by:  Nancy Wartik

Reprinted from Loose Connections Vol IIX Number 2 1993

People often spend less time choosing a physician than they do deciding where to take their next vacation. If you're doctor shopping, do your homework, particularly if you're in the market for a general practitioner or a family physician. (If you've joined a health maintenance organization (HMO), of course, the decision will be largely out of your hands.) The family doctor you choose not only will be your primary physician, but also will serve as your medical mediator, helping you determine when you need specialty help, what kind of specialist you need and whom you should see.

Approach the situation as if you were an employer. Line up candidates through word of mouth, referrals from your state or local medical society, even the yellow pages, and then get as much information as you can about each doctor by calling the doctor's office. Is he board-certified (meaning he has passed an exam in a given specialty)? With which hospital is the doctor affiliated, and would you be comfortable going there? How much time does the doctor allot for each patient? Who covers the practice on weekends or during vacations? Does the doctor have telephone hours? What are the fees for first-time and follow-up visits and, if it's important to you, will the office accept "assignment", or whatever your insurance company pays?

Schedule interviews with the top contenders. You may be charged for the visit, but it's worth the fee. If you have specific medical beliefs - if nutrition is important to you, say, or if you try to limit reliance to medication - determine whether the physician will be sympathetic. Pay attention to whether the doctor treats you courteously, answers your questions clearly and makes you feel at ease.

Once you've found Dr. Right, your real work as a patient begins. "In general, people don't take their doctor visit seriously enough," says Dr. Sheldon Greenfield, a senior scientist at the Health Institute of the New England Medical Center in Boston. "They have only 20 minutes, but they don't prepare the questions they want to ask or think about what they want to get from the visit. Before they go in, they sit in the waiting room with a vague sense of anxiety, reading outdated magazines. You'd never treat a job interview like that."

Internist David Stutz, the author of The Savvy Patient (Consumer Reports Books, 1990, $14.95) agrees. "If you don't have an agenda before seeing the doctor, the doctor will set one," he says. "I see it happen all the time. A patient will come in with a headache, worried that he has Alzheimer's because his mother did. But the question isn't addressed, because the patient never asks it. So he just gets a prescription and goes away very unhappy. You have to be honest with yourself about what your real questions are."

When discussing symptoms, present them in descending order of concern. Dr. Stutz cites a Michigan State University study that found more than a third of the physicians involved began to develop a diagnosis after talking to a patient for only 30 seconds. Have ready the information your physician may need. Know the medications you are on, and think about aspects of your medical history that might relate to your ailment. If all this sounds like a lot to remember, bring a list along. And during the visit, take notes if needed.

Communication is a two-way street. If your doctor is talking jargon you don't understand, say so. "It's helpful for patients to think they're entitled to be given certain information." says Greenfield. "They have to make themselves heard. If they do, most doctors will respond in ways that surprise even themselves."

You may want to take a spouse, friend or relative into the examining room with you. Dr. George Wootan, a family practitioner in Hurley, New York and the author of Take Charge of Your Child's Health (Crown, 1992, $18), points to studies showing that accompanied patients get better treatment. Wootan also notes that a spouse or friend can remind you of questions to ask and later help you recall details of what the doctor said.

Tow-thirds of patients feel doctors don't give them enough information about the medications they prescribe, according to a Food and Drug Administration study. Be sure you know about a drug's side effects, how long it takes to work, how long to take it and whether it interacts with other medications you may be using. When X-rays or lab tests are ordered, ask what the studies will reveal, whether the results will change your treatment and how such a change could help you. Medical testing in this country is a business worth more than $30 billion a year and many experts believe such tests are regularly overused - often to protect the doctor from lawsuits or recoup in an investment in equipment. You're never obliged to undergo a procedure the doctor cannot justify to you.

After you've gotten a medical diagnosis, you may face some difficult choices. But don't panic and rush into treatment. "Unless your situation is very unstable and irreparable harm would result from delay, don't give up the right to explore your options," says Stutz. For example, if your doctor recommends a hysterectomy for uterine fibroids, it's useful to know that an estimated 25% or more of hysterectomies are unnecessary. Hormone medications that shrink tumors or a myomectomy (which removes the tumors but leaves the uterus intact) may be appropriate alternatives.

So quiz your doctor thoroughly about your choices and the risks and benefits of each, given your age and condition. Find out what will happen if you simply continue to monitor your complaint and treat the symptoms. Do research on your own, and don't hesitate to get a second opinion. "I tell my patients that if you ask your doctor whether a second opinion is needed and get an emphatic 'No!', then you need one. No one's judgment is perfect," says Dr William Follansbee, director of cardiovascular services at the University of Pittsburgh Heart Institute.

The doctor who made the first diagnosis may not be your best source for a second-opinion referral: He may recommend a colleague who is likely to support the original diagnosis. Locate a specialist yourself, or at least get your doctor to give you more than one person to call. Ask friends for recommendations, or call the best teaching hospital in your area. They "physicians" section of your yellow pages will have a partial listing of board-certified specialists in your area, under the heading "American Board of Medical Specialties." You might want to get a second opinion from a specialist whose orientation is different from the first doctor. An orthopedic surgeon and a sports medicine specialist, for instances, may have very different ideas about how to treat lower-back pain.

In the end, you and your doctor may have a different view of the advantages and disadvantages of a given treatment. If one cancer cure is disfiguring but has high survival odds, while another is less disfiguring but has poorer odds, you may disagree on which treatment is preferable. But you're the one who will live with - or die from - the results. So speak up.

"Being honest with your doctor and asking 'Couldn't we pick another strategy?' can be very difficult," says Dr. Sherrie Kaplan, a senior scientist at the Health Institute of the New England Medical Center. "We're not used to saying 'I don't want my hair to fall out or to have terrible diarrhea.' But patients need to express their values and preferences clearly, to negotiate for treatment consistent with their lifestyles. The best doctors aren't rigid. They'll listen to reason."

And what if, despite your best efforts, your doctor still tells you "Leave the practice of medicine to me"? Then, says Greenfield, "You may need to vote with your feet - and go elsewhere. If patients ask reasonable questions, if they're not hostile and obnoxious and they still don't get answers, it's a clue that they're in the wrong place. Don't let yourself be intimidated. Find a doctor interested in treating you with respect."

Nancy Wartik is a Contributing Editor at American Health