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If a sudden illness occurs, your life can be thrown into a state of disarray requiring immediate decision making. Moreover, decisions such as whether to have surgery or to undergo a potentially lifethreatening treatment can have significant consequences. Our views and values about these consequences will strongly influence our decision. In order to avoid making some of the most important decisions of our lives at a time we might feel the most helpless and out of control, we need to take as many steps as we can in advance. Of these steps, the most important by far is the selection of a physician whose expertise and judgment you trust. In this chapter we will examine the importance of the doctor-patient relationship, discuss how to find a doctor if you do not already have one, and how to make the most of your doctor visits.
Your relationship with your doctor can have a tremendous impact on your response to care and treatment. If you have confidence in your physician, you may experience a healing power that goes far beyond a comforting feeling of security or peace of mind. Your body can be significantly affected by stress, and every doctor has seen a situation improve dramatically by reassurance. Your doctor is an essential part of your treatment--you should have the best you can find.
Your regular doctor should be someone who understands you in particular and the needs of elderly people in general. An appropriate choice of physician might be a family practitioner, a general internist, or a geriatrician. In order to receive a medical license, all physicians must have graduated from an accredited medical school and have at least one year of training after medical school. However, for your care, this minimal level of training is far from adequate. Physicians must complete additional training, usually called a residency, to become eligible for certification by the board of the given medical specialty. Residency programs vary from two to six years of rigorous, supervised experience. Physicians must then pass a certifying exam to demonstrate that they have at least the minimal knowledge in the specialty. At this level of training, the name of the physician's medical school is not as important as whether the physician is board certified in a medical specialty. You will want a physician certified in a primary medical care discipline such as family medicine or internal medicine.
Geriatric care is a relatively new specialty; geriatricians specialize in the care of the older adult. A specialist in geriatric medicine has first been certified in either internal medicine or family practice and has had additional experience in caring for elderly people, either by completing two additional years of intensive hands-on training called a fellowship, or by having extensive clinical experience. Generally, physicians specializing in geriatrics focus their skills on very frail elderly people who have extremely complicated medical and social problems. You are probably too healthy to need the specialized services that can be performed by a geriatrician.
If you do not have a regular doctor, you should select a physician before you get sick. If you wait, you may be forced to take the first available doctor regardless of quality. Good medical care does not happen by accident and it is very risky not to have one personal physician in charge of the process. Your personal doctor can keep things coordinated so that you are not on too many medicines, you do not have unnecessary medical or surgical procedures, and so that recommendations from consultants are carefully considered to advise what is best for you. Someone needs to have the full picture of what is going on, to make sure that all the information has been gathered appropriately, and to see that nothing is missing.
You want your physician to have character and be competent and you want to be compatible. Character implies honesty, humility, an awareness of strengths and limitations, and a sense of responsibility. Compatibility is ultimately the physician's ability to gain your confidence, which depends upon an agreement of personalities.
Medical competence is also difficult to evaluate. You should not rely on a layman's testimony alone because people can be easily misled about a doctor's competence, and many people feel grateful to anyone who makes them feel comfortable. As a rough guide, doctors use the medical school, residency training, hospital privileges, and any specialty certifications when considering the competence of another physician.
Many personal preferences are involved in choosing a new doctor. The attributes you want, however, generally center around someone who is concerned about you, who can communicate with you, and who can anticipate your problems. A good physician will listen carefully to you and explain things clearly and completely, leaving time for questions and discussion. In addition, a good doctor must be available to you when you need his or her services. At the very least, alternatives to office visits with your doctor need to be provided, whether this means having another doctor on call if your doctor is unavailable or being able to reach your doctor for consultation over the telephone, or receiving visits at home. Other considerations in choosing a new doctor are more personal. Some women may feel more comfortable with female doctors, and some men may feel more comfortable with male doctors.
You already have a doctor whom you see for checkups, minor problems, or for medical conditions that have occurred in the past. However, you may need to find a new doctor if you move, if your regular doctor retires or dies, or if you become dissatisfied with your current doctor's services. If you live in a small community, your choice may be limited. If not, your search may be challenging. Your best source of information is a level-headed, responsible physician. A medical school's chairman of internal medicine or family practice can provide recommendations. The chief of medicine at the best hospital in your area can also give you some names. If you have moved, your previous physician might be able to recommend someone in your new location.
Doctors play such an important role in our lives that you should be prepared to spend whatever time, money, effort, and energy you need to find the best possible physician. Therefore, once you have identified a person as a potential physician, schedule a visit to find out in advance whether this particular physician will suit your needs. To do this, when you make your telephone call to a new doctor's office, notice how the assistants respond to you. Are they abrupt or courteous, helpful or aloof? Ask if the doctor is accepting new patients and how soon you can have an initial examination. An appointment within a month is acceptable; any longer may imply that the doctor is overworked.
You and your physician will need to work together to develop a comprehensive plan for your health. Your responsibilities are to be prepared to ask the right questions and to be a good listener. This book can help you in two of these three areas. You should gather all your relevant past medical information, including any old records from past physicians. You can send a written request to your previous physicians to have copies of your records sent to your new physician. You should also compile a brief family history, which includes any illnesses or causes of death within your immediate family. It is also important to bring all your current medications with you, including any medicines you may have purchased without a prescription. Because you will probably need to undress for the physical exam, it is important to wear clothing that you can remove easily.
Allow time for traffic and parking when you reach the doctor's office and try to get there a few minutes early. Your first impressions of the office are important. Are things organized? Someone will probably first check your blood pressure and weight and then either have you wait in the waiting room or direct you to an examining room. It is not unusual that doctors become a little behind their scheduled appointments. If, however, you have to wait for more than 20 minutes, ask someone about the reason for the delay. You may wish to reschedule the visit if the delay is going to be excessively long and, in any case, just knowing the reason for the delay can be reassuring.
When the doctor arrives, you will want to make every second count. To use the time efficiently, have a list of your concerns with you. The first time your doctor sees you, there will probably be an extensive interview and physical examination, which may take up to an hour or even longer. The conversation should be balanced with neither you nor the physician doing all the talking. Ask plenty of questions and make sure that you understand the physician's answers. You do not want to be confused or uncertain when you leave the office and certainly not when you arrive home. If your doctor has used medical terms that you do not understand, ask for simple definitions. An example of a list of questions related to an illness would be: Exactly what is wrong with me? Is this a common problem? What other conditions could possibly cause this and how likely are they? What do I need to do now? Is there anything that I shouldn't do or that would cause me difficulty? What are the options and alternatives for treatments? You will very likely have additional questions, based on the specific problems and concerns you may have, but the point is for you to leave the office with a clear understanding of what is going on and a basic understanding of the treatment.
After the office visit, think clearly about what has happened and always remember that you have an active role in making the decisions about your own health. Your doctor's advice is certainly important, but you are free to accept or reject this advice. You are the one who must consent to various medical or surgical treatments, and your decisions must be made on the basis of your personal beliefs along with the doctor's advice, but remember, nothing can be done without your consent. If you have continuing concerns about the visit, go to the next person on your list. You must have trust and confidence in your physician.
Every significant relationship requires careful maintenance to allow it to grow. Once you have chosen your doctor, understanding a few basic principles can help make the most of the relationship. Having an up-to-date list of your medical problems or health concerns is important. You should know what to do in the case of an emergency. Should you call the physician first, go to the emergency room first, or have the doctor call the emergency room in advance? Find out the hospitals for which your doctor has admitting privileges. If you go to the emergency room of a hospital where your doctor does not have admitting privileges, you will consult and be examined by one of the doctors who are associates, with privileges, to that particular hospital.
It is important to let your doctor know if there are any aspects of your care that you are unwilling or unable to do. Discuss all tests with your doctor before they are ordered to find out why they are being performed, what the risks are, and how much they cost. Keep track of the test results and review them periodically with your doctor to understand how the evaluation is progressing. Obviously, if medications are prescribed, you will need to understand the reasons for their use, any side effects that may be expected, if any less expensive or dangerous alternatives exist, and how long you will need to be on the medications.
Information that you give your doctor is strictly confidential and therefore honesty between you and your doctor is very important. Although some information may be very embarrassing for you to share, it is essential for your doctor to know everything.
Deciding on a personal physician is one of the most important decisions you will ever make: One day your life may depend on your choice.