at the physician's office. Here are some questions you may want to ask:

Will access to the specialist be difficult?
How many similar cases has the physician treated during the past year?
What is the specialist's success rate in treating patients with your condition?
How many days per week does the physician see patients? (some physicians may spend more time in research positions, so you'll want to know how much experience he/she has treating patients)
How do you reach the physician in an emergency?
What should you expect on initial and subsequent visits?
Who takes care of patients after hours and when the physician is gone?
Is your insurance plan accepted?
To which hospital(s) does the specialist have admitting privileges?

Step 3: Ask Questions During the Visit

What is my diagnosis?
What treatment options do you recommend?
What are the side effects of the treatment?
Will any tests need to be performed, and what will they tell us?
How long after treatment before I begin to see any improvement in my condition?
Do you recommend lifestyle changes which could help my condition or prevent it from recurring?

Step 4: Ask Questions After the Visit

Although your choice of specialists may be limited due to your personal health insurance plan, it's still important that you feel comfortable with the physician, including his/her bedside manner. After the appointment, ask yourself these questions to help you decide if this is a physician with whom you want to establish a relationship.

Did you feel that the doctor really listened to you?
Was the visit long enough, or did you feel rushed?
Did the specialist take time to explain everything about your condition and treatment?
Was the specialist willing to discuss treatment options, or did he/she offer only one treatment plan?
Were you encouraged to call with questions about your treatment or changes in your health?
Were you treated with respect as an intelligent and capable person?
Were the office staff courteous and helpful?

Even if you're restricted to specialists within your health insurance plan, you should let your PCP and health plan know if you're unhappy with the specialist who is treating you. This way, the problem can be addressed and possibly resolved, or you'll be referred to another specialist. It's your health, and you should feel confident in the care that you're receiving from your healthcare team, including your specialist.

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The above documents are provided with permission from CareCounsel, LLC. The above documents are for informational purposes only and should not be considered advice or counsel as to any particular individual or family's situation for health insurance needs