One of the most difficult and perhaps the most important tasks facing a health consumer is finding a primary care physician. The choice of a primary care physician is highly personal. The reasons for choice are clear. We all want to pick a physician who is competent; that is, one who is intelligent, caring, and well informed. It is critical that a patient and a physician work well together. Research has confirmed that patients are likely to do better medically if they have a doctor with whom they can easily communicate and who encourages them to be actively involved in their own health care. We all want a doctor who remembers our medical history. We are likely to trust a physician who knows us personally.

In February 1995, Consumer Reports published results from what appears to be the largest single survey conducted on the physician-patient relationship. More than 70,000 readers were surveyed. MIU highly recommends that every health consumer and practitioner reads this report. Briefly, most people were satisfied by their overall care, and believed that their doctors were competent and concerned. However, some potentially serious problems were uncovered. A significant number of readers responded that their doctors were not always open to questions, did not ask their patient’s opinions about their medical problems, and did not advise them on making healthy lifestyle changes. Approximately 25% of the time, doctors did not discuss side effects of the medications they prescribed. Patients with chronic, painful and difficult to treat problems were often the most dissatisfied. Patients who reported that their doctor did not communicate well were most likely to be non-compliant, and were the most unlikely to improve. Women found female doctors to be more caring, thorough, and communicative. Men found male and female doctors to be about equal. Respondents who had been hospitalized versus treated as an outpatient were more likely to be critical of their health care experience.

Primary care providers.

There are five categories of primary care physicians. For children there are pediatricians, general practitioners, and family practitioners. For adults there are family practitioners, general practitioners, and internists. For older adults, there are also geriatric specialists.

After receiving their MDs, family practitioners complete a three-year residency (postgraduate training) covering aspects of pediatrics, internal medicine, obstetrics, and orthopedics. After their training, they must pass a comprehensive examination. Family practitioners treat most acute and chronic illnesses, and provide some psychological counseling of people of all ages. If an illness is quite complicated, they may refer to a specialist.

General practitioners have been declining in numbers since around 1910. Requirements have been an MD and one year of residency followed by a licensing examination. Usually, general practitioners are older and have been in practice for many years. They make up for less postgraduate work by increased clinical experience. General practitioners treat the full spectrum of medical disorders and refer to specialists when needed.

Internists specialize in nonsurgical treatment of adults. They take a three-year residency in advanced treatment and management of most common medical problems. Some internists will take further training in a subspecialty. Examples are, cardiology, oncology, rheumatology. When internists refer to a subspecialist for diagnosis, they usually maintain treatment supervision.

What questions to ask.

When evaluating your potential primary care provider, try to get answers to at least the following:

1. What are the doctor’s professional qualifications?

• What is the educational background?
• What are the professional associations?
• Is there a board certification?
• Where are the hospital privileges?

2. What is the doctor’s availability?

• What are the office hours during the week and weekends?
• How long dose it take to get a phone call returned by the doctor? By the office nurse?
• If you have an emergency, will the doctor talk to you by phone in a timely fashion? Will you be seen the same day?

3. How are the doctor’s communication skills? Does the doctor take time to actively listen? To ask thorough questions? To demonstrate compassion and understanding? To answer questions clearly?

4. Are the office staff professional and courteous?

5. What is the doctor’s medical approach? On one hand, does the doctor prescribe medication every time a patient has a complaint? On the other extreme, does the doctor dismiss all of the patients complaints?

6. What are the costs for office visits, examinations and laboratory analyses?

7. Are there charges for phone consultations?

8. Is payment required at the time that service is rendered? Is a payment plan available? Will they bill the insurance company or accept Medicare?

9. Do you feel comfortable with the doctor and office staff?

10. Is this a solo or group practice? How do you feel about the other doctors who might cover for your primary physician when he is not available

How to get the answers.

Getting the answers is often difficult. You could try the following.

• Ask friends or family for a referral.
• Call doctors’ offices and ask the office managers or nurses, "If you could not recommend the physician you work for, who would you recommend?
• Call a local teaching hospital, and ask for a referral from nurses.
• Call doctors offices and ask the office manager as many of the questions that she or he could answer.
• Ask for a get acquainted appointment. A number of physicians offer free initial visits to help the prospective patient decide if there is a good match.
• Call the state or local medical society to ask questions about a physician’s credentials.

Primary care providers and managed health care.

The task of finding a primary care physician has been complicated by HMOs, PPOs (preferred-provider organizations), and insurance plans that limit choices to enrolled physicians. There are pluses and minuses. Consumer Reports has produced an excellent review of HMOs and PPOs (Part 1 of a series was published in the August 1996 issue.). They spent almost a year gathering data by visiting HMOs throughout the USA, interviewing health-care managers, patients and experts in the field. They also surveyed over 30,000 readers enrolled in HMOs and PPOs. The data they collected rates the biggest managed care plans and provides guidelines on how to get the most out of the plans. MIU highly recommends this report to anyone who is contemplating enrolling in, or is enrolled in an HMO.

Another consideration: hospital care.

While locating a physician, it is wise to keep an eye open for the type of care available at a hospital where your prospective physician has admitting privileges. Significant differences in the approach to patient care exist at different hospitals. There is a growing movement in hospitals toward patient-centered care. The progenitor in this movement is Planetree. In Planetree affiliates, patients share in decisions, have their preferences respected, are helped to learn more about their illness, and have their family and friends involved in their care. They have their emotional needs met, e.g., feelings of financial worry, anxiety, depression. There is a warm, home like environment. There is one person in charge of a patient.

To learn more about true patient-centered care, contact Program Planetree, 621 Sansome St., San Francisco, California 94111. Planetree, is a nonprofit organization. At their 19 affiliates, they offer health related materials free of charge to the public. At the resource centers, consumers can use medical texts, newspaper clippings, and other health-related publications. Consumers can also perform medical searches using Planetree’s computers.

Copyright© 1996-2002 by Medical Information Unlimited, Inc. All rights reserved.
Revised: May 07, 1999.