The Art and Science of Picking a Doctor

Selecting a doctor may be one of life’s most important consumer choices, yet even the most savvy shopper can be reduced to a state of childlike bewilderment.

Let’s face it: It’s not as simple as picking out a pair of shoes.

The biggest impediment is the patient’s actual or perceived lack of knowledge about the product--medical care. How do you know your doctor knows best? How do you separate the quality professionals from the quacks?

Certainly, it helps to have some expert advice--a recommendation from your brother-in-law the brain surgeon or another trusted physician. Failing that, however, many doctors and consumer advocates recommend relying on a few key guidelines, common sense and, to a large extent, instinct.

Managed care and geography do some of the choosing for you. Most patients must pick from among doctors in their area who are on their plan’s approved list. Yet a long list of local strangers doesn’t make the task any less daunting.

One of the primary principles of doctor-picking--according to health care experts--is finding someone you can talk to comfortably. Health problems often are personal--even intimate--affairs. Patients need to feel free to ask questions; good doctors offer explanations that make sense.

Even in this era of stopwatch medicine, finding a doctor who cares is not shooting for the moon, experts say.

“I think you should pay attention to gut feeling,” said Dr. Brian Johnston, former president of the Los Angeles County Medical Assn. “See if the person seems to care, judge your own comfort zone. I don’t care how well-qualified a doctor is--if you don’t feel comfortable with him or her, it’s probably not the right physician for you.”

Feeling rushed is unpleasant, but time is not the sole measure of compassionate care. Studies have shown that satisfied patients tend to think they had more time with their doctors than they actually did, Johnston said.

One gauge of a doctor’s suitability may be his or her handling of sensitive procedures, says Candis Cohen, spokeswoman for the Medical Board of California. Does the doctor tell you what he or she is going to do before, say, a pelvic, prostate or breast exam? Do you feel safe asking about the procedures or conveying discomfort or pain? Does the doctor listen well?

“One of the problems we see here at the Medical Board are communication problems . . . questions not asked, procedures not explained. [As a doctor] you’ve got to communicate, tell patients what you are doing and why.”

Before making an appointment, however, it is wise for the patient to do some homework.

If you are starting from scratch, you don’t have to slog through the Yellow Pages. The American Medical Assn. has a Physician Select site on the Internet (https://www.ama-assn.org) that allows consumers to search for a doctor by specialty, location and name. Most doctors in the United States are listed. MedSeek also operates a physician directory (https://www.medseek.com).

In general, for your main physician, you should consider a family practitioner, general practitioner or internal medicine specialist. Women may select an obstetrician-gynecologist, and parents may want a pediatrician for their children.

If you have a doctor in mind, it is wise to check the physician’s licensure and background with the Medical Board of California. Check the board’s Web site, https://www.medbd.ca.gov, or call (916) 263-2382 to speak to a representative. Among other things, you can find out the medical school, year of graduation, past or pending disciplinary charges, malpractice judgments, serious hospital disciplinary actions and felony criminal convictions.

This is not a perfect screening mechanism. The board cannot disclose information about complaints against a physician unless it has filed formal charges. And it may take months to investigate complaints before charges are filed and made public.

On the other hand, a single malpractice judgment does not necessarily signal a problem practitioner. Look for patterns; ask your doctor about any concerns.

Some doctors insist that choosing a board-certified physician is the way to go. Some HMOs require board certification. It doesn’t mean a doctor has a charming bedside manner--but it does mean that the physician has been trained and supervised in a specialty and has proved his or her competence on an examination. Check for your doctor on the Web site of the American Board of Medical Specialties (https://www.certifieddoctor.org)--which doesn’t cover all specialty boards but includes two dozen.

But, remember, board certification is not medicine’s gold standard. As journalist Ellyn Spragins points out in the book, “Choosing and Using an HMO” (Bloomberg Press, 1997), not all boards are created equal; some offer rigorous oral and written examinations, while others offer short multiple-choice tests. Some require recertification every decade or so; others do not.

If a doctor isn’t board-certified, check whether he or she is “board eligible”--which means the physician has completed the specialty training but hasn’t yet passed the test, advises Dr. Janet Pregler, director of the Iris Cantor-UCLA Women’s Health Center in Westwood. Beyond that, she says, it is useful to ask the office staff what professional organizations the doctor belongs to.

The major groups “have national meetings, publish journals and offer guidelines.” she said. “Physicians who belong to them have this ability to keep up.”

It is also useful to consider if the doctor is affiliated with hospitals that have good continuing education programs, she said.

Once your homework is done, it may not be practical to call for a get-acquainted appointment. But many experts advise slipping in some basic questions between deep breaths as the cold stethoscope moves about your chest.

Here are some questions suggested by the California Medical Board:

* What are the doctor’s areas of specialty?

* Who covers patients when he or she is not available?

* Which other physicians or medical professionals will participate in your care?

* What special training does he or she have in managing the medical conditions you have?

* At which hospitals does the doctor have admitting privileges? And if the doctor doesn’t have admitting privileges, how are hospitalizations handled?

Pregler says patients should also consider personal preferences such as the practitioner’s age, sex and language skills, although she challenges patients not to adhere to rigid stereotypes. (Women won’t necessarily be the best communicators; nor will men necessarily be the most efficient.)

When it comes down to it, choosing a doctor may be a lot like practicing medicine--as much art as science. Many rely on intuition or rave reviews from good friends.

“If [patients] find out all this information about a doctor and they don’t trust the doctor, it’s useless information,” says Dr. Ed Hill, a family doctor in Tupelo, Miss., and member of the American Medical Assn.’s board of trustees.