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Wednesday, July 16, 2008 9:00 AM

Navigating the Health Care System: How to Choose a Doctor

Debra: Navigating the Health Care System isn’t just about dealing with hospitals and health care plans, it’s also about building the relationship between patients and their clinicians. It’s important to select someone who will meet your needs, can communicate well with you, and provide quality care. But how do you choose the right doctor for you? AHRQ Director Dr. Carolyn Clancy has some tips. Dr. Clancy, welcome.

Dr. Clancy: Thank you.

Debra: We know quality health care is important, but how are consumers supposed to know if the clinician they want to choose is a quality provider?

Dr. Clancy: That’s a very good question. It’s important to choose a doctor carefully, because quality does vary. But there are many ways to check on the quality of care that clinicians provide. For example, you can find out if a consumer group or other organization has rated doctors in the area where you live. Some of this information can be helpful, however, keep in mind that it’s not always entirely reliable. There are also other resources for finding out information on doctors: you can find a listing in a publication on our Web site at www.ahrq.gov/consumer. Also, you always want to check and make sure the doctor you select is board-certified. "Certified" means that a doctor has completed a training program in a specialty and has passed an exam to assess her knowledge, skills, and experience. The American Board of Medical Specialties has a toll-free number you can call to find out if a doctor is board certified.

Debra: But what about if your health plan only lets you choose from a specific list of clinicians or group practices?

Dr. Clancy: If you are in a managed care plan, you do need to check the plan’s list of doctors first. But there are ways to decide which clinician or group is best for you. Some people really like to ask friends, family, neighbors, and even co-workers if they can suggest someone. I would also suggest calling the office and see if you can speak directly to the clinician. Some are happy to do this and don’t charge for a brief phone conversation. The next step, of course, is to schedule a visit with your top choice. During that first visit you will learn a lot about just how easy it is to talk with the doctor.

Debra: What about other factors I should consider?

Dr. Clancy: Well, it’s good to know at which hospitals a doctor has privileges meaning where he or she is permitted to practice. If you have a preference of hospitals this could be a deciding factor in which doctor you choose. If you have any medical conditions, you may want to consider if the doctor has experience in treating that condition. Research shows that doctors who have a lot of experience with a condition tend to have better treatment success. In addition, you may want to consider some logistical issues, such as how long it usually takes to get a routine or a specialty appointment. This is extremely important to many patients. In fact, the Pacific Business Group on Health asked patients of California doctors’ groups how they rated their care. The results found that more than 80 percent of the patients said they were satisfied with their care, but less than two-thirds were happy with the ease of getting that care.

Debra: So what if I really want to select a clinician who is not in my health plan?

Dr. Clancy: You need to check with your health plan, ahead of time is better, on its policies regarding the use of non-plan physicians. In some cases, you may need to pay extra for seeing someone who’s not the plan’s list. Overall, you need to select a clinician who meets your medical needs. And it is really important to feel comfortable with the doctor you choose because that person will be your partner in taking care of your health.

Debra: Dr. Clancy, thanks for joining us.

Dr. Clancy: My pleasure.

Debra: For more tips on how to choose a doctor, see AHRQ’s guide on choosing quality health care available online at www.ahrq.gov/consumer.

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