WhiteCoat

Choosing a Doctor

selecting-physicianThe December 29th edition of American Medical News has an article about how patients choose physicians.

For primary care physicians, more than half of patients choose their doctor by word of mouth and another third choose their doctor based upon a referral from a health plan or from another health professional.

With specialists, a vast majority of patients choose them based upon a referral from the primary care doctor or another physician.

Almost 90% of the time a hospital is chosen based upon where a patient’s physician has privileges or based upon the recommendation of another physician. Friends and co-workers often ask me where they should go for treatment.

One of the interesting things about this survey – which was a national survey of more than 13,500 adults – was that very few patients chose physicians based upon internet sites and only a little more than 4% of patients chose hospitals based upon either the internet or upon “books, magazines, or newspapers.”

The Cliff Note’s version is as follows:
1. If you are a primary care physician, be nice to your patients and take good care of them. Not only will they stay your patients, but they will help you build your practice.
2. If you are a specialist, be nice to the primary care physicians. They account for more than two thirds of your business.
3. If you are a hospital administrator, see #1 above. Invest in your patients and your docs and the rest will follow.
Oh, and all that advertising isn’t doing much to gain you market share. Likewise, no one is paying much attention to that comparison bullhokey at www.hospitalcompare.whatever.com. Stop worrying so much about “quality indicators” that have no basis in science and start worrying more about being good to your patients and your staff physicians.

Word of mouth will get you a lot farther than that ad in the paper.

26 Responses to “Choosing a Doctor”

  1. Tisdone says:

    My wife had to select a new primary after her last one moved away. We had moved slightly, so the old practice wasn’t as convenient anymore, so she wanted to look for a new one. The problem being … even in doctor-rich Massachusetts … finding a local doc that was accepting new patients was difficult. So she ‘settled’ for going to a new doc at the same practice that was taking most of the old doc’s patients. Where does that fit in this survey?

  2. kmostl says:

    here’s how i chose my primary….got his patients in and out with minmal testing and consulting and they left smiling and well..he blocks in time everyday for emergency appointments at his office and the icing to the cake is one of the funniest people i know. btw his dad was the father of wrestling in st. louis and did all his contracts on a handshake…just threw that in for fun

  3. Marilyn says:

    When we moved from one state to another, I was very nervous about finding a new doc. I was blessed to have what I considered the absolute best! I asked my pediatrician what he recommended we do and he said “go to the local emergency room (department of course, if you are Dr. WC) and ask the doctors and nurses who they respect and who actually shows up for their patients”. That was very helpful.

  4. MM says:

    I am a little surprised to see that people choose a hospital according to the Dr performing the procedure.
    There must be a lot of people wealthier than me (well, I already knew that!), because I choose mine solely based on finances, if:
    a)it is in my health plan network and b)if my PCP has privileges there.

    And I also chose my PCP according to my health plan network. He is not that wonderful but he will do. I am richly blessed with excellent health and plenty of common sense, so I hardly ever see him anyway. :-)

  5. MM says:

    oN second thought, maybe I misunderstood!
    What does “Dr performing the procedure” exactly mean? My current doctor or the area famous Dr Wunderbach?

  6. PJ Geraghty says:

    I like Marilyn’s idea for PCP selection. We chose ours based on an urgent care recommendation and have been happy ever since.

    For orthopedic care, I have relied on the hospital ED where I arrived those days. The first time was a poor outcome, but the second time was good.

    Hospital choice is based on where the doc practices, and where I am when I need an ED, but mostly on my experience with and perception of the hospital. There are several to which I would adamantly refuse transport.

    I work with a neurosurgeon to whom I have referred several friends for spinal issues. They are a little leery of taking a neurosurgery recommendation from me, since I tend to see the neurosurgery patients who didn’t have good outcomes, but they (the friends) have all been very satisfied

  7. Pamala says:

    We fell into our pediatrician and through him was introduce to our PC doctor. We were referred to Kaylee’s specialist by her doctor but I didn’t like the endocrinologist so I asked my friends if they knew of any and researched all the suggestions online and found some rating information and things like that and decided to go with the doctor we currently go to and he’s great.

    I really wish people took advantage of the websites that are online because the more information you have on a doctor the better prepared you are when you see them.

  8. Evan Falchuk says:

    This is great advice for physicians.

    You make an excellent observation about the trouble with so-called “quality” measures.

    The data available do help you understand if a hospital has done many cardiac bypass surgeries, for example. But they don’t tell you anything if you’re, say, a cancer patient trying to decide between a lumpectomy or a mastectomy or something else entirely. This is a higher-stakes — yet unaddressed — problem.

    The most important thing is to have a doctor who you like and trust. Beyond this, that he or she is able to spend the time you need with you on your medical problem. But however you find your doctor, it’s worth the effort to do it right. The good news is that there are many, many extraordinary doctors out there.

    The other really good advice for patients and doctors alike?

    Don’t get sick.

  9. igloodoc says:

    What is completely lost in the carpeted section of the hospital is the answer to the question “Who is the customer?” Most hospital administrations wrongly think it is the patient. This proves, beyond a doubt, that patients are patients and physicians are customers. Press Gainey surveys are moot!

  10. ERP says:

    Yeah Dr Specialist, be nice to us in the ED and we will try to send you the “good” patients. If not, you are getting the well insured but total-pain-in-the-ass-drug seekers.

  11. Moondust says:

    Wait, how do people walk into the local ER and ask the doctors and nurses there for a PCP rec? They actually stop to talk to you?

  12. rlbates says:

    Merry Christmas and Happy New Year to you and your family, WhiteCoat! Hope it’s blessed.

  13. TDB says:

    When I moved back to my home state after college I had my family ask about good PCPs and specialists (I needed a neurologist). I really like both of them. The recommendation actually came from a radiologist who my mother knows and who happens to be good friends with my PCP. My neurologist also came highly recommended by the same person.
    I was very glad to have such great recommendation because when in college I had to have surgery and the surgeon my PCP sent my to was so full of himself that he blaimed me when the surgery left me in 3+ years of significant pain (I followed his care instructions word perfect too!). I am glad that he is really the only bad experience I have had and in general I really like my Dr’s because they have treated me like my problems do matter.

  14. SeaSpray says:

    Igloo doc – at the hospital I worked in they did instruct us as to who our inside and outside customers were and then questioned about it our annual mandatory testing. The hospital corporation included doctors as customers.

    I have always sought WOM when it comes to choosing doctors. I also review our plan, then choose the best WOM physician that is on our plan.

    First of all… I asked the doctors and nurses I worked with, plus I formed my own opinions while working there. But I did get the inside scoop as far as surgeons, etc.

    I will say though that an ED doc once told me that nurses don’t pick doctors for the right reasons. He was a surgeon and an ER doc. Anyway…I don’t recall why he thought that. He also recommended that my mother see a specialist over the general surgeon who was handling her gynecologic care. That ED doc’s advice may have saved my mother’s life or at the very least…spared her a hysterectomy in her golden years… and he went against a colleague by doing that. I respected him greatly for speaking up and telling me what he really thought.

    While there were a lot of docs I worked with that I liked and would go to…I opted not to and usually sought doctors that worked outside our hospital system because I wasn’t about to get nekkid in the northern regions or Bajingoland for doctors I worked with because that would be like getting nekkid for your boss. Conversely…if I already did get nekkid.. been there done that…then it wouldn’t matter.

    So..I have done it both ways… word of mouth and using plan.

    I will say that wom is the real catalyst for me to go to a doctor. My orthopedic dr is not on my plan and I chose him because of how much he helped 2 friends and I opted NOT to go to the one on my plan…even though I liked him at work and heard really good things about him…because of how he treated one of my friends in the end of his treatment with her.

    She had broken her foot. First round of casting…it wasn’t healed and so she had to do it again. It still hurt her and he told her to just walk on it that nothing was wrong. he snapped at her. not only did she limp away from his office but he was rude to her in her last visit. My friend is an intelligent, warm and humorous person who because of certain circumstances was on MDCD. So the doctor wasn’t making much on her. I don’t know if that was the reason that he cut her loose, but I wondered.

    About a week later, my friend was limping into the health center (thinking she had to work the pain out) when her pcp saw her and asked what was wrong that she was limping. She heard the story..said that she should not be walking that way and insisted she get an x-ray…which revealed a hairline fx.

    She went to the guy I go to, ended up getting a TENS unit donated to her (miraculously)after the new ortho doc said that is what she would need. She healed after that. She thought the new ortho doc was much nicer. So when I injured my knee (both times) I chose him even though he wasn’t on my plan and he is terrific!

    Other specialists I have seen…have ALWAYS come through the primary care physician…which I check to see if they are on my plan… but again… I sometimes go with the nonPPO doc…although I would prefer it be more cost effective. If the bills were going to be huge..then I would HAVE to stay with he plan.

    The emergency department referred my urologists. I don’t know anyone who uses a urologist and so if I had to cold call…I would have called the urodoc’s on my plan.

    Sometimes…availability is a determining factor too. Sometimes I can wait and sometimes no.

    I want to give a plug for doctors with web pages or public blogs.

    I think it may be a growing trend. I think the phone book is archaic. I personally can not stand to use the yellow pages!

    It is so much more efficient/expedient to google for a doctor.

    That being said… When I had to seek out another urologist to do what was thought to be imminent high risk surgery…I was scared. I didn’t know who to pick or where I should have the surgery done.

    I went on line and looked up the list of urologists on my plan, ran some by my urodoc …that went to a hospital I decided I wanted to do the surgery in. When I read the bio of the urologist I chose…I was greatly comforted. I also appreciated being able to read about their entire staff… partners, office and looked at all their pictures. So reading about the doc I was choosing and his partner’s bios (because they could be treating me too)helped to reassure me during a very uncertain time.

    I have since told that doctor that he is everything his bio says and more. :)

    I am always directing people I meet to the physicians I go to and informing them of the good patient care that I receive and I praise the office staff too… because as a patient who has felt vulnerable, afraid and/or just not feeling well … the last thing you need is a rude office. A patient should be well received and felt taken care of. You can’t please everyone and there are limits… but…there are doctor’s offices…and then there are doctor’s offices… and I prefer warm, friendly professionals.

  15. crankylitprof says:

    I found my new PCP on the blogs. (Hi, Dino!)

    While bitching about the eight-month-from-call-to-physical lag, I got a post from a Saurian, and followed up on it. I’m damn happy now.

  16. SuperBadJack says:

    I found my PCP cause the giant recruiting firm I work for placed the Doc.

    Bwahahaha.

  17. I often give my patients a range of choices to choose from. I also tell them which have the best bedside manner but I also remind them that it doesn’t matter. The only thing that matters is the quality of care. Most of my patients are from word of mouth. That’s the best advertising one can get.

  18. StLMOtoo says:

    In college I just used the school doc and then went with recommendations from mom and dad when I needed an internist and a gyn. Gyn was good then but I don’t think so much of her now after 25 years, internist not so good after all. Then long period where I didn’t need a doc. When I finally did need one, I went to one based on the recommendation of a co-worker. That doc might have been fine for general things but I wound up developing a chronic condition and he wasn’t aggressive enough with treatment for my escalating condition even though he’d specialized in that. His staff was rude, and he dictated his notes in the middle of me trying to give history which was irritating. So I wound up firing him. I started looking for a new specialist, first by going to the plan and then choosing to go with one in academia. She is great, and I’ve taken several referrals from her for PCP’s. Then referrals from those PCP’s for other specialists. The PCP’s she chose were pretty good, the one I chose on my own based on plan and sooner time to be seen wound up farming out much of my problems to other specialists and I found out that was just a money making scheme amongst friends and not so much on who was really good for me. I’ve also taken referrals from my two best specialists when I needed to find specialists for family members or friends. On the whole, I’ve preferred the academic docs, though I know there are good private ones out there too – just harder to find. I’ve never looked at any of the rating sites, because I don’t want to pay for it, and as someone above said, they can’t always steer you towards what you need to know. I do google up referrals and do google to find bios when I’m making considerations and the bios can go a long way too.

  19. Country Doc says:

    I’m always amazed at this time of year when specialists that most of the year won’t give us primary care docs the time of day remember that we are the source of their business and flood of our offices with holiday treats.

  20. SeaSpray says:

    StLMOtoo – you can go to vimo.com and find some things about docs. Education, years practicing..very general but it is something. Also patient evaluations of docs. I wrote a nice one for my docs… and someone wrote something nice about him after me. Of course it is subjective and you never know who is really writing them..good or bad, I suppose.

    I also would not pay for more info.

    WOM is still best. :)

  21. kmostl says:

    stlmotoo you from the gateway to the west?..quick how do you pronounce gravois with or without the s?

  22. SeaSpray says:

    Merry Christmas WhiteCoat :)

  23. StLMOtoo says:

    Thanks for the tip Sea Spray – will check it out. Hard to get that info on private docs who either don’t have sites or don’t post that type of information. Suppose that’s one reason I gravitated to the academic docs as you can see their research insterests or other activities. It doesn’t tell bedside manner, and although that shouldn’t be a huge factor, it sometimes can be, especially if you need to get along with a doc to work on managing long-term issues.

    Hi,Kmostl! Yes, from the Gateway! Not born here, though grew up here – therefore, I pronounce it WITHOUT the “s” of course! What high school did you go to? :>) Happy Holidays to All!

  24. c says:

    Thanks for the post, WhiteCoat, and also to those who provided such useful comments. Now can we please stop the incessant, largely irrelevant hospital advertising? If/when I need a hospital, it certainly won’t be because “the whole hospital is a WiFi hot spot” (as touted by the county’s leading hospital), or because it has “a no-wait ED” (as my town’s newsletter gushes). My friends and family avoid the latter and have advised me to do same – no positive WOM. (OT: Could anyone comment on ‘no-wait’ EDs, favorably or not?)

  25. StLMOtoo says:

    I think hospital internet sites, with lots of info on the docs and staff (pics are nice too) can potentially go a long way. If the site is well set up and easy to navigate and includes a lot of useful information on conditions (not just really general info though) for those who do have complex decisions to make regarding treatment options, this can help a patient feel a little more comfortable in choosing that hospital. It must be easy to navigate and delineate departments and treatments. Of course what/who is covered by their plan makes the first if not a big difference, but the websites can really complement that for those who surf for that type of information.

    Mailings and newsletter with general information not near as much because most get thrown away without ever being read, and again, just too general in information if you ask me.

    I suppose the ads touting wifi and no wait ED’s will help with those patients who never think about health care until they are in an emergency situation. Although wi=fi is probably tempting to those who know they will or may wind up in the hospital for any length of time (mainly those with chronic conditions who are already educated on potential related emergencies) and who are daily internet users, thus that could be appealing, although again should be on the bottom of the list of why to chose a hospital. At least one might know the doc can google up information quickly if needs to! But for some, they get their support groups online and this can be huge factor in trying to stay positive if in the hospital for a while.

    So I would say internet (not rating sites) with bios and lots of information is the way to go for hospitals and docs along with keeping good relationships with docs who will refer back to you and keeping good relationships with your patients for WOM which is priceless. Bad WOM goes a heck of lot further than good WOM does, so keep that in mind. People spout off about their bad experiences much more than they do about good ones. Lots of older folks out there are good on the internet so don’t think it’s only catering to the younger crowd.

    C – can’t speak to the no wait ED, but I think I heard an ad here for one, just can’t remember which hospital it was. Last time I was in an ED was about 12 years ago and though I think I got back to a room in ED quickly, it took 4 or more hours to get discharged for a damn hairline nose fracture and they knew I was trying to get upstairs to see my dying father. I got hit in the parking lot while walking in to see him. They made me take an ambulance the 50 ft from the lot to the ED too. That one is near my house and my family has gone there for years. I have yet to be an inpatient or ED patient at the hospital that all my docs have privileges at in the City, and will go there if it has anything to do with the chronic condition. Although I had surgery at the City hospital as a young kid, and this probably helped when I was trying to find specialists later in life.

  26. Dianne H. says:

    This sounds stupid, but it ended up working better than any other method might have.

    Husband & I both needed new doctors. Where to find one? So I thought “Husband is Swedish, why don’t I start with Swedish Hospital?” Sure enough, their webpage has a ‘physician finder’ and I narrowed it down to two doctors. I called one and it turns out he wasn’t accepting new patients, so I made an appointment with doctor two.

    The best choice I’ve ever made in my entire life. We love our doctor, he’s just the best!

    I also thought I’d mention, I haven’t been to the Emergency Room since I was 16, I’m 44 now….

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