What to look for and how to interview doctors: A followup on the self advocacy article

My last newsletter to you all included an article regarding self advocacy and it created quite a buzz around here. I had numerous requests about how to go about how finding a good doctor, how to interview a doctor, what to do when you feel you are not getting the best possible care, how to get a second opinion and more. I’ve been doing a lot of research and managed to create a list of possible things to consider as well as what to ask during the interview process and that will be the focus of this posting. I’ve also been very fortunate to interview Dr. Mark Levy of the South Austin Medical Clinic whose comments are incorporated into the post.

First of all, never feel like you have to settle…there are so many doctors in this town it’s unbelievable. Second, the staff makes a huge difference in the quality of care you receive so if you don’t like them, go somewhere else. I’ve left good doctors because the staff was either consistently rude or incompetent. Third, remember that doctors are regular people who have good and bad days and in the end, they  have only their education, experience and perspective to offer you. If you want someone who is going to have a wide view point, look for a practitioner who can offer you more than just Western Medicine.

Making the list of questions for an interview is very important and very personal. I can suggest a few things but you’ll need to think about your health and your personal preferences to come up with a truly authentic list. Doing this exercise may actually help you determine what it is you want from a doctor. Be aware too, that many doctors now charge for these visits but if you have insurance, the cost will typically be the amount of your co-payment.

Dr Levy: I would suggest that a good way to get a feel for a prospective doc is to schedule an initial visit about some real or specific issue, and in the course of discussing that issue you could ask about the practice philosophy, policies, etc. I think you might get a better sense of the person’s style observing them addressing a concrete issue, as opposed to having them talk about how they address a concrete issue. The two are not always the same.

Basic Things to Look for When Considering Doctors

Timeliness:  Ask him if he runs on time or if he consistently late. If you get the impression that the doctor will be on a strict time frame and that you will be hurried in and out…and you want something different that is something to look out for. I interviewed one doctor who told me up front that she would always be late and sometimes up to two hours. She suggested I bring some work or form of entertainment to do while I waited. She even told me that she is consistently late for her first appointment of the day.  Another doctor told me that I might get to an exam room within 20 to 50 minutes of my appointment but that I might wait an additional 20-50 minutes in the exam room. Whatever the doctor’s reason it’s a good idea to ask what you can expect if timeliness is an important concern for you.

Dr. Levy: Regarding timeliness: As I read your comments about the issue I felt the impulse to point out – as I will now! – that (timeliness) is almost always a function of the messy nature of primary care. You never know what people are coming to see you about. Sometimes it’s straightforward, sometimes not. Sometimes I am running on time within a minute and someone walks in with a laceration, bleeding, which truly needs immediate attention. The time spent with a particular patient almost never has anything to do with thinking “I have x amt of time to spend” – each day is dynamic, with lots of issues, lots of people, and lots of unpredictability. For the docs in my practice the answer to “do you run on time” would be “sometimes yes, sometimes no”. The best guarantee of timeliness might be a younger newer doc with a smaller practice.

Rapport: You will get a sense of the doctor’s ability to relate with you during the interview. Is your conversation easy or is it strained? Do you like the individual? Do you feel you are treated as an equal or subordinate? Does the doctor inspire confidence? Is he or she a good listener? Does he communicate in a style you are able to understand and appreciate?  If you want a doctor who will will take the time to explain all the  issues whatever they may be rather than just giving you a synopsis, be sure to tell him/her that.  Look for someone with whom you have rapport and also confidence rather than picking and sticking with someone whom you feel is “just doing the job or is on your insurance plan.” Its a good sign if you pick up that the doctor (and staff) is happy and enjoys his job.

Dr. Levy: So much of the relationship is about personal chemistry. At every practice I have been in, with every doc I have worked closely with – and this includes some of Austin’s grooviest over the years – there were people that love them and people that, well, don’t. It’s like life, we are all different. I believe for my part, I can tell in one interaction if it’s likely a good fit or not.

Insurance: Certainly,  if you can go to a great doctor who will also take your insurance go that route. Beware, however, that some doctors may be on your plan but will want you to pay up front and file yourself. Finding the right doctor who is also on your plan is sometimes a challenge. Interestingly, I have found that some insurance companies have staff nurses available who can recommend doctors that will meet your needs. I personally have managed to find some really terrific doctors who accept my insurance but I interviewed several of them before I chose to establish a relationship with one of them. I also see some doctors who are not on my insurance plan because I feel I can better reach my goals with them.

If insurance isn’t an issue, well, your a lucky duck!

Check out his/her credentials and experience: Where did he/she go to school and when. Is it important that the doctor is Board Certified or that he went through a fellowship program?  Is the particular school of importance to you? Do you want a new doctor or a seasoned one?

Location: Where is the doctor’s office located? Are there multiple locations in town? Is it easy for you to get there? Is parking available? Is it near public transportation?

Possible Interview Questions:

1. What is your availability? How long must I wait for an appointment? Can I be seen the same day if I have an urgent situation? If I experience any problems or have a serious concern, can I possibly speak with you or will it always be a staff member?

2. With which hospital(s) are you affiliated? Ask yourself if you are comfortable going to those locations?

3. What do you think/recommend when a patient asks about alternative and complementary care: herbal/vitamin remedies/acupuncture/chiropractic, etc?

Dr. Levy: I agree with your asking about non-traditional therapies. This is one area where one can give a pretty clear answer about philosophy. Me, I call myself a medical libertarian. I am open to just about everything but will acknowledge up front if it’s an area I don’t have expertise in and hence won’t give advice. Some (patients) like my candid approach, others don’t.

4. What are your feelings about referring patients to specialists? Do you often refer out or do you prefer to manage the care yourself? Are you comfortable giving second opinions? Are you comfortable with me seeking second opinions?

5. If I or my partner/friend don’t understand your explanation for a question we asked, or a procedure that you are explaining, will you help us better comprehend and answer our questions until we do fully understand?

6. If I call you with a question, Will it be you or a member of your staff that returns my call? How long will the wait time be? Do you have particular times of day that you return calls? If so, what are they?

7. Who will take over for you when you are away? Ask yourself if you are you comfortable working with those doctors?

8. Does the office process insurance claims or will I need to pay at the time of service and file myself?

9. Where are routine x-rays and laboratory studies performed? Can these be done in-office, or will you have to go to an outside laboratory?

One final note: It might be wise to find out whether a physician is in good standing with state licensing agencies through a Web site run by administrators of several state medical licensure boards. The Web site Administrators In Medicinecan provide information about disciplinary actions taken or criminal charges filed against physicians in many states.

I hope that helps. Next time we’ll talk about getting second opinions.

Dr. Mark Levy can be reached at the South Austin Medical Clinic

2555 Western Trails Blvd. Ste 101.

Austin, Texas 78745

512-892-6600.

Your Partner In Health,
Carol Bilich