Choose A Doctor As If Your Life Depended On It

A massive shift to managed health care that the experts say is gathering momentum makes wise choice of a primary physician more important than ever.

Under managed care, the doctor - typically a general practitioner or family-doctor type - who is picked by a person as his or her primary physician becomes that person’s gatekeeper.

It is this gatekeeper who decides how much and what kind of health services the person gets within guidelines established by a board of directors whom the patient doesn’t know and never meets.

So, the big question is, who is your No. 1 doc? And even more to the point, how do you go about picking a good one?

Well, to begin with, refuse to take off your clothes until you’ve met the doctor, advises Mary Mitaguy Miller, who has had seven operations, spent months in hospitals, practiced 10 years as a physician assistant in family medicine, and knows tons of doctors.

Standing there naked in front of a complete stranger is hardly the ideal way to start a new give-and-take relationship, counsels Miller, who works for Group Health Northwest.

And increasingly, that is what modern health care is about. Give and take.

“In the past, the doctor typically took the lead and the patient followed,” says a new booklet on Talking With Your Doctor that is put out by the National Institutes of Health. “But today, a good patient-doctor relationship is more of a partnership.”

The booklet goes on for more than 30 pages about how to pick and talk to a doctor. (To order this free publication, phone 1-800-222-2225.)

“Choosing a primary-care provider,” writes Newsweek magazine’s Susan Brink, “has a lot to do with personal chemistry. But it also has to do with a meeting of the minds on such issues as treating a condition with medication vs. a lifestyle modification.”

Physician assistant Miller laments, “The average American spends more time finding a good auto mechanic than choosing a doctor. Yet this is the single most important health care decision you make.

“When you get sick, having a doctor you can trust and talk to means more than all the CAT scans in the world.”

Miller is editor of Northwest Health magazine, a publication of Group Health Northwest, an expanding regional managed care plan.

Also underscoring the growing importance of choosing the right primary physician is a new poll by the Harvard School of Public Health and Louis Harris & Associates. They surveyed thousands of sick people in managed-care programs with gatekeepers and others in traditional insurance programs who could go to any doctor they wished.

Those in managed care complained more than twice as much - 12 percent vs. 5 percent - that their doctor provided inadequate care. Four times as many managed care patients - 12 percent vs. 3 percent - complained that a specialist’s exam was inadequate.

U.S. News & World Report says more than 40 percent of Americans are presently enrolled in managed care networks, and the numbers are mushrooming.

An abundance of help on how to choose a doctor exists.

For example, Newsweek advises: Make a list of desired attributes, identify several candidates, ask friends and relatives and health professionals, consult reference sources. And “try on more than one” doctor if necessary.

Group Health’s Miller strongly seconds that.

For what it’s worth, she confesses that even among health care professionals the most common way of scouting out a doctor is “word of mouth.”

Miller advocates asking a person’s insurer for any ways they may have to help make choosing easier. For example, Group Health Northwest has patient service coordinators who work with the doctors and can provide written profiles and credentials.

I found Miller refreshingly direct, articulate and helpful.

“Stand up for your rights!” urges an article she penned for her own publication. “You’re in charge.”

In shopping for a doctor, ask tough questions on vital issues, she counsels. As to gatekeeping, for example, ask, “If I want to see a specialist, how will you handle that?” And insist on acceptable answers.

Over time, says Miller, “it is possible to develop a good working relationship - maybe even a friendship - with your medical practitioner.”

, DataTimes MEMO: Associate Editor Frank Bartel’s column appears on Monday, Wednesday and Sunday.