WHAT TO LOOK FOR IN HEALTH CARE PROVIDERS

Qualifications Physical Access Communicate Access Financial Access Qualitities and Attitudes Rating Providers Dangerous Warning Signs

Qualifications

YES / NO

____ ____ Board certified?
____ ____ Board eligible?
____ ____ Are they familiar with treating people who have a similar disability or condition?
____ ____ Does their specialty, sub-specialty or advanced training relate to your condition or disability?
____ ____ Are they aware of the important health and disability-related issues specific to your condition? Are they willing to learn more?
How do they keep current on issues related to your specific medical and health needs? ___________________________________
How long have they been in practice? ____________________________
Where did they receive their training? ____________________________
____ ___ Do they teach other providers at a university? (Teaching often indicates their colleagues consider them knowledgeable in a specific area.)
____ ___ Do they have a record of formal disciplinary action or malpractice suits?

Physical Access

____ ____ Is the office physically accessible to you? Can you get to, into and use the facility?
____ ____ If you need a motorized exam table, do they have one? Can they assure you it will be available for your visits?
____ ____ Who covers for them when they are gone (partners, other providers)?
____ ____ How long must you wait for a routine appointment, urgent or emergency appointment?
How long is the typical wait in the reception area? __________________ A fifteen-minute wait or more, without an explanation, can be unreasonable.
____ ____ Do they appreciate the value of your time and will they call you if they are running late?
____ ____ Do they have evening or weekend hours?
____ ____ Are their hospital privileges and x-ray services in the same or other accessible and convenient locations?
Which hospitals do they prefer to use? ___________________________
____ ____ Do they have a relationship with a rehabilitation hospital or other facilities (teaching/ university or community hospital) that treat your type of condition or disability?

Communication Access

____ ____ Are they proficient in your native language? If not, will they use an interpreter?
____ ____ Will they meet you for a get-acquainted meeting without charge?
____ ____ Are they good listeners?
____ ____ Do you feel comfortable talking with them?
____ ____ Do they take adequate time with you or do you feel rushed?
____ ____ Can you reach them easily by phone?
____ ____ Will they return phone calls in a reasonable amount of time?
____ ____ Will they take time to communicate with you on the phone or by e-mail, instead of always saying, "Come in and we will talk"?
____ ____ How can you reach them when the office is closed?
____ ____ Do they take non-emergency phone calls during your visit?
____ ____ Do they initiate calls to you to check on new medication or other treatments?
____ ____ Do they encourage your using a tape recorder?
____ ____ Do they encourage your bringing a support person (friend, family member)?
____ ____ Are their explanations understandable?
____ ____ Do they provide full information on medication, tests, procedures, treatments, etc.?
____ ____ Do they ensure that you understand and agree with decisions?
____ ____ Do they give you information materials in a format accessible to you: Braille, large print, disk, audio cassette, video (with captions or audio described)?
____ ____ Is the staff friendly, courteous and helpful?

Financial Access (f applicable, depending on your type of health insurance)

____ ____ Do they accept your insurance?
____ ____ Is preauthorization from your health insurance carrier required?
____ ____ Are they a preferred provider?
What are their standard fees? ________________________________ Be suspicious of providers unwilling to share their fee schedule.
How well does your insurance cover their fees? ____________________
____ ____ Do you accept their payment and billing policies (do you have to pay for the visit at the time of the appointment rather than being billed or waiting until the insurance carrier pays their portion)?
____ ____ Will their office complete insurance forms for you? If yes, is there a charge?

Qualities and Attitudes

____ ____ Do you like the provider?
____ ____ Do you feel respected by them?
____ ____ Are they comfortable with a partnership approach and sharing the decision-making process with you?
____ ____ Will they give you copies of your x-rays, copies of medical reports and visit summaries for maintaining your own health records?
____ ____ At the end of a visit, will they summarize or read back what they wrote down or recorded as a way for you to learn how to interpret information and review the results of the visit?
What are their views on assisted suicide, advance directives, medical proxies, etc.? _______________________________________________

Source: Copyright © 1998 Be a Savvy Health Care Consumer, Your Life May Depend on It! by June Isaacson Kailes, Disability Policy Consultant. For nformation on ordering this guide, contact the author at jik@pacbell.net or write to KAILES - Publications, 6201 Ocean Front Walk, Suite 2, Playa del Rey, CA 90293, or visit /resource.html

Although some patients argue that they are hesitant or are not qualified to check on a doctor, it seems folly not to make every effort to do so, especially when one considers the money that will be spent for the physician's expertise and the fact, also, that one's physical and psychological well-being is going to be entrusted to this person.
Paul A. Williams, M.D.
University of Missouri

Given the massive changes in health care, fewer people have as much flexibility and freedom as they used to when it comes to selecting providers. However, even in HMOs or PPOs, you usually have the right to change your primary care provider. In some geographic areas provider availability may restrict choice. In spite of the fact that selecting providers is more restricted than it used to be, you still have the right to evaluate providers assigned to you and request a change if needed. This section focuses on choosing new providers as well as evaluating your current providers.

GET RECOMMENDATIONS

Select your provider while you are healthy. Be clear about the kind of relationship you want with a provider. Convenience alone should not dictate your choice of providers. Be careful in using provider referral services as often they are only advertising vehicles.

Ask your friends, relatives, colleagues, support groups, health care providers and disability-related organizations for referrals to good providers. Call the chief resident at the local teaching hospital and ask, "Who is the best internist, primary care physician, etc. in town?" Ask your health care providers who they see for their health care. The more people you talk to, the better. Keep asking for names. You may begin hearing the same two or three names, which could either indicate popularity and confidence or a scarcity of providers.

Investigate the provider's reputation. Ask colleagues, friends and acquaintances about their experiences with providers. Try to get a feel for the level of care, time spent with individuals, and experience the provider has in working with people who have similar conditions.

ITEMS TO CONSIDER

It's not always easy to judge a provider on the first visit, but you can get a sense about your willingness to go back again. The WHAT TO LOOK FOR IN HEALTH CARE PROVIDERS checklist contains items to consider. Make an appointment for an exploratory, get-acquainted office visit. Usually providers charge for this visit as an initial evaluation, but not all do. Sometimes you can interview providers on the telephone or write a letter stating your medical conditions and that you're looking for a provider. Ask if they feel they can assist you. You may want to include some questions listed in WHAT TO LOOK FOR IN HEALTH CARE PROVIDERS checklist.

If you decide to interview a provider, ask about consultation fees. If there is a charge, arrange to have some routine tests or procedures done, i.e., blood pressure, x-ray, etc.

Evaluation of a provider can start before you meet the provider. For example, is the staff friendly, courteous and helpful when you call? The way staff treats you often reflects the way a provider will treat you.

If you really want to see providers who are not taking any new patients, don't give up. Sometimes you can get on a waiting list. Calling back periodically or writing the providers explaining your reasons for wanting to see them can be effective (Miller, p. 62).

Age and number of years in practice are also considerations when looking for a provider, although these should not be the primary considerations. Some people are comfortable with providers who are older and have been practicing for many years. People sometimes believe providers who have been in practice the longest are the most qualified. This is not always true. Some providers who have been in practice for many years may have a tendency to be less medically current. After a certain age, some providers may not pursue new information as often as they used to. There are always exceptions. Providers who have completed their training over the last ten years tend to have more current information. These providers may also be more enlightened related to positive attitudes toward disability (Bontke, p.12). Again, this is not always true.

If you want a long-term relationship with a primary care provider consider these items:

number of years in practice
commitment to remaining in practice
commitment to remaining in the community
projected years before retirement

Another strategy to use when you have the freedom to select a provider is to ask the provider to put you in touch with some patients in their practice with whom you can talk before making a decision.

Qualities and Attitudes

If a provider's attitudes, beliefs or values clash with yours, find another provider. It is important to respect providers professionally and personally. Having confidence in them is critical. If you don't respect them, you'll always have doubts about their recommendations and may be less likely to comply with treatment plans. If you are very assertive, you want providers who won't feel intimidated or get upset when you disagree with them. You should test this or at least state this need in an initial visit.

RATING PROVIDERS

It is not always easy to judge a provider on the first visit but you can get at least a sense about your willingness to go back again. After the office visit, rate the provider on the items most important to you. You can also check for any pattern of malpractice suits by calling the state licensing board.

The items listed in the WHAT TO LOOK FOR IN HEALTH CARE PROVIDERS checklist do not all carry equal weight or value. For example, when you are looking for a surgeon, the fact that one of several you visited has an outstanding reputation, excellent skills and successfully performs the procedure more times than any other doctor in your state, should carry more weight than the fact that you don't care for their office location, bedside manor, personality or the "barracuda" employed as the receptionist.

It is unlikely you'll find providers who meet all your criteria and possess all the qualities you desire. It bears repeating, if you do find a provider who has the qualities most important to you such as skill and knowledge, you may decide that some aspects such as office staff, ease of getting a non-urgent appointment, and inconvenient location are of lesser importance to you.

DANGEROUS PROVIDER WARNING SIGNS

As you evaluate providers, consider some of these "dangerous provider" warning signs:

has a reputation for diagnosing the "illness of the month" - one that's currently big news

gets angry or defensive if you want to get a second opinion

sidesteps questions about their training or credentials

makes promises that sound too good to be true, promises too much or a no-risk cure

refuses to answer questions or will not provide explanations in terms you can understand

routinely orders batteries of expensive (possibly hazardous) tests

prescribes antibiotics, tranquilizers or other potent drugs too quickly

does not evaluate your needs regularly before prescribing new drugs

does not tell you the risks and side effects or alternatives to treatment, surgery or medication

is unable to provide written proof from recognized sources (journal articles, research reports) of the legitimacy of a procedure

makes sexual suggestions

promotes own brand of vitamins or medication

(Adapted and expanded from Tamara Eberlein, Redbook, June 1991, "Give Your Doctor a Checkup," p. 118)

According to the Federation of State Medical Boards, the total number of serious disciplinary actions against doctors across the country was 3,375 in 1995, about 0.5 percent of all doctors. To find out if a particular provider has been disciplined by your state, call the agency that licenses those providers in your state. To get the phone number of the agency that licenses physicians in your state, call the Federation
of State Medical Boards for the number to call in your area, 817-868-4000. Some State Medical Boards also track malpractice and related lawsuits, but not out of court settlements.

Administrators in Medicine, an organization of state medical board directors, operates a Web site - http://www.docboard.org - where you can find information on doctors in a growing number of states. This information includes disciplinary actions, but not malpractice histories.

Questionable Doctors, published by the Public Citizens' Health Research Group in Washington, D.C., can be found in many public libraries, or you can order a state supplement by calling 202-588-1000.

None of us would ever consider giving total control of our life savings over to a complete stranger. Yet this is how most of us choose our physicians and entrust them with the future well-being of our bodies. We permit doctors to make decisions about the most important aspect of our life, our health, and more often than not, we do not know a thing about their medical acumen.
Catherine Bontke, M.D. Associate Professor of Physical Medicine and Rehabilitation, Baylor College of Medicine

Bontke, Catherine, Fall 1994. "Patient Rights and Your Physician." ABLED! Active Beautiful Loving Exquisite Disabled Woman, Volume IV, No. 3, pp. 12-15.

Miller, Marc, ed., 1995. Health Care Choices for Today's Consumer, Families USA Guide to Quality and Cost. Living Planet Press, Washington. DC.

Source: Copyright © 1998 Be a Savvy Health Care Consumer, Your Life May Depend on It! by June Isaacson Kailes, Disability Policy Consultant. For nformation on ordering this guide, contact the author at jik@pacbell.net or write to KAILES - Publications, 6201 Ocean Front Walk, Suite 2, Playa del Rey, CA 90293, or visit /resource.html

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