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Is There A Doctor in the House?

(A Guide to Choosing a Physician)

by

Jeffrey Pearson, D.O.

 

[Although this patient education handout was written and copyrighted in 1985, most of it remains timely and practical to this day.]

We have always made jokes about doctors and how hard we try to avoid them (remember an apple a day keeps the doctor away?). To some, the mere mention of them conjures up visions of sadistic ghouls brandishing hypodermic needles resembling spears arid proctoscopes the size of the Lincoln Tunnel.

Sooner or later, everyone faces the reality that illness is an unavoidable part of life and off we go in search of medical advice. Many people begin with their families and friends. It is only after consistently stumping them, however, that they realize the apparent hopelessness of the situation and finally resolve to visit a professional - the physician.

How does one select a physician? Do we really need to see the same one each time? How can we determine if he or she is good???

These are just a few of the more frequently asked questions posed in the pursuit of the elusive Dr. Welby. This article will address these concerns and offer useful guidelines in finding the physician who is just right for you. You will also be exposed to contemporary issues regarding the practice of medicine, and gain insight as to how they affect you, the medical consumer.

THE PATIENT-PHYSICIAN RELATIONSHIP

It is of vital importance that patients establish and maintain a good relationship with a physician throughout their lives. The physician who knows his or her patients inside and out (literally!) carries substantial advantages over others in rendering quality medical care. This is based upon the fact that the medical history provides at least 80-90 percent of the information that is required to identify a diagnosis and to treat the individual. The following examples will serve to illustrate:

a)   Remembering that a patient complaining of lightheadedness and fatigue has a history of Diabetes can save time and money in the diagnostic work-up.

b)   Knowing that a hypertensive (high blood pressure) patient complies poorly with instructions would provide us with the insight to dispense a prescription for a once-daily medication.

c)   It is helpful being aware that certain children in our practices suffering from asthma or resistant ear infections have responded better to medications that may not have otherwise been another physician s first choice.

By providing continuous care to the patients, this type of relationship tends to be very cost-effective. Repeated routine testing for various reasons is often avoided because there is no need to build a database up from "ground zero" at each visit. Contrast this situation to patients who tend to use emergency rooms and urgent care centers frequently. Different physicians usually examine them at each visit, often undergoing batteries of expensive lab and x-ray procedures in order to avoid missing a diagnosis (basically protecting their medicolegal tails).

Incidentally, this has been a prime reason why state Medicaid programs waste so many health care dollars. Emergency rooms are notoriously expensive places to receive medical attention for routine medical problems. In response to this fact, some states have recently introduced plans restricting Medicaid patients from using emergency rooms without first consulting primary care physicians to whom they are being assigned.

In short, your health is much too important to always be entrusting it to complete strangers if you don't have to. Plus, in these days of ever skyrocketing medical costs, you may save yourself some money as well.

WHAT KIND OF DOCTOR DO YOU NEED?

All physicians can generally be lumped into one of two groups: primary care providers and specialists. This is akin to the old adage about seeing the forest or the trees. Primary care physicians maintain the "forest" as a whole, and in order to do a good job, they must know something about each of the "trees" as well. Specialists, for the most part, limit their practices to and deal mainly with specific individual "trees". They leave the rest of the "forest" to be maintained by other types of specialists and/or primary care physicians.

Primary care physicians should ideally be considered the first line of defense in medical care, i.e.. the first professional sought out by a patient. They are adept at assessing problems and are able to treat the vast majority of cases by themselves. These providers include pediatricians (children), general internists (adults and elderly), family physicians and general practitioners (all ages), and some gynecologists (women). In addition to acute medical care and follow-up visits, these physicians' responsibilities also include preventive medical screening for diseases such as Cancer, Heart Disease, and Diabetes. They provide counseling for nutrition/weight loss and help their patients to cope with daily stresses that may be related to organic illnesses (such as peptic ulcers and emphysema) or their environment (family, work, or school). They are also educators and are often the best source of information regarding your health-related questions.

If a patient 's problems are particularly complex, or out of the primary care providers scope of practice, then he or she may then request a consultation with an appropriate specialist, who may be medical or surgical. For example, a young child may present to an office with complaints of stomachaches, loss of appetite, and fever. If a tentative diagnosis of acute appendicitis is made, then a general surgeon may be asked to consult and perform an appendectomy, if indicated. A 45 year old male smoker may be experiencing increasingly frequent bouts of angina (chest pain). A Family Physician would not hesitate to consult his or her local cardiologist (heart specialist) for a more extensive work-up that may include stress testing or even a cardiac catheterization. If indicated, a cardiovascular surgeon may even be called in for coronary artery bypasses.

Some of the other more common medical specialties include: Pulmonary medicine (lungs and breathing problems). Hematology (blood abnormalities), Gastroenterology (stomach and intestinal disorders), Neurology (brain and nervous system), and Oncology (cancer). Surgeons can be Orthopedic (fix broken bones), Ophthalmologists (eyes), Otolaryngologists (ear, nose and throat), Vascular (blood vessels), and Urologists (deal with disorders of the male and female urinary tract). A complete listing of the many medical and surgical subspecialties is beyond the limitations of this article. (I confess, however, that I am no longer amazed when I hear of further subdivisions within already sub-specialized fields of practice. It will not surprise me to learn of doctors in the future who will treat only one side of the body or the other!)

It is important to realize that the primary care provider should not simply drop out of the picture as soon as a referral is made. They still maintain an important role in their patients' care, often acting as advocates upon the behalf of their health interests. In complex cases, primary care physicians coordinate the activities of the various specialists that may have become involved, helping to control extraneous and redundant tests (and their associated costs). They are also often the ones who explain just what the heck is going on (to an already scared patient), in good old-fashioned plain English.

"Well Mr. Jones, your hemoglobin test demonstrated a profound anemia which predisposed you to a hypoxic situation that was made even worse by your smoking. With this last exertion, you didn't experience your usual anginal episode, but rather you suffered an acute myocardial infarction. Were going to put you into the CCU, give you intravenous medications that you can't pronounce, perform daily electrocardiograms and radiographic examinations of your chest…" 

Incidentally, the preceding information nearly always manages to be dispensed in under 30 seconds - just a moment longer than it takes the over-stereotyped specialist to walk out of the room and before the patient has chance enough to muster sufficient breath for a question. [Now before I become inundated with hate mail from my colleagues, I will be the first to point out that this is a gross exaggeration and that many of my specialist friends are in fact empathetic, caring physicians who do talk to their patients. Unfortunately, however, we all know of cases where this situation is reality much too often. 

Seeking out the advice of a trusted primary care physician in selecting a needed specialist makes good sense in other ways as well. Many family physicians treat their patients truly like family and refer them to the same doctors that they themselves would use in a particular situation. This is based upon an 'enlightened appreciation" for a specialist colleague's skills that would most likely be lost by a lay person. (We do our best to insure that our patients get directed to competent specialists in the appropriate fields.)

The Initials Game

Another source of confusion among patients is how to identify a 'medical physician. ' The alphabet soup of degrees behind the names of the many individuals calling themselves "Doctor" is not always clear.

In the United States, there are only two degrees that represent trained individuals licensed to practice the full scope of medicine in all 50 states - M.D. and D.O.. Both are able to diagnose and treat disease, prescribe medications, perform surgeries, and perform diagnostic tests. M.D. 's are considered Allopathic physicians, whereas the D.0. degree denotes Doctors of Osteopathic Medicine. The American public is well-aware of what an M.D. (allopathic physician) is, thanks largely in part to the exposure from television shows such as Marcus Welby, M.D., Medical Center, and M.A.S.H. to the present day St. Elsewhere. Osteopathic physicians are less well-understood and hence a brief historical background is provided. 

Osteopathic Medicine was developed by an American physician (M.D.) in the mid-19th century in response to the limited medical knowledge that was available in the country at that time. Traditional medicine had been focusing on the treatment of specific symptoms/diseases/organ systems. After watching helplessly as family members were wiped out by a meningitis epidemic, Dr. Andrew Taylor Still set out to re-evaluate the medical and scientific knowledge of his time. The "Osteopathic" medicine that he developed put it's emphasis on "Holism" - the treatment of the "whole individual", rather than its specific parts; He realized, what all physicians today know to be fact, that the structure and function of body organs are interrelated and that because of complex nervous connections, an illness in one organ of the body may affect other parts and create a constellation of symptoms. For example, it is well-recognized that in addition to chest pain, a person suffering from a heart attack may experience nausea, difficulty in breathing, profound sweating, and frequently referred pains in regions such as the left upper arm or jaw.

Today, these historical differences have translated in the fact that the majority of D.O. 's are involved in primary care, whereas M.D. 's tend to specialize. Both receive many years of education and medical training that includes college, four years of medical school, internship, residency and fellowship programs. Virtually every specialty is duplicated within the two degrees: from Family Practice and Cardiology to General Surgery and Neurosurgery.

In addition to the standard medical curriculum, Osteopathic medical students obtain extra training in Manual Medicine (including spinal manipulation) which is a valuable tool for them. They learn to palpate (touch) the body in such a way that they can recognize referred nervous impulse patterns to assist their diagnostic abilities. For example, pain from an inflamed gall bladder can be referred to the right lower shoulder blade region. Therapeutically, they may use their skills to relieve musculoskeletal aches that may be associated with a neck whiplash or back injury. They can also help to relieve the discomforts associated with dysfunction referred from internal organs. An Osteopathic physician would use medications to reduce the acid production in a peptic ulcer patient much like his M.D. counterpart but, in addition, he or she may also use manipulation to help relieve some of the back pains that may accompany the problem.

A gross oversimplification would be to state that a D.O. is what you get when you add an M.D. to a chiropractor. The philosophical distinctions aside, however, this is probably the impression that most patients deal with on a practical level, When one stops to realize that, next to the common cold, the second most common presenting complaints in a family physician's office are musculoskeletal (headaches, neck and assorted back strains), it is easy to see how this additional training helps the Osteopathic physician in his practice.

Doctors of Podiatric Medicine (D.P.M.) are licensed physicians and surgeons, but the scope of their practice is generally limited to the knee and below, depending upon your community. They administer foot care ranging from simple problems like athlete's foot, bunions, and fallen arches to Diabetic wound care and complex surgical procedures. They are a valuable member of the Sports Medicine team as well.

Dentists, Orthodontists, and Oral Surgeons similarly are licensed physicians and surgeons whose practices are limited to a specific region of the body, in this case the mouth and teeth. They too can prescribe medications in accordance with the nature of their work.

Doctors of Optometry (O.D.) are skilled and licensed professionals who deal with vision and eye care. They are not "medical" physicians and do not perform eye surgery or treat eye disease in some states. They do screen for serious eye problems such as glaucoma and cataracts. They also screen for systemic diseases such as Diabetes and Hypertension, and make referrals for proper care. They provide a valuable service to the millions of Americans who count on them for vision care which is provided by means of glasses, contact lenses, and vision therapy.

Understanding just what chiropractors do is often difficult for the general consumer because the profession consists of two distinct groups; "Straight" chiropractors limit their practices solely to the spinal column and associated nerve conduction problems that may be diagnosed. They examine patients for misalignments of the spinal bones, called "vertebral subluxations, " and employ specific manipulative techniques ("adjustments") to reduce or correct them. Although they may take X-ray pictures of the spine, they cannot by law (nor choose to) "practice medicine" (le. prescribe controlled medications or perform surgeries). A skilled straight chiropractor can provide excellent adjunctive therapy in the care of common musculoskeletal problems such as tension headaches, whiplash, and back strains. Good straight chiropractors, like physicians, understand the limitations of their abilities. They do not hesitate to consult a medical physician (M.D. or D.O.) if the possibility of a complicated problem is suspected.

"Mixing" chiropractors often attempt to duplicate the services of the medical doctor, in addition to the aforementioned abilities. Many use physical therapies and acupuncture, although they do not receive the same training as physical therapists and acupuncturists. They prescribe and sell vitamin supplements - possibly a mimicry of the medical doctors' prescribing of drugs. Many claim to make medical diagnoses, although they lack the proper medical training, residencies, and "hospital experiences to do so. In fact, some states allow their procedures to range from general physical examinations and blood testing, to gynecological exams and orthopedic casting.

While both straight and mixing chiropractors are awarded the same degree (Doctor of Chiropractic, D.C.), a straight chiropractor generally labels him/herself accurately as "chiropractor" or "straight chiropractor. " Mixing chiropractors often label themselves as "chiropractic physicians," which may mislead the public to believe that they are "more than" a chiropractor when, in reality, they are not. If you have any questions regarding an individual chiropractors qualifications or scope of practice, ask them.

What qualities should you look for?

Basic medical knowledge and competence almost go without saying as being key criteria. You should be aware, however, that a medical degree alone (M.D. or D.O.) does not give a physician a right to practice medicine. These degrees are conferred immediately upon the completion of medical school. Physicians must then complete at least one year (in most states) of post-graduate training, to gain some clinical experience, plus successfully complete their respective National Board Examinations before becoming eligible for licensure.

This first year of post-graduate training may be a so-called "rotating internship," where young physicians rotate through most of the major specialties in the hospital (inpatient) setting, whereby providing them with a firm base of medical knowledge. This experience can be valuable in their future interactions outside of their eventual specialty as it exposes them to what others can offer their patients In the way of alternative therapies.

Some physicians may elect to go immediately into a residency program directly from medical school, skipping the rotating internship. A residency consists of several years of training (average is three) wherein a physician becomes immersed within a specialty, generally the broad fields of Internal Medicine, Pediatrics, Family Practice, or Surgery. Should they desire to sub-specialize, they would then enter a "fellowship" program for additional training beyond the residency. For example, an internist could subspecialize in Cardiology or Gastroenterology and a surgeon could go into Orthopedics, Plastic/Reconstructive, Vascular, or other fields of interest.

A physician who has completed a residency or fellowship programs' requirements is then said to be Board-eligible. He or she may then sit for examinations testing their newly-acquired knowledge. A physician who successfully passes these exams is then considered to be Board-certified. There was no compelling motivation for Board certification years ago, aside from the personal satisfaction of achievement. Today, however, insurance reimbursements are often higher for Board-certified physicians. Considering this and the current medicolegal climate in the country, more physicians are opting to "go all the way" and obtain their specialty certifications.

What's Next? So now you've got a dozen Board-eligible or certified names on your list of potential physicians. What else should you look for that makes your physician so special? Several qualities can be best summed up by an axiom often dispensed as advice to new physicians regarding the qualities needed to become a successful practitioner: affability, availability, and affordability.

1. Affability- Do you like the individual? Does he or she express a genuine concern for patients? Are they willing to take the time to discuss your medical problems with you, rather than talk at you?

Good communication facilitates good care! (I can think of few other instances where this simple fact needs to be stated as emphatically as when you are dealing with someone's life.) People visit physicians for all sorts of reasons. In some minds, illness is perceived as a sign of weakness and some may feel a sense of embarrassment for coming in and "wasting the doctors time. " The patient should always feel comfortable talking with the physician - whether discussing a nagging sore throat, the intimacies of ones sex life, or dealing with the death of a close friend or family member. A good physician can be a source of strength in tough times. Often enough, patients will come to discuss problems on the job or with a relationship. Being a good listener can make all of the difference in the world in the mind of someone who is depressed and feeling ignored or helpless.

Taken to the opposite extreme, poor communication between a physician and patient can result in malpractice litigation, even in instances where no malpractice had occurred. This has been documented in interviews with patients who had previously filed claims against their physicians. Many of them felt that hitting particular physicians in their pocketbook was the only way that they were able to express their feeling of displeasure towards these individuals. The bottom line: talk is a good bargain; failing to talk can be very expensive in both quality of medical care rendered and financial terms.

2. Availability: Can you see your physician when you need him? No matter how routine or benign a problem might be, it is often compelling enough to seek prompt medical attention. While many physicians are attuned to the needs of patients, some fail to appreciate this simple fact. What may only be considered a "trivial" diagnosis in the eyes of a particular physician may represent a significant mental burden to a layperson. A good example is the fear that any newly discovered mole may be a malignant skin cancer. Fortunately, in these days of increased competition and awareness of patients' needs, the situation is definitely changing towards better physician accessibility. There are some specialties that will always be difficult to book routine visits, e.g. ophthalmologists, due to the nature of their examinations and volumes of patients. Still, more and more physicians in all specialties are now often intentionally leaving openings in their daily schedules for walk-ins and emergencies. (The attitude that non-emergent problems can wait for days to weeks, by some physicians. I believe is a reason behind the recent glut of so-called "urgy" centers. During discussions with patients at a local urgent care center, one woman told me that she only goes to her regular doctor when she gets really sick, because he absolutely wouldn't take any patient without an appointment and that took too long to obtain. As a result, she has her ear infections tended to by these local centers and her regular physician probably is wondering why his office practice is slowing down. )

Practicing medicine is not a 9 -5 job, but rather one where doctors are expected to be available for patients 24 hours a day, seven days a week. They frequently answer telephone calls at three and four in the morning, not to mention visiting the Emergency rooms at those times. Physicians need frequent breaks to prevent them from stress "burn-out. A good physician will ensure that he or she arranges for qualified doctors to cover during these times. The patient should never have to feel abandoned in a time of need.

Contracted or "brokered" health care systems have been introduced to our society gradually over the last few years, in some regions (e.g. California) stronger than others. This is represented by Health Maintenance Organization (HMO)-type programs where individual insurance companies "contract out" specific doctors in a region to treat patients who carry that particular type of insurance coverage. In other words, a company will instruct patients that they can receive covered medical services only through certain physicians in their community. Should a patient visit a "non-participating" physician, then they will be responsible for the bill, possibly in it's entirety.

Participating primary care providers are generally required to refer only to specialists who have also contracted with the insurance company. Theoretically, this can lead to problems in that a physicians first choice for a particular consultant may not be a participant in the same program and may be forced to refer to his or her second, third, or even fourth choice. (I had personally witnessed patients from one H.M.O. present to a local Emergency room with broken bones in need of an Orthopedic surgeon, only to find that the participating specialists were not available. After several hours delay, they were finally seen by non-affiliated physician. ) Words to the wise: when investigating all of the glamorous claims that some insurance salesperson may boast, make sure that whatever type of physician you need is readily available at all times.

I know of no patients who schedule to break their hip in the middle of the afternoon when there is lots of help available (fractures always seem to occur during the night). Know in advance that someone will always be available for you in times of emergency.

3. Affordability; Physicians fee schedules are based upon several independent factors. Primary care providers and medical specialists generally determine their fees by the length of a patient's visit coupled with the complexity of the problem(s) presented. A simple sore throat in an already established patient will obviously be less expensive than a comprehensive evaluation of chest pain in a new one. The American Medical Association has created various visit descriptions and codes ranging from brief and minimal to extended and comprehensive that are commonly used for billing purposes. 

Surgeons, on the other hand, must also factor in values representative of the degrees of skill and risk involved in their procedures. They pay significantly higher premiums for their malpractice liability coverage and these incre8sed costs get passed on to their p8tients in this manner.

Where a patient resides in the United States also influences the charges of medical office visits. Doctors that practice in the greater populated regions of the country, such as New York City, must account for substantially higher overhead operating expenses for rent, utilities and employees salaries. (I trained in the Midwest where the costs of living were not as great and this resulted in significantly lower office charges for the local physicians. )

Something that physicians have traditionally tried to deny to themselves is the reality that medicine is indeed a business, as well as a profession. This fact has been forgotten by many of their patients as well. While much attention has been focused on the revenues coming in, it is not generally appreciated that the office visit charges do not disappear directly into the physician's pockets. Instead, it goes toward significant expenses, some unique to a medical practice. Practitioners employ not only receptionists, bookkeepers, and insurance specialists, but nurses and other technicians, too. Each employee expects appropriate salary increases and benefits, just as would be expected in any other profession. Medical equipment is also quite expensive. (When you consider that something as basic as a stethoscope typically runs $75-150, you can well imagine that maintaining up-to-date necessary equipment such as EKG machines and x-ray facilities approximates many thousands of dollars. ) Medical malpractice liability insurance is another necessary expenditure that varies upon a physicians specialty and region of the country. Other sources of expense include answering services, transportation to house calls and hospital/nursing home visits, office supplies… the list goes on.

Contrary to popular beliefs, physicians are every bit as aware, as is the patient, of the exorbitant costs associated with quality health care delivery. As noted earlier, many doctors are trying to be cost-effective without compromising the quality of care that. is being rendered. Many would love to practice medicine strictly because they enjoy the satisfaction that is derived from helping people. Unfortunately, as outlined above, a physician who does not charge accordingly will soon find himself or herself out of business quite rapidly. He or she cannot then do much good for anyone.

If you find that your medical expenses are adding up faster than you are able to manage them, it is important that you feel comfortable discussing this with your physician. When asked, many physicians will try to help in any way that they can if they are made aware that a patient is experiencing financial difficulties. Most doctors prefer that patients explain their reasons for nonpayment and then work out a mutually agreeable arrangement (this is better than turning an undeserving patient over to a collection agency).  In contrast to the trends in urgent care centers where payment is mandated at the time of visit, it is obviously easier to arrange extended credit if needed with a physician with whom you've developed a rapport over the years. (Incidentally, payment at the time of visit helps to defray the costs of office charges in the long run; offices that extend significant credit lines need to raise their fees more frequently in order to meet their payroll and other expenditure deadlines.)

You will find that most fee schedules tend to be consistently competitive within any given region of the country. With the exception of the wide variety of pre-paid health care plans, there is little or no difference in office charges between physicians of similar specialties in a particular community. This fact tends to lessen the importance of price considerations in the doctor shopping equation.

Exceptions can be found however, for patients who are age 65 and over, due to the present confusion in the Medicare system. The system now requires special price-fixing of doctors fees based on what are called Maximum Actual Allowable Charges or "M.A.A.C. s". Each physician in the country has been assigned M.A.A.C. s based upon formulas that no one quite appears to understand. These charges are based on outdated figures kept by the government and are generally well below the current charges of most physicians. An individual physician is not allowed to charge a Medicare recipient anything higher than his M.A.A.C. for a particular visit or procedure, if he does not accept Medicare assignment. The problems began to surface early when it was discovered that there existed vast discrepancies between the M. A. A. C. 's of physicians within a community and even within office groups. (My partner and I. for example, had two separate M.A.A.C. profiles which created considerable confusion within our office to our patients and ourselves.) Individuals can take advantage of this Medicare oversight, before it is corrected, in shopping for physicians. (This is not recommended, however, because it will lead some of the elderly to distort their priorities; they will be seeking out physicians on the basis of Medicare assignment, rather than on quality which should be their primary concern. )

Dr. Welby, where are you?

OK, so you are new in town and looking for that special physician who is knowledgeable, talks to you, and is both available and affordable. Where do you begin?

The first bit of advice is to avoid the telephone book Yellow Pages. They are excellent after you have already discovered a name and need only to find an address or phone number, but not for initially selecting your doctor. Remember that anyone can make himself look like a hotshot with fancy, glitzy advertising. While you may get lucky, all too often people wind up getting burned. A nice advertisement is no guarantee for good medicine.

It is recommended that you begin by consulting with local family members, friends or other trusted acquaintances. Ask them whom they use and whether or not they are satisfied with their elections. Be sure to ask them about all of the issues that have been discussed previous to this section. Try to obtain several opinions so as to not be biased by the possible personality conflicts that occasionally arise in even the best of circumstances.

Another excellent source of referrals are your local allied health care professionals. These include nurses, pharmacists, physical therapists, and many others. Find out whom they go to when they are sick. They can often point you in the direction of competent and caring individuals based upon their daily interactions at work.

Some physicians are very active in their local community affairs and offer frequent presentations on common maladies such as Hypertension, Diabetes, and Cancer just to name a few. They may sponsor local health screening fairs or sports clinics. Attending some of these discussions may expose you to physicians who exhibit genuine concern towards the public welfare and preventive medicine. These physicians should be actively sought out if you liked them.

Local hospital and county medical societies usually maintain current listings of available physicians in their areas, if the aforementioned options are not available to you. One should bear in mind though that not all physicians belong to all hospitals, nor participate in their local societies, for reasons that may be unrelated to their ability to render good medical care.

Only if all of the above suggestions are unsuccessful, should you choose a doctor's name at random from the telephone book. In fact, in some regions of the country, physicians have been warned from experience to pay particularly close attention to any new patient who admits to finding them through this manner because some have subsequently turned out to be addicts seeking narcotics.

That dirty word…malpractice

Certain realities must be faced. In our nations present medicolegal climate, nearly every practicing physician will be sued at least once, whether true malpractice has been committed or not. Because of the considerable complexities, time, and expenses that go along with defending a malpractice case, some doctors do decide to settle out of court even if they were not at fault. Many feel that the incredible mental stresses and pressures placed upon themselves, their families, and practices do not make it worth fighting the long years. (One cannot really imagine the degree of depression experienced by a caring physician against whom a malpractice claim is filed. It can be quite a disabling experience and create serious inner self-doubts, even in cases that are settled on the physician's behalf. Some doctors never practice the same type of medicine again after being sued- tending to view each new patient as a potential adversary rather than as someone to exchange trust. They may find themselves ordering excessive tests that they never would have if they hadn't been concerned about protecting themselves from some future claims, whereby contributing to the increasing costs of medical care. )

Statistics clearly demonstrate that only a small percentage of physicians are sued twice or more, with some specialties inherently carrying more risks than others do e.g. surgeons vs. internists. It certainly cannot be stated that real malpractice does not exist, but the vast majority of physicians are practicing good, safe medicine. There is little dispute amongst authorities that, in our country today, more people have access to better health care than ever before. Yet, cries of rampant gross negligence are still heard from a very vocal minority of individuals (some of whom I suspect in some way feed off of the panic that they create).

(It is with this latter grouping that I place those who advertise in the newspapers about offering to sell lists of a doctor's malpractice claims. My personal biases aside, subscribing to these, sometimes expensive, services will usually not provide particularly useful information to the average patient due to the very few numbers of lawsuits per physician. plus the inaccuracies that may have been included as the result of pro-trial settlements.)

Summary

It should be clear that developing and maintaining a long-lasting relationship with a physician is one of the most important decisions that one can make. Allopathic (M.D.) or Osteopathic (D.O.) primary care providers will generally serve the needs of most patients with qualified specialists available for special or complex cases.

You should seek out a Board-eligible or certified physician with whom you feel comfortable communicating and is easily available when needed. He or she should be respectful of any financial concerns that you may harbor. The best way to find a physician is through people whom you know and trust. Local allied health care professionals, hospitals, and county medical societies may also play important roles. Avoid the telephone book Yellow Pages.

Take your time and do your research carefully. The decision that you make affects not only your pocketbook, but perhaps your life as well. Some people hire accountants and brokers to manage their savings and money funds. Similarly, physicians are 'hired" as health managers.

Finally, physicians are human beings. They are not always perfect, nor gods. Most try very hard to perform to the best of their abilities. Your physician should be ever-respectful of his or her limitations and should involve you in the decision-making processes whenever possible. After all, it is only together that we can work for our common interests, which is keeping you, our patients, number one.

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