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By TARA PARKER-POPE in Wall Street Journal - February 3, 2004
Copyright Wall Street Journal
You don't have to be a doctor to be treated like one.
It's an open secret in medicine that doctors receive better medical care than the average patient. Part of the reason is professional courtesy -- doctors give other doctors the red-carpet treatment. But doctors also get better care because they know how to get it. They take time to find the best doctors, they ask the right questions and they know the secrets of the health-care system.
Even patients who are limited in their choices by a managed-health plan can still shop around for the best care if they follow some basic advice from doctors themselves:
Look at the frames on the wall. When doctors walk into an exam room, one of the first things they do is look for a framed diploma to see where the doctor went to medical school. They look for the state license and a certification by one of the 24 boards in one of the three dozen specialties recognized by the American Board of Medical Specialties (www.abms.org). They ask doctors where they trained for their specialty -- a doctor who has trained with another top doctor will eagerly brag about it.
Choose a hospital as well as a doctor. Ask your doctor where he or she has hospital privileges. Most doctors look for a doctor who has privileges at a medical-school teaching hospital. It simply requires more time, expertise and professional recommendations to win privileges at a teaching hospital.
"They've been through a filter of questions that often most patients can't ask," says Kenneth H. Falchuk, associate professor at Harvard Medical School and co-chairman of BestDoctors.com, an Internet doctor referral and information service.
Pamela F. Gallin, director of pediatric ophthalmology at Children's Hospital of New York Presbyterian, thinks patients should pick the hospital first, then select a doctor who works there. Dr. Gallin notes that patients often are treated by a team of "invisible" doctors, such as a radiologist or anesthesiologist, so choosing the best hospital gives added assurance about all patient care. And most of us live within three hours of a major teaching hospital or an affiliate.
Ask your doctor how many times they've performed a procedure. Whether it's for a colonoscopy or orthopedic surgery, doctors ask their own doctors how many procedures they perform. "If I'm going in, I want a team of people used to doing this procedure over and over again," says longtime emergency-room physician Kevin J. Soden in Charlotte, N.C.
Pay attention to small details. Does the doctor touch you, performing an exam every time you visit? Does the doctor talk to you during the exam, explaining what they hear or see or what your blood-pressure reading is? Does the doctor listen or interrupt your answers? New York cardiologist Eric S. Levine suggests checking out your doctor's stethoscope. Ask where it came from and how it compares with other models. It's a small detail that can give you insight into your doctor's priorities. The top-of-the-line models cost about $200, and Dr. Levine says he would be wary if the stethoscope has pink tubing or the name of a drug brand -- which suggests it was a freebie from a pharmaceutical representative.
Ask to see your medical records. Doctors know that medical records belong to the patient, and doctors always look at their own records and ask for copies of a doctor's notes and all correspondence between their primary-care doctor and specialists.
Come prepared. Physicians always come to the doctor with an agenda -- specific concerns and questions. Patients should always show up with key questions jotted on a note card, and, in the case of more serious health problems, bring a friend or family member to help remember everything. "The reason I say write it down is that the medical encounter is enormously stressful and people become distracted," says Edward T. Creagan, oncologist at the Mayo Clinic in Rochester, Minn.
Know when to schedule appointments. Early appointments are more likely to be on time, and everyone is simply fresher and more alert at the start of the workday. Doctors also know never to schedule elective surgery in July or August, when inexperienced medical students begin their residencies and hospitals are notoriously chaotic.
Make nice with the staff. Doctors know how overworked their own staff members are, and they also know the power the receptionist wields, controlling who gets appointments on short notice. Dr. Soden suggests getting to know the staff, coming prepared with the right forms and bringing coffee or treats when you visit. "It's amazing how you can get worked in if they like you," he says.
Check out the doctors who provide coverage for your doctor. Most doctors work with one or two other physicians who cover for them when they aren't available, but most patients forget to check them out. Ask the same questions about these doctors as you would your main doctor.
Ask a doctor where they would send their mother. It's a simple question that reflects exactly how doctors find their own doctors. Doctors are sometimes obligated to refer patients to someone in their own medical or insurance group. But when pressed, most doctors will tell you to whom they would entrust the care of their own family.
THE INSIDE TRACK
Some recent books from doctors offering insider tips about getting the best medical care.
• "How to Survive Your Doctor's Care," by Pamela F. Gallin, MD
• "Special Treatment: How to Get the Same High-Quality Health Care Your Doctor Gets," by Kevin J. Soden, MD, and Christine Dumas, DDS
• "What Your Doctor Won't (or Can't) Tell You," by Evan S. Levine, MD
• "Secrets of a Beverly Hills Cosmetic Surgeon," by Robert Kotler, MD
• "How Not to Be My Patient: A Physician's Secrets for Staying Healthy and Surviving Any Diagnosis," by Edward T. Creagan, MD
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