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How to Choose a Doctor

From an e-mail I received:

As a proponent of SBM, and a someone who places a high value on reason, logic and evidence, I would like to find a physician who shares this mindset.

He went on to ask how he could go about finding one.

Another correspondent was referred to a surgeon by her primary physician, and the surgeon inspired confidence until she started talking about using homeopathic arnica pills to improve healing post-op. How she could determine the technical competence of this surgeon? Was acceptance of homeopathy a reason to shed doubt on her judgment in other areas? Should she seek a second opinion?

I get a lot of inquiries about how to find a good doctor. I don’t have a good answer. I thought it might be useful to throw out some ideas that have occurred to me and hope that readers will have better ideas and will share their experiences about what has or hasn’t worked.

What Do We Want in a Physician?

  • We want a doctor who is knowledgeable and technically competent.
  • We want one who exercises good judgment.
  • We want one we can trust not to use quack diagnostic tests or quack remedies.

There are a lot of other considerations. Do you like him? Does he act like he cares about you as a person? How’s his bedside manner? Does he explain things well? Does he encourage questions? Is he authoritarian or does he treat the patient as a partner in making decisions? Is his office conveniently located? Is he booked up months in advance? Is he on your insurance plan? Is he available in an emergency? Is he reachable by phone or e-mail?

If it’s a straightforward technical matter like setting a broken bone, personalities may not matter; but in other cases (a difficult diagnostic puzzle, a chronic disease, or a psychological issue) they may matter a great deal. Sometimes through no fault of their own, a patient and doctor are simply not a good fit for each other for developing a good doctor/patient relationship. Perhaps the doctor reminds the patient of an uncle who abused her; perhaps the patient reminds the doctor of his wimpy, hypochondriacal cousin. Perhaps they have different political opinions, different religions, or different cultural backgrounds with different world views. I know an atheist who walked out of a doctor’s office when she found out he was a Christian.

What kind of doctor?

As a family physician, I’m partial to a board certified family practice doctor (FP) as primary physician; as a general rule, the FP mindset tends to be more comprehensive and practical than that of internists or specialists. A urologist sees a lot of prostate cancer and is more likely to insist on PSA screening; an FP is more likely to weigh all the pros and cons and involve the patient in deciding whether to screen.  (Of course there are exceptions.)

Consider other options besides MDs. In the US, DOs pass the same licensing exams and are trained in the same residency programs as MDs and can be considered equivalent. Physician assistants and nurse practitioners tend to be more “interested” in routine patients; many of them work in group settings with ready access to doctors when needed.

How To Find One

I have no experience in choosing a doctor. I’ve always been arbitrarily assigned to one in the military health care system. But let’s say you’ve just moved to a new city and want to find a primary physician. How could you go about it? I don’t know, because I’ve never had to do this, but here are some ideas that have occurred to me:

  1. Word of mouth. Ask friends, relatives, neighbors, and co-workers about their doctors.
  2. Ask your previous doctor. If he doesn’t know anyone in your new area, he might know someone who does.
  3. Use the Internet. Social networking sites, forums, sites that rate doctors, lists of licensing board disciplinary actions and malpractice lawsuits, the websites of doctors and the groups they work for, etc.
  4. Nurses know things. If you can find a nurse who works in a local hospital or medical center, who has had experience working with lots of different doctors, she may have a good sense of which ones are better than others, and she might have heard some pertinent grapevine gossip.
  5. Call the doctor’s office and ask if the receptionist or nurse knows if the doctor ever recommends CAM or refers to CAM providers.
  6. Check to see if the doctor’s group includes CAM providers or advertises “integrative” medicine.
  7. Ask about credentials: training, board certification, hospital privileges, etc. If you are contemplating surgery, ask about the doctor’s and the hospital’s volume and complication rates for that operation.
  8. Interview the doctor. Make a new patient appointment and tell the doctor you want to ask some questions to see if you and he are a good fit. Ask how he goes about deciding when to adopt a new drug and whether he gets his information from drug reps. Ask what he thinks about CAM. If you have a medical problem, ask what experience he has had with that problem. Watch to see if he washes his hands.
  9. If for any reason you don’t feel comfortable with a doctor, don’t hesitate to look for one you feel more comfortable with.
  10. If you have any doubts about a recommended treatment, it can never hurt to get a second opinion.
  11. Ask if the doctor reads SBM. If he answers yes, that’s a good sign! If he answers no, maybe you can get him to start reading it.

Maybe I’ve been unusually lucky. In the military health care system, I’ve been treated by MDs, DOs, PAs, NPs, and even a clinical pharmacologist; some of them were military officers, others were civilians employed by the military. I’ve seen multiple specialists in the military system and when appointments were not available in the system I’ve been referred out to civilian doctors, both primary care and specialist. None of them ever mentioned homeopathy, acupuncture, chiropractic, or energy medicine. When they talked about questionable areas, they always acknowledged that the evidence was inconclusive. The surgeon explained the biology and the statistics and then asked me to choose between breast biopsy and watchful waiting. The retinal specialist gave me a brochure about a new vitamin mixture that I “might” want to consider as a possible preventive measure for macular degeneration, but she wasn’t selling it herself or even recommending it, and she said so far there was no real evidence for prevention but only for slowing progression of established disease.

I know the medical profession includes a significant number of charlatans, of individuals who don’t really understand science, and of gullible, misguided swallowers of the Kool-Aid. But in my own anecdotal sampling of the medical profession, I haven’t come across a single health care provider who would not be acceptable to patients who are “proponents of SBM, and who place a high value on reason, logic and evidence.” I’m guessing a doctor picked at random would be more likely to agree with SBM than with Mercola. I’m hoping our readers will comment and offer practical suggestions about how best to avoid the minority of duds.

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42 thoughts on “How to Choose a Doctor

  1. Ken Hamer says:

    Having recently been through a similar process (looking for a physiotherapist for back pain) I for once feel qualified to comment.

    Last June I hurt my back. As is apparently quite common, I didn’t appreciate how badly until several days after the fact, when my back suddenly hurt so much I was essentially immobilized. I called the provincial health/nurse line and got some quick advice. The next morning I called my doctor’s office at about 8am, and booked an appointment for 10am. She put me on “doctor’s orders” to not travel for a period, prescribed Tylenol with Codeine, and gave me a referral to a physiotherapist. But she was hesitant to recommend one, feeling that she wasn’t qualified to know who would be most suitable for me.

    I began a Google expedition for physiotherapists in the local (Vancouver) area, and to my dismay almost all of them featured various flavours of voodoo, including the usual suspects:
    - accupuncture
    - chiropractic
    - reiki
    - human sacrifice
    - theraputic touch
    - naturopathy and homeopathy
    - and of course the catch-all “modalities”

    I found one website without a hint of woo, and promptly booked an appointment. I was impressed with the approach — 90 minutes of interview, testing (i.e. how far can you bend), a little bit of poking and probing, and so on, followed by 30 minutes of apparently very specialized exercise, with a detailed (and completely sensible) explanation of what each did. After that initial 120 minutes I felt about 80% better, and after another couple of sessions over the next few days (along with a 3 times daily exercise/stretching regimen) felt about 95% better. Two weeks, and 99.99% better.

    The only concern I encountered was when she spoke of some sort of electrical stimulation. I looked but couldn’t find a satisfactory answer about the legitimacy/efficacy of the treatment, so I turned to the absolute best source of science-based medicine on the web. One Dr. Harriet Hall was good enough to point me to a US government website that acknowledged there was some evidence for its use. Nevertheless, the exercises so quickly relieved so much of the pain, there was never a need to utilize it.

    But I was very pleased to find a physio clinic that was strictly evidence based, and maybe even completely science based.

    BTW, total time from perceived injury to physio and substantial relief was about 36 hours, I spoke only to the nurse on the health line, my GP, and the physiotherapist. Total cash outlay, including the drugs, was $0.00.

    (And a big, belated, and overlooked thank you to Dr. Hall.)

  2. Ken Hamer says:

    Whoops, forgot the prescribed back X-rays. Drove from my family doctor’s office to the the closest X-ray lab, about 10 blocks down the road. Was X-rayed perhaps 15 minutes after leaving GP’s office, and sent on my way after about 45 minutes.

  3. Ken Hamer says:

    As for finding a good GP, this is the route I took (which may or may not work for others):

    After my previous GP of 30+ years retired, I began utilizing walk-in clinics. Given that there were lots close by and convenient, and that I had no particular health problems, this worked well. Of course each time I went I saw a different doctor. While not intentional, this continued until I found a doctor I rather liked.

    After that I tried to arrange my visits when she was on duty. After a few visits, she allowed repeat patients to book appointments with her ever though it was otherwise a walk-in clinic. After about 3 years of this, she opened her own office and invited me to follow her there, which I did.

    Mostly a case of good luck I suppose, but keeping my eyes open while exploring the options of many different doctors seems to have paid off. She’s also younger than me so hopefully she’ll outlive me and I won’t have to look for another doctor.

  4. papertrail says:

    “Consider other options besides MDs. In the US, DOs pass the same licensing exams and are trained in the same residency programs as MDs and can be considered equivalent.”

    Uh-oh, I think if you’re going to offer some ways to minimize the chance of landing with a doctor that uses dubious practices, don’t recommend DO, at least not without caveats. That could be a topic in itself for this site. My doctor (interestingly, Christian posters on the walls yet science-based in practice, at least with me) gave me a look and a head shake when I said I was considering going to a DO. Mercola and Buttar are both DOs, if that tells you something (although plenty of medical doctors offer woo too). Some DO do craniosacral treatments, light touching on the scalp that is magically supposed to move the bones of your skull to solve problems in other parts of the body. Some DO might be science-based, but you have to screen even more carefully than with an MD.

  5. Dawn says:

    As a nurse, I’ve seen a lot of doctors. Some great, some awful. My recommendations of doctors to friends are usually based on doctors I’ve gone to as a patient, not worked with as a nurse (it’s a very different role). I would happily recommend my current FP MD (whose new partner is a DO – haven’t met him yet).

    @papertrail: DOs can be woo based, but the ones I knew from several residency programs all practiced SBM. And this is going back 20+ years. A few may offer craniosacral treatments. The ones I knew offered good medical practices.

    For my recent surgery in January, my plastic surgeon gave me, (no purchase required) like Dr. Hall’s correspondent, homeopathic arnica pills. I read the box carefully (and did some on-line research) and figured it was JUST possible the first three pills (Pre-op day, op-day, first-op day) might contain enough arnica to have a possible effect. The remaining 3 weeks of pills were purely sugar. For the fun of it, I *did* take the first 3 days of pills. Having had surgery in the past, I knew my healing rates and chances of bruising. My n of 1 said the pills had no measureable effect compared to past healing rates. However, he also prescribed me actual medications (antibiotics, pain medications, muscle relaxants). His surgical technique was excellent, his office manner was great, and when I go back for a final post-op I’ll discuss the woo with him. But even so, I’d recommend him to patients for surgery. The woo was a sideline which didn’t effect the care (in fact, he never even asked if I was taking those pills, though he did ask about the antibiotics, etc).

  6. Donna B says:

    My preferred method for choosing a doctor is to use my health insurance company’s website to search out doctors who meet my criteria (specialty, location, etc.). Then, I weed through my results by checking out their credentials listed, especially whether they are board certified or board eligible. Admittedly, I’ve only done this when I’m looking for a specialist, but it’s a viable option if one is seeking a GP.

  7. Janet Camp says:

    I’ve had pretty much the opposite experience of Dr. Hall. I’ve moved a lot and changed insurance a lot, and been without insurance a few years at a time. Consequently, I’ve had to look for a doctor a number of times which usually boils down to: Who is taking patients who also takes my insurance or will work with me if I have no insurance?–not everyone will.

    I won’t continue with doctors who show any signs of woo (that would include arnica pills!). I once lived in a city that was heavily Mormon and I avoided Mormon doctors if I found out because I think in the case of something as outright weird as Mormonism, it amounts to woo for them to claim to be scientific–any religion that is fundamentalist would fall into this category for me as its adherents would be suspending a great deal of the substance of one or the other. I don’t do Catholics either because I don’t feel they will advise me without bias on my reproductive health.

    I don’t see any reason to be tolerant with something as personal as my medical care. I won’t go to any hospital with a St. in front of its name if I can avoid it–once or twice, insurance limitations have forced this. I had an Indian doctor (recently immigrated I think) for my hysterectomy who could not look at me when he explained post-op instructions that included a time frame for resuming sexual activity and referred to such activity as “the relations”! I can’t say for certain that this was because he was Indian, but he was very competent otherwise, so I decided it was merely amusing.

    I agree with Dr. Hall about FP vs. internist and have found this limiting with my current doctor (internist), so as much as I like her, I’m looking for a FP. The problem for me is she is also very young and seems unsure of herself at times, so refers me to specialists for everything. My FP’s handled a lot more themselves and I was able to develop a better working relationship with them. With the internist I feel I just drop by for a referral to someone I’ll only see once or twice and then move on to another specialist.

    So–I will see whoever I can in a crunch, but I won’t continue if I’m not happy. I will do substantial research to find out what I need to know, including chatting up the front office staff.

  8. AlexisT says:

    FP vs internist can be very local. I originally come from an area with relatively few FPs–I don’t think there’s a big supply of FP residency programs, either. So I went from a ped to an internist. Where I live now, there are more FPs.

    My kids go to a ped, because half the FPs in our area won’t take young kids–they don’t have the volume to justify supplying vaccines. So the “let’s all see one doctor” advantage is gone. I found an IM practice I liked and stuck with them. My internist is not a specialist pusher (they do have cardiologists as well, and I’ve never seen one, though I did get some extra tests that another doc might not have ordered. OTOH, I developed stage 2 hypertension at 28, so…) The FPs I’ve seen didn’t wow me, and I encountered the FP vs endo TSH war. I’ve encountered internists I was unenthusiastic about, but I seem to get a better hit rate on internists.b

    The woomeisters in my area are often DO FPs. The converse isn’t true–not all DO FPs are woomeisters–but DO FPs are disproportionately represented in the woo pool.

  9. Scott says:

    A warning sign I’ve encountered is if they have flyers plastered all over their office encouraging you to buy supplements from them.

  10. laproxdoc says:

    Hmn, choosing a general doctor is very different from choosing a specialist and is quite situation dependent. As an example, my father, a busy surgeon, was a gifted technical operator and diagnostician – frequently called in by colleagues to assist on or take over difficult cases and provide insight and expertise on diagnostic dilemmas. He was also very rigid, arrogant, and opinionated, did not suffer fools gladly and did not hesitate to speak his mind. He was a stickler for accuracy, logical thinking, professional honesty and integrity, science based practice, careful technique, continuing education, had low infection rates and great outcome results. Was he empathetic, a warm and fuzzy understanding good listener, respectful of patients as individuals? Absolutely not. He was hard on everyone around him and expected that they show the same dedication as his own. Patients, colleagues, nurses either loved him or hated him. He was definitely a “good doctor” but not a good physician. Would you refer a loved one to him? If they had a problem that needed his skill set: yes for sure, otherwise perhaps not so much.

  11. jpmd says:

    As a family doc who read SBM, i feel pretty good right now. however, it is really tough finding a doc. Popularity is no assurance a doc is good, as I have seen lousy docs with thriving practices. Internet ratings are not too helpful as you find great docs with a few patients they refused Vicodan that trash their ratings. I would have to go with the personal recommendations along with board certification. Board certification has its limitations, but at least it shows a willingness to keep up with medical education and a desire to maintain standards.

  12. I have a friend who has found it very challenging to find a woo-free psychologist. One after another was either focused on spiritual/ new age philosophies or a book with all the answers that will change your life.

  13. annappaa says:

    I don’t have health insurance and am pretty healthy, and thus hardly ever find myself in any health-care situation. But last year I saw a nurse practitioner at some low-cost clinic, and was rather appalled by my interaction with him. I asked him about a fungal infection in a fingernail, and he suggested treating it “homeopathically.” Before running out of the room, I allowed him to continue, and from context it became apparent that he thought “homeopathy” meant “home remedy,” because he was suggesting I treat it with a 50-50 bleach solution (rather than with a 15C bleach solution). I gently tell him what “homeopathy” really means and he shakes his head “no,” and goes on to tell me that the bleach solution is better than the antifungal meds because it’s “not a chemical.” I say, “Bleach is a chemical,” and he says, “Well, it’s not a harsh chemical.” Then he tsk-tsks me for being vegetarian, which sealed the deal. I don’t care if that clinic is convenient and low-cost, I’m never seeing that dude again.

  14. thatguybil81 says:

    @Janet Camp
    You honestly think some one will treat you differently based on there personal religious views?
    You think that some one can not practice SBM because they are religious?

  15. Jacob V says:

    My MD of 23 years recently took a job as the sports medical director of a local university. I joked with him that given he lived near the campus he clearly only wanted a job where he could walk to work. He said it was more about working for the state and having a good insurance plan given he has three children still living at home. Anyway, he gave me the names of a couple of local MD’s he liked and respected, and I did some online checking to make sure there were no complaints or sanctions. I also checked some doctor review websites that I did not find that helpful. In the end I chose one of the two recommended doctors based on when they could see me. At my first appointment the doctor was personable and at one point he leaned back and asked me about myself, my work, family and interests. This provided a great opportunity to talk about my skepticism, my appreciation of SBM, and that I was not interested in CAM whatsoever. When I mentioned CAM he raised his eyebrows and asked, “so you’re *not* interested in CAM?”. I said no, I’m not interested in any form of treatment that is not supported by good quality evidence and scientific research. He then smiled and said he was in total agreement with me and that what he regrettably hears from many new patients is the exact opposite, that they want a doctor who will consider and recommend alternative approaches and CAM. Needles to say I was very pleased with this first appointment. And I intentionally went with an internist because I wanted a doctor who’s focus was adults (I’m 52), and frankly I was no longer interested in sharing a waiting room with little tikes and tots.

  16. Quill says:

    “I don’t do Catholics either because I don’t feel they will advise me without bias on my reproductive health.”

    Perhaps one’s sexual preferences should not be a factor in choosing a doctor?

  17. DKlein says:

    My husband and I found a great FP by word-of-mouth as well as a back-up clinic when we couldn’t get an appointment with the FP. We both had specialists for certain conditions but our insurance company started forcing the issue of getting a GP instead of specialists. The name of one particular physician came up a few times from friends and coworkers, we checked the ratings websites and found mostly good reviews – ease of getting an appointment the only complaint. I booked a physical examination and found her to be very knowledgeable on everything from migraines to bio-identical hormones (not recommended), dietary nutrients vs supplements, and pleasant without being too chummy,and just very matter-of-fact. She did eliminate the need for a migraine doctor. My husband, who was having some really confounding symptoms, went to see her and she offered different avenues to explore that were very helpful.

    Unfortunately, in order to get an appointment, one must leave a message and wait for a call back. On two occasions, we were never called back, and on another it was days after the fact. The FP also has an NP and a PA, but the appointment-scheduling problem precluded even seeing them. We ended up going to one of the local hospital’s off-site medical groups where they take walk-ins. We like two doctors there as well and all these doctors including the FP are on staff at the same hospital. Though we would like to remain with FP, we have no problems switching over to the medical group because they do take on regular patients and don’t seem to have the same issues with appointment setting. We did let her know of the problems encountered and she appreciated the feedback.

  18. EricG says:

    @thatbuybil81

    the devil’s in the details…

    *personal* religious views was obviously not an accident in word choice. in any other case, you are right, except that my “personal views” on Twilight movies is unlikely to impact my practice of medicine…

  19. mousethatroared says:

    Huh, I was treated by a clinical social worker once who looked almost exactly like a coworker. I think he was actually very good, but I just could not feel comfortable with him, even though I liked my coworker, there was still this strange uneasiness. Like I had entered one of those bizarre doppelgänger movies.

    For my doctor, I did not trouble myself to much, just choose a network whose hospital I liked from our insurance coverage and picked a woman doctor. It’s a rather large office and we use any doctor available for sick visits, if I was not happy with my doctor, I could probably find one there who I liked better.

    My doctor recommended a couple of pediatrician’s. I meet with both of them at an expecting parents open house. I asked them a couple question about our impending trip to Kaz to adopt our daughter and I choose the doctor who I thought gave the most understandable and accurate answer. I believe that I had some slight disagreement with our Ped, but I was happy with how she handled it. I think that’s very important, particularily in a pediatrician, to find a doctor how can disagree with you in a polite and reasonable way and is good at explaining their concerns. Sometimes we parents can lose perspective…

    We were the most meticulous about choosing my son’s cleft team and plastic surgeon. I called the local programs and asked a few questions to see how responsive the office staff was. A couple of family member are health care providers at a local hospital, they asked around about the reputation of different surgeons and programs. I also posted on a yahoo group of parents of kids with clefts asking for recommendations in our area. The information we got from the group and our family member was very similar and helped our choice. Since we had many good recommendations, our decision was only a bit about the doctors competence or skill. The reputed bedside manner of the doctors, the age of the doctors (one doctor was near retirement and would not be able to see my son through years of treatment) and the hospital association (children’s vs regular) were the other deciding factors.

    Okay, I’m rambling. I think I’ve got a cold virus that’s gone to my brain.

  20. papertrail says:

    RE: finding a SBM psychologist, I would start with someone practicing “Cognitive Behavioral” therapy.

    RE: MD vs DO
    Dr. Hall, I hope you decide to put a caveat on your statement about Doctors of Osteopathy. I posted a link to Quackwatch’s statement and want to also recommend scrolling down to read the comments on that page.

    And here’s a good relevant article contributed to Forbes by Steven Salzberg (a Johns Hopkins professor with a “Fighting Pseudoscience” blog on Forbes). The author concludes:

    “So the training is not the same: the universities offering DO and MD degrees are largely disjoint, the standards are higher at schools offering MDs, and osteopathic colleges offer “extra” training in pseudoscientific practices. All that being said, ODs do get standard medical training, and some of them are undoubtedly very good doctors.

    So yes, Joseph Mercola endorses and profits from pseudosience on his site, as I’ve written before. And he has a D.O.., which I think is not entirely a coincidence. However, plenty of M.D.s are just as misguided as Mercola.

    Still, when I’m looking for a doctor, I want someone who went to one of the best medical schools and received strictly science-based training. Colleges of osteopathic medicine do not fit the bill. On the other hand (again), a growing number of maintstream medical schools offer training in “integrative” medicine, the latest marketing term used to disguise pseudoscience in the guise of real science. Those medical schools – including the one at my own University of Maryland – have some explaining to do as well.”

  21. papertrail says:

    Oh wait, now I see this follow-up by the author of the Forbes article where he softens his critique of DO. Still…

    http://www.forbes.com/sites/sciencebiz/2010/10/29/second-thoughts-on-osteopathic-medicine/

  22. Harriet Hall says:

    @papertrail,

    I don’t see the need for a caveat. Whatever health care provider you choose, you should make sure he’s not promoting any kind of quackery. MD schools used to be more science-based than DO schools, but now with the inroads of quackademic medicine, I’m not so sure. Residency training, board certification, and current practices are far more important than which school he went to or what grades he got.

    You say,”I want someone who went to one of the best medical schools and received strictly science-based training. Colleges of osteopathic medicine do not fit the bill.”

    Andrew Weil and Dr. Oz fit your bill. Nuff said! Please don’t write off DOs; there are some very excellent science-based ones out there.

    My medical school was at a state university, probably not “one of the best,” but the only one I could afford. It was openly critical of GPs, and there was no department of family medicine back then. When I started my family practice residency, I had never even met a family physician. My med school said its job was not so much to teach us current medicine (because practices are constantly changing and improving), but to teach us to speak the language of medicine so we could get a constantly updated education after graduation, and I think I managed to do that successfully. A lot of DOs did the same.

  23. papertrail says:

    Ugh, I’ll take it all back after reading more about (and comments from) Doctors of Osteopathy. It looks like it might be about equal now where you have to watch out for MDs using dubious CAM as much as DOs using dubious CAM, and there’s talk of merging the degrees. So, never mind, Dr. Hall.

  24. papertrail says:

    Our posts crossed and yet we ended up at the same place.

    Just to be clear, I didn’t say, “I want someone who went…”, that was part of the article I was quoting.

    Thanks for your reply.

  25. papertrail says:

    I don’t know how to indent a long quote, so that that doesn’t happen again where it looks like I’m saying something that I’m quoting. Can I use html code?

  26. Mitzi says:

    Choosing a doctor is complicated pretty dramatically if you have a rare chronic condition. We have to be extra careful not only to avoid overt quackery, but also to avoid doctors who cannot think outside the box. I have a genetic connective tissue disorder, so my joints dislocate on a regular basis. Some FPs only treat symptoms. I was told to take tylenol for a partially dislocated rib, as it was not serious as long as it was not puncturing a lung. You try breathing with the point of a screwdriver in your back.
    I’ve met rheumatologists and physical medicine/rehab specialists who could not reset an ankle. The only help I can get is from physical therapists and chiropractors. No, I do not go to the ones who crank your head around or push supplements, just as I do not go to MDs who use iridology or dark-field microscopy for diagnosis. But a chiro who knows Dequervain’s tenosynovitis when he sees it, and knows how to tell me to rehab it, is far more valuable to me than an MD with a color-coded prescription pad. 50 years from now I hope chiropractic evolves into poor man’s physical therapy (it costs about 20% as much per session). Some practitioners are already moving in that direction, and trying to set up board certification accordingly.
    I seek out advice about finding doctors, because I would really like to get genuine help for my condition from conventional medicine. But many doctors do not believe a partial dislocation of any joint is possible (smacks of “subluxation” to them), and I must be exaggerating. I show the same joint to a PT or a good chiropractor, he says “How are you walking? Hold on to the table.” resets it, and the pain is gone. Would a DO have the training to help? All my experience with MDs has been dismaying to this point.

  27. Janet Camp says:

    @thatguybil81

    You honestly think some one will treat you differently based on there personal religious views?
    You think that some one can not practice SBM because they are religious?
    ———–

    It isn’t a matter of how a practitioner of a fundamentalist or cultish religion will treat me–s(he) might be a perfectly nice person–but rather that I could not trust such a person’s scientific credentials. I would always feel that he/she had not really been paying attention in biology or biochemistry.

    And, yes, I think it would be very difficult for someone who denies evolution to practice SBM. Keep in mind that I qualified my statement by limiting my objections to fundamentalists and Catholics. It seems easier to avoid Catholics than to try to determine which ones are going to try to limit my options.

    I have had doctors who are nominally religious.

    ===========

    @Quill

    “Perhaps one’s sexual preferences should not be a factor in choosing a doctor?”

    Sorry, I don’t get the question. I think some, if not many, Catholic doctors would not want to fully discuss my healthcare options, particularly in matters of reproductive health. I might feel differently about particular specialists such as cardiology or oncology or others that have nothing to do with women’s particular health needs. I wouldn’t call that a “sexual preference”, so I’m not sure what you are saying.

  28. mousethatroared says:

    @ Janet Camp, I don’t get it. How do you know a doctor’s religion in order to disqualify them as Catholic?

    I don’t feel good about asking a doctor their religion as a screening question, anymore than I would feel good about someone asking me my religion before hiring me.

    If you are concerned about reproductive health issues, why don’t you just ask the doctor if they have any moral or ethical reservations about offering ALL the options legally available for reproductive health?

  29. AlexisT says:

    There are catholic doctors who will not perform Church unapproved procedures and are open about that. I will not use OB/GYNs practicing under Catholic health directives. (I know for a fact that the practice owned by the nearby Catholic hospital does this, and so I did not use them. I knew I wanted an IUD and I didn’t want judgment over my theologically unsound infertility treatment.)

    I have found that asking people who are into alternative choices can be quite helpful. I get a list of people to avoid and some bonus helpful feedback. Works best for pediatricians and OBs in my experience.

  30. BillyJoe says:

    Sometimes you can rule out someone by perusing at their website.
    Here is the website of a couple of quacks in my neighbourhood:

    http://www.healthwiseinstitute.com.au/

    Cross off the list.

  31. Chris says:

    Dr. Hall:

    My medical school was at a state university, probably not “one of the best,” but the only one I could afford. It was openly critical of GPs, and there was no department of family medicine back then.

    Wow! Things really changed there, and quite quickly. Perhaps starting with the creation of the WWAMI program in 1971, which was to meet a need for primary care physicians over some states with large areas and few people. Which made family practice an actual focus, from that site:

    The University of Washington School of Medicine has been identified as the nation’s top primary-care school in each of the last 18 years by U.S. News & World Report as well as the top medical school in the nation in family medicine and rural medicine training for the past 20 years.

    I have been at the same family practice for over thirty years due to meeting one of the founders of that practice at the Hall Health Center when I was a grad student (the first time around, I was working full time and dropped out). Her patient load was full, so I was assigned the token male doctor of that family practice clinic. I, and my family lucked out.

  32. Janet Camp says:

    @mousethatroared

    What Alexis said. Also, I just ask around and avoid. Sometimes it only comes up during a visit and then I simply find someone else.

    I don’t feel odd at all asking an ob/gyn if his/her religion conflicts with offering me a full array of options. It’s my life and my health–not a job interview.

  33. Franky says:

    Choosing a new physician can be a difficult task, especially if you have moved and are living in a new community. Asking for recommendations from coworkers, neighbors, and friends is a good way to start, but ultimately you will have to decide which physician is best suited to your individual needs and situation.
    For online medicine order check
    http://www.jackedup.me/

  34. Barry2 says:

    Your state’s board of registration in medicine (or social work, etc.) might have a web site listing the credentials of and sanctions against its members. Here in Massachusetts, the physicians’ board is at http://profiles.massmedboard.org/MA-Physician-Profile-Find-Doctor.asp. As readers may know, there is some controversy about the significance of malpractice judgments against doctors, and indeed a surgeon who saved my mother’s life paid a malpractice settlement in a later case. Perhaps he settled at the advice of his attorney or the urging of his insurance company, or perhaps he’s bound to have trickier outcomes because he takes on trickier cases. But if I know little about a doctor, and I see a malpractice settlement in his record, I look for someone else.

    After a life-changing episode of malpractice at the hands of a physician’s assistant, I now refuse to let PA’s examine me. For all I know, there may be many good ones out there, but after my experience, I read that PA’s didn’t have as much training as nurse practitioners. Is there any reason for a medical practice to use a PA rather than a nurse practitioner, other than cost?

    My last primary care doctor used to joke that he wasn’t as bright as other doctors and went to a “dinky” medical school. Since he was in practice with a highly rated doctor, I thought he must be OK. Then he finally demonstrated that he truly wasn’t that good, when he told me that C. diff. was easy to treat. I found another doctor. From now on, I will agree with any doctor who jokes that he’s not that good. I will also not assume that a good doctor’s reputation extends to the other members of his practice.

    Due to a medical condition that’s been difficult to diagnose and treat, I’ve been to a couple of top research clinics. While one might think that would guarantee top-notch care, it doesn’t always work out that way. Stellar researchers aren’t necessarily good at managing clinics or hiring good people.

  35. Chris says:

    Franky:

    For online medicine order check

    Spam, spam, spam, spam!

  36. nobs says:

    Perhaps some more meaningful queries of a Doc:

    1- Does the Doc have ownership/investments in the imaging center you are being referred to?

    2-Does the Doc have ownership/investments in the physical therapy clinic you are being referred to??

    3-Does the Doc have investments in the device company that he/she will be using for your “recomended” surgery?

    4-Is the Doc being paid as a “consultant”? …..By whom?

  37. Chris says:

    Ooh, good question nobs. Kind of like Burzynski owning the pharmacy that he sends his patients for over priced pharmaceuticals. Or a chiropractor asking for multiple X-rays.

    Actually, last time my son had an MRI it was at a university hospital, so that was not a real issue. Plus we had to send the 30-day Holter EKG monitor back to the company across the country.

  38. Franky says:

    @nobes
    very good questions… totally agree to you…

    http://www.jackedup.me/

  39. Kultakutri says:

    The other day, I talked to my doc friend. He works in another town so it would be too complicated to get the blood work done by him so he told me to go to my GP.
    Said GP is okay… but for one thing – I’m on antidepressants and she tends to consider me a nervous, excitable and unstable person. And, as of recently, it’s two things. I’ve suffered from excessive sweating and a few other things so I presented my problems, got an answer along the lines of It’s most likely nerves, you poor nervous thing, insisted on an answer to a plain question of What to do when I walk two blocks and I’m literally dripping sweat and look as if I had peed in my pants. GP said that regular medicine can’t do anything and offered me homeopatics. I burst out laughing and as politely as I could, I explained that chocolate is my placebo of choice, thankyouverymuch, and left.

    I don’t know what to think. If the GP thinks it’s psychosomatic and I need a placebo, I find it somewhat offensive because I don’t get stressed easily and if I do, I recognize the feeling just fine. If she believes in homeopathy, then how do I know she’s going to treat me properly?

    I haven’t had any bad experience with said GP, she treats several of my family members, from experience I can say that she’s no woo peddler but I feel uneasy.

    Now what.

  40. Newcoaster says:

    I think most of the points raised by Dr Hall are reasonable. Most physicians don’t have the experience of having to look for a doctor ourselves. Actually, many physicians don’t even have a doctor themselves. I wouldn’t rely on RateMD or similar sites, they are uncontrolled and mostly seem to be ratings by disgruntled patients who didn’t get what they think they should have.

    As a Canadian Family Physician, I have a bias in favour of FP. I do understand that FP’s are not as common in the USA, and often patients have general internists to deal with their primary care needs. In Canada, we no longer are turning out General Practitioners (GP’s) since the early 90′s. In the good old days, after completing 4 years of medical school, one then spent a year doing a rotating internship usually consisting of 3 months each of medicine, surgery, obstetrics and pediatrics. Armed with that knowledge, if one didn’t have aspirations to be a specialist, you hung up your shingle as a GP. These days, Family Practice is a recognized specialty, and in Canada there is a 2 year residency training program.

    Just because a doctor went to a prestigious medical school, doesn’t mean they are a good doctor or free of woo. One of the local family doctors in my small town runs the local diabetic clinic, and is very heavily science based when he wears that hat. Unfortunately, he also likes to do Acupuncture and Therapeutic Touch, which leaves me with a dilemma when referring newly diagnosed diabetics for the teaching sessions.

    You may be interested to know that doctors screen patients as much as patients screen doctors. I see new patients for a “meet and greet”, but there is no guarantee that I will assume their care. You do need to have a good fit, and there are personality conflicts, too high expectations, or a fondness for nonsense that may give me reason to decline taking on a new patient. I am usually upfront with them about my views on AltMed in general, and specifically will tell them that I don’t make referals for chiropractic or acupuncture, as often people need a doctors referral to have AltMed covered by a 3rd party insurer (AltMed is not usually covered in Canada, though sometimes it is partly covered for low income people. Don’t get me started….)

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