A physician has difficulty choosing a primary care doctor

In the debate over health care reform the issue of choice is often brought up.  I’m not referring to a women’s right to choose or the birth control controversies but the simple idea of individuals being able to choose their health plan or physician.

However most physicians would probably agree that for much of health care, especially unexpected and sudden illnesses, the idea of choice is an illusion.  Patients rarely choose the doctor that examines them in the emergency room, the cardiologist that does an angiography, in the middle of an MI, a patient will not ask about door to balloon time at the hospital when they walk in, complication or readmission rates at that hospital.

Rarely, if ever, do patients ask us if we are diligent about reading the New England Journal of Medicine or what our Board scores were what medical school we went to. Ultimately all of that doesn’t matter in the calculus or an emergency nor does it really matter in making a choice about a primary care doctor.

I recently relocated and decided I should see a primary care doctor.  I’m fortunate in that I’m insured and feel like I’m relatively well informed. I’m a physician who trained in internal medicine so, how hard can it be to find a doctor? But I found myself utterly puzzled, how do I even go about it?

I tried asking friends for recommendation but inevitably their different insurance plans didn’t cover the same physicians or they went to Kaiser Permanente which had a closed plan and assigned patients to physicians.

I have insurance that gives you access a web-based database of their affiliated physicians that simply provides names and location.  In addition to location, I could filter by gender, language(s) spoken, whether they were family medicine or internal medicine trained, and board certification.  I was still bewildered. The list was too long and I didn’t know how to make sense of it.  I tried Googling some of the names. As wonderful as google is, this felt very unscientific.  Where does it say whether the physician is competent, a good listener, and nice?

The irony that I was a physician bewildered by the task of choosing a physician for myself was not lost on me.  It made me wonder about not only the tools out there for patients to make an informed choice in choosing a physician. And what does an informed choice mean?

As the health care coverage expansion begins, what are the tools we need to have in place to help patients navigate this process? What are the tools that are already out there? And if choice is overrated, how do we advocate for and build a system that is coherent and ensures access not only to a physician but one who is competent, caring and close.

Teeb Al-Samarrai is a physician and epidemiologist. This post originally appeared on Progress Notes

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  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for this post Dr. Al-Samarrai. You highlight a challenge in “finding a good doctor” that has always existed.

    The health plans simply list specialty and location
    Quality is assumed if their boards are up to date
    Your friend’s recommendation aren’t available to you if you don’t have the same insurance

    Social Media to the Rescue?

    This is an area where social media consultants claim their services are a major benefit to both the patient and the doctor. If you “google” the physicians available to you and they have a “Really Cool Facebook Page” … it could help you learn more and make a more informed choice.

    The downside is whatever online presence they maintain is an Avatar and may bear no resemblance to the experience of being their patient. Buyer Beware.

    My two cents

    Dike Drummond MD

  • tmomaslomez

    Yelp.com has physician Listings/patient reviews, you can even filter by specialty, neighborhoods etc. I suspect that insurance companies could devise some metrics for measuring how effective a doctor is, based on things important to a consumer. I’m not involved in healthcare, so just an observers opinion.

  • http://twitter.com/Clinician1 Dave Mittman, PA

    As a PA who moved into a new state, I did what any good clinician should do. I went to the local best hospital’s ER and asked the nurses who the best internist was (actually I asked the top two). Said I was a PA and wanted someone who was better than I was. They gave me two names, both excellent physicians, one who has a PA in his practice with him.
    Dave Mittman, PA, DFAAPA.

    • ChuckPilcher

      Absolutely perfect approach! Any individual could probably do the same with a phone call to the ED. Nurses have opinions, and are often willing to share them. Another approach would be to call a couple SPECIALTY offices – cardiology, general surgery, etc. – and say to the receptionist “I’m looking for a PCP. Who would you or Dr.. ____ see if you were in my shoes?” A corollary: If you need surgery, ask an anesthesiologist for a recommendation. Then ask that surgeon who your anesthesiologist should be.

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