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Are You and Your Doctor a Good Fit?

As I write this blog entry my phone is all abuzz with notifications related to a tweet I made about “doctor shopping” – any idea what this is? It’s when people don’t like what one doctor tells them so they continue to see other doctors until they get what they want- a lab test or x-ray or specific medicine. In this particular example the topic was shopping at different medical providers for antibiotics during a viral illness (antibiotics won’t help because they only work against bacteria). I’ve written about antibiotic stewardship before, but the overarching concept of seeing many different doctors inappropriately has resonated with enough people that I want to share a few thoughts about finding the right clinician “fit” so that you DON’T have to shop around in various venues until you get what you (think you) want.

I know I don’t have to prove to you that finding a health clinician that you like and trust is a major factor in your and your child’s wellness. I’m going to run with the fact that you believe this as fervently as I do. From disease prevention to child development to guidance during acute illness and injury, having a health professional who is your ally and advocate can make all the difference between experiencing a health disaster and a health success. So what are the elements of finding such a person? I’m going to stick to the clinical/medical aspects in this post and will consider the insurance/billing/financial components in another post if you guys think that would be of benefit. Just lemme know.

dr christina johns twitter post

Here are some ideas to consider when picking a healthcare provider:

First, and I think this is important, are you comfortable going to a big practice with lots of clinicians or do you want a small, maybe even solo practice? There are advantages and disadvantages to both. A larger practice usually offers more hours, weekend and evening options, more location choices since there are frequently more than one office, and more opportunity to change providers as the need arises (for example-male to female or vice versa, as kids grow and may feel more comfortable with a male or female). That being said, some people feel like a large practice can be difficult to find a personal connection with one clinician since many times the practice is so big that you see a different provider at every visit.

Small practices do provide a very intimate, personal feel. You have one or two clinicians who know every patient in the practice, so with each visit you don’t have to re-invent the wheel and tell your life story all over again. However, one or two people can’t cover 24 hours a day/7 days a week and so after-hours communication may be limited. Sometimes small practices band together for on-call coverage and a physician not even in your practice who you don’t know may be the person you reach.

Second, what’s the provider mix of the practice? Is it staffed by all physicians, or are there physician extenders such as PAs (physician assistants) or NPs (nurse practitioners) who see patients alongside the physicians? As with any profession and just as there are great doctors and not so great doctors, the same applies for NPs and PAs. In many areas these clinicians are able to see patients independently and so it’s important to understand that you may not see a physician as your healthcare provider. Personally, I’ve been a patient in all of these scenarios and have had good and so-so experiences in each, so I have no judgment to pass on this particular issue one way or another. I just want everyone to have as much information as possible when they make the important decision about the person(s) to whom they are entrusting their healthcare.

Third, what kinds of additional skills and services are offered at the practice? And do any of the clinicians have specialty training in an area that pertains to you? Some practices have doctors with specialty training beyond primary care that may be helpful. For example, is there an allergist in the practice that could care for a child with significant food allergies? Finding a connection like this could streamline your healthcare significantly. If you are looking for healthcare for your child, are there doctors with pediatric training or will your child be getting care from a family medicine physician? Not all practices have staff with different training backgrounds, but it’s worth it to ask. Is there an urgent care/walk-in component? And what types of urgent situations do they handle- stitches? Respiratory treatments?

Not all practices are created equal in terms of lab support, either. Some practices will do basic, routine bloodwork on the premises while others send every test to an outside lab.

Fourth, what hospital does the practice usually refer to? If inpatient care were to be needed, would you be getting it at a hospital that is nearby, that you trust, and that is in your insurance network? For children, it’s crucial to make sure that there are pediatric services at the selected hospital, and if not, determine where is the nearest referral center to which your child would be transferred.

Fifth, go with your gut about the overall experience and be persistent about finding the right fit. Do you feel like you connect with your doctor? Did you have enough time to address your questions? Did your clinician listen to you? Was the front desk staff helpful and knowledgeable? Did you leave with a clear understanding of what’s next for your health?

The ultimate goal is to find a clinician who will be your partner in health advocacy, someone that you trust to guide you and/or your child on your medical journey, so that you don’t have to be that person with a common virus who goes around to many clinicians (who don’t know your history) and ultimately wind up with medicine that might not help you at all.

Good luck in your quest, and cheers to you if you and your healthcare provider are already well matched!