By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center
Many people don't think much about doctors until they need one. Take it from a physician, if you don't have a doctor, a crisis is not the best time to pick one. Although an emergency room or urgent care center may help you with your immediate need, having your own doctor will allow you to manage your health and the health of your family for the long term.
Each fall, employers conduct their annual benefits enrollment. As a participating employee, you may be asked by your health insurance plan to select a primary care physician (PCP). How selective are you?
In deciding on a doctor, you should consider your needs and preferences --not just pick a name out of a catalog. Your age, gender, marital status, family members and any current medical problems will (should?) influence your decision. Almost everyone should have a primary care physician (PCP) -- a medical professional who will be responsible for your health on a continuing basis with emphasis on prevention of future health problems. The PCP, usually a family physician, internist or pediatrician, should also coordinate the care provided by other specialists.
Do you like the idea of the entire family seeing the same doctor? Not everyone does. If you do, consider a family physician. If you prefer a doctor specifically trained in one area, you should choose a pediatrician for your children, an internist for the adults and an obstetrician-gynecologist for women's health care.
Pediatricians provide both preventive care and treatment for children into adolescence. General internists provide care for all adults, usually from about age 18. Family physicians care for people of all ages, including children and older adults. Sounds pretty straightforward, but the differences among these types of physicians are more than the ages of their patients.
Pediatricians spend time training for the more complicated problems of childhood, including hospital care such as intensive care, problems of prematurity, cancers, heart disease and so on. In practice, pediatricians do not commonly do office surgery and many do not provide gynecology treatment. Internists, or doctors of internal medicine, emphasize prevention and treatment of diseases of bodily systems and often focus on hospital treatment. Internists do not manage gynecology or do office surgery, but their training includes both common and unusual medical problems.
Family physicians are trained in the broad range of medicine and learn to care for infants, older children and adults of all ages including office surgery, gynecology and obstetrics and hospital care. Because of the wide scope of family practice, some family physicians focus more closely on certain areas and refer patients for things they do not handle often, such as obstetrics. Similarly, internists and pediatricians may refer people for medical conditions that require a more focused approach to treatment.
Many primary care practices include nurse practitioners (NP) and physicians assistants (PA), often referred to as "mid-level" practitioners. NP's are registered nurses who earn a master's degree by training for two years after college in a specialized field of medical care. They work with a physician in a variety of ways -- treating common problems, evaluating chronic health conditions, educating patients, helping with hospital rounds and so on. PA's have a four year college degree and train specifically to work with a physician in the day-to-day management of routine problems, both in and out of the hospital. These practitioners are not substitutes for doctors but are considered "physician extenders" because by working with a physician, they allow physicians to focus on people with complex or time-consuming problems.
Once you have decided what type of doctor you want, you should consider the style of practice you prefer. Recommendations from friends and relatives are often helpful. Of course, you may have to choose from a panel of practitioners that participates with your insurance. However deep the field of choices, it's worth taking the time to do a little research.
Many physicians and group practices have Web sites you can surf for information and most will have a brochure about the practice and with profiles of their physicians. No longer is the typical physician a man; more than a third of primary care physicians under 45 are women and most U.S. physicians are less than 50 years of age. Some older physicians may have a large panel of patients already and may not take new patients because adding new patients means less time available for existing patients. You should always check with the physicians practice before listing a doctor as your PCP.
Physicians, like everyone else, have different personalities. Your health depends as much on your relationship with your doctor as it does on the physician's expertise. You must trust your doctor so it should be someone with whom you can relate.
Once you have decided the type of physician and practice, consider asking to meet with one or two doctors who can accept new patients. Find out the doctor's training and if the doctor is certified in his or her specialty. Certification means the doctor has passed a test of his or her knowledge. Some specialties require recertification regularly to assure that the doctors keep up with advances in medicine. Ask about the doctor's approach to patient care, how information is communicated, whether electronic communication is available, how the practice is covered after hours, whether the doctor can meet the needs you have for yourself and your family. Do you feel comfortable with this person? With the office and office policies? If not, keep looking.
Once you have established yourself in a practice, ask to sign a records release for the old records of your prior physicians so your new doctor will have a complete file on you. See if you are due for any regular check ups, screening exams or immunizations. If you are already on medications, schedule an office visit well before they are due for renewal and bring along all your medications. Prior to the visit, write down any questions you want to discuss when you get there. If you have many questions or more than a couple things to discuss with the doctor, tell the person scheduling you that you need a longer appointment. Many doctors can arrange to book your appointment for a longer time if you need the doctor to thoroughly evaluate your concerns.
Your health is your responsibility, not just your doctor's, so you should know the details of your health problems, the names and doses of all your medications and why they are prescribed. That "little red pill for my heart" could be almost anything. With so many medications and possible adverse interactions among them, you and your doctor must discuss medications by the exact name and strength.
In order to get the best results from your care, you must understand and agree with the recommended course. Before you leave the office, be certain you understand what you were told. If you disagree, tell your doctor. If you do, you may be able to get more information or perhaps a second opinion.
Your doctor has the expertise but it's your body and well-being. Together, you and your doctor are a team with a common goal -- your good health.
For links to Penn State Hershey Medical Center's Primary Care Physicians, visit http://www.hmc.psu.edu/upg/index.htm