August 28, 2016

Selecting a New Doctor? Here's How I Decide.

This year, I've changed my two most important doctors: my primary care provider and my neurologist. 

Here, in no particular order, are some of the factors I kept in mind while making those decisions.

Office Location
In light of my age (87) and my Parkinson's disease, the closer the office is to my house, the better. I'm fortunate to live in the Palisades section of Washington ("country living in the city" is how we describe it), where many doctors practice from several small office buildings (and most of these docs know one another – another advantage). Whether I use Joey (my part-time driver) or Uber, it’s a snap getting to these offices within 10 minutes.

My dentist and my dermatologist have offices just over the DC line in Chevy Chase, MD, and getting there is almost as easy. When I have to make trips to doctors’ offices in downtown DC -- along the K St. corridor or around Washington Circle -- it's more of a hassle.

Hospital Access
When I have to go to a hospital for tests or other reasons, I prefer Sibley Hospital. It’s the closest to me, and the only Washington DC hospital that earned three stars in Medicare's recent rating of hospitals. The neighborhood doctors I’ve chosen are more likely to use Sibley. I liked this facility best when it was a small, independent hospital, before it became larger, more crowded, and more bureaucratic as part of the Johns Hopkins network.

Doctors Affiliated with Hospitals
Several of the doctors I've used recently are affiliated with either Georgetown University Hospital or George Washington University Hospital. I've come away with the feeling that these doctors tend to be clock-watchers, eager to keep our visits as short as possible. I've talked with other people who’ve developed similar impressions of hospital-affiliated doctors.

Office Ambience
OK, call me an elitist snob, but I prefer walking into a doctor's office with a nice comfortable reception room and a receptionist who greets me with "Hello, Mr. Schappi." It doesn’t happen very often, which is probably why it makes such a positive impression on me when it does.

At the other end of the spectrum is the waiting room in the geriatrics department for doctors affiliated with George Washington University Hospital. There, I stand in line to check in, and then sit in a large drab waiting room with other patients, waiting to be summoned.

Use of Computers
I was talking with a friend recently about how our doctors use computers to take notes during our office visits. We both thought that this practice impeded easy, comfortable conversation. Thinking about it now, the docs with whom I’m most comfortable don’t use computers while we’re talking.

My blood pressure doctor is an exception. I completely enjoy our conversations, even though he uses a computer. Here’s why: He doesn’t sit at a desk and place me off to the side while he types away. Instead, he sits directly across from me and manages to maintain eye contact while he takes his electronic notes. This doctor explained his note-taking to me in a recent email:
I bring the computer into the room with the patient because if I don't, I often don't remember everything that was said. Because I have kids, I don't write my notes until the night time, after they have gone to sleep. By 9 pm my brain is exploding with all the things that happened that day. The computer helps me jot notes down during the visit and I never have to worry that I will lose track of my papers with handwritten notes. So, by using the computer - touch typing while you're speaking, trying to keep eye contact! - I can write notes that are far more useful to myself and others. 

My new neurologist told me she was the only doctor in her office who didn't use a computer to take notes while talking with patients. She felt that worrying about getting things right on the computer inhibited her conversations with patients. But as soon as they leave her office, she enters notes on her computer.

Use of Email 
With each passing year, it's more of a struggle for me to get dressed in something more presentable than my usual sweatpants and t-shirt, then arrange transportation, and go out for a doctor's appointment. I often think, "Wouldn't it be nice if I could just stay home and take care of this issue with an exchange of emails with my doctor?"

I predict that five years from now online communications will be the norm, not office visits. Today, however, doctors have a wide variety of email policies. Most of my doctors’ offices allow patients to use email for making appointments and other routine tasks.

Several doctors have been open to limited email discussions with me. Understandably, doctors don’t want to open the floodgates to unlimited email dialogues with all their patients.

I've wondered what policies Medicare has for reimbursing doctors who deal with patients by email. I understand Medicare will introduce new policies next year to encourage more treatment experimentation, which might lead to more electronic contacts between doctors and patients.

The current over-reliance on office visits may end up disappearing the same way house calls did a few decades ago.

Bottom Line
For me, one factor outweighs all of the others I’ve just discussed. I want a doctor who believes in collaborating with the patient to develop treatment strategies.

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