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Caregiving: Choosing a doctor

By ALEX CUKAN, UPI Health Correspondent

ALBANY, N.Y., Aug. 1 (UPI) -- Choosing a doctor can involve a lot of research, but some extra effort can mean the difference between muddling through and finding a good match.

"See four or five different doctors -- don't just pick a doctor sight unseen," Dr. Vicki Rackner, a surgeon for 10 years and a patient advocate for the past five, told UPI's Caregiving.

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"Know what you want -- do you want a primary care physician who writes a lot of referrals? Or do you want a quarterback coordinating your care among several specialists?"

The doctor/patients relationship can be one of the most important in a person's life, but many pick a doctor as a bureaucratic decision -- they pick a name off a list.

The best care comes when you and your doctor work well together as a team; historically, the interactions between doctor and patient looked like those between a parent and a child, according to Rackner.

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"We're evolving into an adult-adult collaboration," she said. "See how the doctor treats a small problem and it'll be an indication on how they might treat a larger problem."

The federal government, state governments and many non-profit and for-profit groups provide lots of advice on how to choose a doctor or a specialist.

In addition, some Web sites provide educational and biographical information on physicians as well as board certifications, hospital affiliations and insurance plans the physician accepts.

Online information can be a timesaver, but some of the information may be out of date or have omissions.

The New York Patient Health Information and Quality Improvement Act of 2000 provides information such as the doctor's medical education, translation services at the doctor's office, hospital affiliations, information about legal actions taken against the doctor as well as health plans the doctor will accept.

I used this Web site to check on the backgrounds of my father's primary care physician and cardiologist, but neither was listed. Yet his former cardiologist, who has been retired for about nine years, is still listed. My doctor has had two legal settlements in the past 10 years. My father's urologist seems to have joined a record number of medical organizations.

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Internet research can help cut down the list of possible doctors to a short one, but it's also recommend that people seek the input of friends and family.

Rackner suggests "dating" the short list.

"Make an appointment for a small problem -- just like a blind date for tea or coffee. For example, say 'I'm worried about this mole,'" Rackner advised. "The visit should be limited in scope and a limited emotional investment -- you're interviewing the doctor, but you don't have to tell the doctor it's an audition."

A doctor will show his or her true colors, even with something small, according to Rackner.

"You can tell a lot if a doctor says of the mole, 'It's nothing,' or 'Let's see, we have an irregular border, you've noticed some changes,' and you can see the doctor is taking the concern seriously and tries to teach at the same time," said Rackner. "See how the doctor treats a small problem and it'll be an indication on how they might treat a larger problem."

It's also important to know the affiliations of the doctor -- hospitals and nursing homes.

While a doctor's hospital affiliation information is readily available, what is often left out is what nursing homes the doctor is affiliated with -- or if he or she if affiliated with any nursing homes.

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"It varies from place to place -- there is a difference in rural and urban nursing homes. There are large nursing homes that have closed staff -- doctors who may be employed by the nursing home or be contracted," Dr. J. Marvin McBride, senior vice president and chief medical officer of INSPIRIS, a healthcare management company focused on improving the quality of life for the frail elderly in nursing homes, told Caregiving.

"Many nursing homes are more an open staff model -- any physician can attend to their patients as long as they meet minimum requirements."

Some practices focus on patients in nursing homes, and some practices don't treat the patient once they have entered a nursing home, according to McBride.

"When I was in practice in Raleigh (N.C.), I had an office-based practice -- when patients were in the hospital I saw them there, and if they went to a nursing home I followed them there. But some nursing homes credential doctors and some don't."

Some doctors who continue treating patients in nursing homes may chose to limit their treatment to three nursing homes as a matter of logistics; otherwise, a doctor could spend a lot of time traveling to 17 nursing homes, according to McBride.

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"However, doctors that do treat their patients in nursing homes may not see them very often -- there are minimum standards such as 30 days for the first several months and every 60 days afterwards, but more often if necessary," said McBride.

"Ask the doctor if he or she continues to treat nursing home patients and which nursing home affiliations he or she has."

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Next: Choosing a hospital

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Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column. E-mail: [email protected]

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