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10 Steps To Finding A Good Doctor And Having A Great Healthcare Experience

I’m excited to announce that US News and World Report has invited me and some other social-media savvy physicians to participate in a live Twitter chat about how to find a good doctor. The chat will be held on Thursday, March 20th at 2pm EST. You can join the conversation by following the #DoctorFinder hashtag or take the pre-chat poll here.

Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way to an excellent specialist – I hope it helps others you find the right doctor as well!

1. Determine what kind of doctor you need. You’d be surprised how many different specialists treat the same symptom – depending on its underlying cause. Take “back pain” for example – should you see a primary care physician, an orthopedist, a neurosurgeon, an anesthesiologist, a rheumatologist, or a rehab specialist to evaluate your symptoms? That depends on the cause of the pain, which might not yet be evident to you. The first step to finding a good physician is to figure out which type is best suited to your potential diagnosis. Bouncing from specialist to specialist can be costly, so if you’re not sure which kind of physician specializes in treating your disease or condition (or if you haven’t been diagnosed yet), start with a primary care physician first.

If you’d like to ask an online physician about your symptoms (or find out which specialist would be the most appropriate for you or your loved one), is my favorite online physician consultant service (note that I answer questions for them.)

2. Compile a list of all the doctors (of the specialty you need) in your area. This list can be generated by your insurance carrier or by an online search of doctor-finder databases such as,, or US News & World Report’s Doctor Finder directory.

3. Narrow online choices by your preferences (available via or databases.) Check out the doctors’:

  • Hospital affiliation(s)
  • Office location(s)
  • Educational background
  • Specialty interests
  • Languages spoken
  • Years in practice
  • Gender
  • Types of insurance accepted
  • Review CV if available (often on affiliated hospital website)
  • Check out patient reviews (take them with a grain of salt in case they are skewed by an unfairly disgruntled patient)
  • Make sure they’re accepting new patients
  • 4. Do an online “background check” of your top choices.

    5. Make an appointment – consider the following qualities in a good physician experience:

    • The team: courteousness of scheduling staff, professionalism of nurses, PA’s, techs, etc.
    • Facilities – cleanliness, comfort
    • Medical records/communication – how will they provide you your data? EMR? Email?
    • Timeliness/convenience

    6. Come prepared

    • Bring your list of medications
    • Bring a list of your medical and surgical history/conditions
    • Bring a list of your allergies
    • Bring contact information for your other physicians/providers
    • Bring your insurance information

    7. Ask the right questions

    • How many procedures (like the one I’ll need) have you performed previously?
    • What are the risks/benefits of the procedure? Alternatives?
    • What should I read to learn more about this?
    • If unsure of diagnosis: What else could this be?
    • Are there other medicines that are less expensive that we could substitute?

    8. Go with your gut

    • Did the doctor explain everything clearly?
    • Did the doctor seem to care about you?
    • Do you trust your doctor to be thorough with follow up?
    • Do you like your doctor?

    9. Get a second opinion

    • If the doctor did not meet your expectations in any significant way, find another one
    • If you want to be sure that you’re on the best path, get a second opinion from one of his/her peers or do it online: eDocAmerica (for generalist questions), Best Doctors (to be matched with top national specialists)

    10. Reward good doctors with good online recommendations so others can benefit. Physician ratings are only as reliable as the reviewers. Help other patients locate good doctors by promoting those who deserve it.

    The Magic Question That Every Patient Should Ask Their Doctor

    I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong diagnosis… There is one “magic” question that you should be asking your physician(s):

    “What else could this be?”

    This very simple question about your condition/complaint can be extremely enlightening. Physicians are trained to develop extensive “differential diagnoses” (a list of all possible explanations for a set of signs and symptoms) but rarely have time to think past possibilities 1 through 3. That’s one of the reasons why so many patients have the wrong diagnosis – which is both costly in terms of medical bills, time, and pain and suffering.

    There is a risk in asking this question – you don’t want to be over-tested for conditions that you are unlikely to have, of course. But I maintain that the cost/risk of living with the wrong diagnosis far exceeds the risk of additional testing to confirm the correct diagnosis. So my advice to patients is to keep this very important question in mind when you see your doctor for a new concern.

    In addition to asking this question of your doctor, you can also ask it during a second opinion meeting with another physician. The good news is that these days you don’t even need to get a second opinion in person. I myself have been working with an online second-opinion service called eDocAmerica for several years. Those who sign up for the service can pick the brains of board-certified U.S. physicians on any subject, 24-7 via email (and in some states via phone). The cost is extraordinarily reasonable when provided by employers, and winds up being about one or two dollars per member per month.

    If you have a complicated disease or condition (such as cancer) where experts may not all agree on the best treatment plan, a company called Best Doctors offers detailed chart reviews and second opinions from top specialists at academic centers. Again, this service is quite affordable and reasonable if the cost is spread among a group. Employers are able to pay a small fee per employee per month to enroll the entire company in the service.

    So why don’t all employers offer these benefits? I suspect that part of the reason is lack of awareness that second opinion services exist, and the other part is tepid demand on the part of employees. So if you’d like to make sure that you’re not one of the five people who have the wrong diagnosis, why not raise the question with your HR department? Enrolling as an individual is also an option, and still as inexpensive as about thirty dollars a month.

    My bottom line: make sure you ask your doctor the magic question at least once for every new concern that you have. And if you’re too shy to do it, or your doctor’s answer seems too short, then get a second opinion online or in person.

    This one little question could save your life.

    About Patient Autonomy

    Recently, I was involved in a discussion on an email list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term “patient” engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like “client” or something similar.

    Having participated in the preparation and dissemination of the white paper on e-patients, I don’t see the need for “factions” or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated: “This is a big tent, with room for all.”

    I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor-patient relationship that I have with them. They make the choice to enter into, or to activate or deactivate, the relationship with me. They may ignore my input, seek a second opinion, or fire me and seek the care of another physician at any time. They truly are in control in that sense. The only thing I have control over and am responsible for is trying to provide the best advice or consultation I can. Read more »

    *This blog post was originally published at eDocAmerica*

    Reflections On The State Of Online Healthcare

    As 2009 draws to a close, the US health care system is ailing and quasi-reform proposals are frantically being debated and voted on. Although some type of reform is likely in 2010, we will have only scratched the surface of what still needs to be changed.

    One particular aspect relates to the ease with which patients can use the internet to improve their health care. At eDocAmerica, we’ve been using the internet to improve the health of our users for over a decade. Ten years ago, I predicted that patients would routinely use internet messaging to interact with the health care industry by now, but I was wrong. Although, increasingly, web 2.0 approaches are providing innovative communication and health management tools for patients, the growth of interaction between patients and doctors has been much slower than I predicted it would be. And the future still remains cloudy. The issues are nothing new and include: Read more »

    *This blog post was originally published at eDocAmerica*

    Medical Discovery Made By Dying Cancer Patient

    By Charles Smith, MD

    This post is adapted from one I wrote last week on Blog.

    Matthew Herper’s post about thalidomide treatment of Myeloma is a good example of how patients will contribute to medical knowledge in the future, and may form a cautionary tale for patients who get involved to this degree in formulating new treatment approaches.

    Read more »

    *This blog post was originally published at eDocAmerica*

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