Thursday, April 29, 2010

Choosing a Good Physician

As a practicing family doctor, it's easy for me to figure out how to choose a great doctor. Let me tell you the secrets in finding the best one for you and what I tell my family and friends.

Look for the following:

Board certification
Report card on quality
Licensing / public reporting

As a doctor, I know many doctors who have great bedside manner but aren't particularly reliable in getting the right medical care you deserve and these traits separate the so-so doctors from the truly excellent ones.

If you've found one that meets all of the criteria and you know is in in your insurance plan, has convenient office hours and easy access, then I'll give some tips on what to look for to determine if she has excellent bedside manner.

Importance of Board Certification
Your physician should be board certified in his field of expertise. Think of it as the difference between hiring a certified public accountant (CPA) and someone who just files taxes for you. While you might get the same result, if difficult issues come up, you may not get the best advice. Given how much we are all paying for medical care, why would you opt for someone who wasn’t board certified?

To carry this distinction, your doctor must have graduated from an accredited residency program as well as passed the passed the governing board’s certification exam. The examination may be a one-day or two-day written test. Depending on the medical specialty, test takers may also need to take an oral examination.

To maintain their board certification, physicians are required to devote a certain number of hours per year to additional medical education. Doctors often fulfill this requirement by attending conferences and seminars. In addition, doctors must re-certify with a repeat examination every few years to continue their status. Given all of these requirements, a board-certified doctor will often provide the most up-to-date medical care. Ensure that your doctor is board certified. As a recent article noted, doctors most likely to provide the wrong medical care for colon cancer screening were doctors who were NOT board certified.

Your physician may display his board certificate in the office. Some certificates may not have an expiration date because in the past, physicians only needed to take the exam once. It was good for life. This is no longer true. Current graduates can expect to retake the exam every seven to ten years.

Learn more and research your doctor at the American Board of Medical Specialties.


Report Card on Quality.
Find out if your doctor is practicing the latest most up to date medical care by checking out his report card on quality. Is he doing the right things to keep you healthy?

For example, unfortunately in the United States patients who have suffered a heart attack get drastically different care and many don’t get the life saving medication they need to prevent a future event. Less than 50 percent of heart attack patients in Mississippi receive this medication known as a beta blocker. Yet in Massachusetts, nearly every heart attack patient is taking it. This failure to prescribe the medication simply was whether the doctor consistently followed the guidelines established by the American Heart Association. It wasn’t whether the patient could afford the medication since all the patients received the same insurance, Medicare.

A review of 20,000 patients from 12 metropolitan areas showed that 24 percent of breast cancer patients, 27 percent of pre-natal patients, 31 percent of low back pain patients, 32 percent of coronary heart disease patients, and 35 percent of high blood pressure patients did NOT receive the recommended care developed by expert medical committees.

If your doctor isn’t doing the right things that experts recommend, then what else is he doing wrong?

See if your doctor has applied for the NCQA quality recognition designation in any of the following programs - Physician Practice Connections, Heart/Stroke, Diabetes, or Back Pain. This designation is like the Good Housekeeping Seal of Approval. To have this distinction, doctors must show the National Committee of Quality Assurance (NCQA) that they are doing the right things.

You can only use these aspect on primary care doctors (except for the physician practice connections which can be any doctor), like family doctors or internists, as other doctors don't typically participate in these medical problems or illnesses.


Licensing / public reporting
Although your physician does not need to be board certified to practice medicine, he does need to be licensed. Find your own state medical board by going to the Federation of State Medical Boards or simply Google your state (like Connecticut) and medical board.

Each state provides different public information about its doctors. This typically includes the name of the physician, his license number, when the license was issued, and when it expires. Other states provide additional information like history of malpractice suits, felony convictions, or disciplinary action by the medical board. Some states split up the licensing and disciplinary functions into two different departments or websites. While at the state website, look for a link either for physician profile or credential search.

California State Medical Board
New York State Medical Board


The first three items, board-certification, report card on quality, and licensing / public reporting I know is unlikely things you would have come up with.


Bedside Manner
So now that you've found doctors that fulfill these basic requirements, what really is important for all of us is our doctors' bedside manner. If you have friends who are medical assistants, nurses, or others in healthcare, ask for recommendations. Often they see us when we are the most stressed. If they like working with us, then it is likely that they will recommend us.

Not sure you got the best? Here is how you know.

Does she...
Sit down?
Listen?
Know your medical history?
Involve you in the decision making process or get your perspective?
Ask you – do you have any other questions?

Finally, most importantly, does she always wash her hands?

Follow this advice and feel extremely confident that you have a great doctor!

5 comments:

Hannah said...

This is Hannah Bevills, I am an editor with Hospital.com. We are a medical publication whose focus is geared towards promoting awareness on hospitals, including information, news, and reviews on them. We would like to have our site included within your blog and offer our information to your readers, of course we would be more than happy to list your blog within our directory as well. I look forward to your response, Thanks!

Hannah Bevills
hannah.bevills@gmail.com
Hospital.com

Michael Kirsch, M.D. said...

I have a different view on the value of board certification and your criteria for finding a 'good doctor'. http://mdwhistleblower.blogspot.com/2010/04/does-board-certification-really-matter.html

Davis Liu, MD said...

Dr. Kirsch, while I understand your concerns, I do believe that board-certification is quite important. In a recent article, primary care doctors most likely to repeat a positive fecal occult stool test to screen for colon cancer (the wrong follow-up test) were doctors who were NOT board-certified. http://davisliumd.blogspot.com/2010/04/seventy-five-percent-of-primary-care.html

Michael Kirsch, M.D. said...

David, with regard to the fecal occult blood practice, it may mean that board certified physicians are already more knowledgeable, and not that board certification made them so.

Davis Liu, MD said...

Dr. Kirsch, while it is possible that board certified physicians were already more knowledgeable, the problem is without having some sort of external designation or objective measure, as imprecise as it may be, insurers, employers, and patients CANNOT tell the difference between quality medical care and substandard care.

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