CHOOSING A NEW DOCTOR TO TAKE HEALTH CARE FOR OLDER PEOPLE: ACCESSIBILITY AND QUALITY OF THE SERVICES
Accessibility
Find out if the office is close by or near public transportation. Will it be easy to get there if your health changes for the worse? Assess how easy it will be to reach the doctor. What are the office hours, and what is the policy if an emergency occurs after hours? Is another doctor on call when yours is unavailable?
If the doctor is part of a group practice, the associates will cover. Doctors in solo practice generally make arrangements with another practitioner to take their calls when they are away. Be as sure as possible that you will be able to get immediate attention when you need it.
Answers to these questions will help narrow your choices. When you visit, look for the following signs.
Quality of the services
Is the doctor prompt, or are you kept waiting for hours? Is the office clean and well equipped? Are you given a thorough examination?
On this first visit, expect the doctor to spend a good deal of time reviewing your medical history. Be prepared to discuss everything important: your major illnesses and operations, the drugs you regularly take, bad reactions to past treatments, any allergies or sensitivities. Get a sense of whether the doctor is questioning you fully and giving you ample time to talk. In the physical examination, the same considerations apply. Is this someone who seems careful and competent? Is this a person you feel comfortable with and can trust?
Look for signs of geriatric sensitivity. Does the doctor dismiss symptoms that bother you as “old age”? Do you get the feeling that what you say is being discounted because you are over seventy-five? Does this person seem to prescribe drugs precipitously? Are you carefully questioned about the medications you are taking now?
If you have a chronic disease, the doctor should be concerned about how your condition is affecting your ability to function and knowledgeable about the total approach to care discussed earlier – rehabilitation, supportive aids and community services. Choose someone who seems interested in more than the strictly physical side of your disease.
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GENERAL HEALTH
General Health
HIGH-QUALITY MEDICAL CARE FOR OLDER PEOPLE: SELECTING A NEW DOCTOR
Changing doctors is an unpleasant task that many older people face, not just the few who awaken to the fact that their trusted family physicians are less than competent. You may have moved after retirement. Or you and your doctor may have grown old together. One year he decides to retire. It is hard to start again from scratch after losing a relationship that may have spanned much of your adult life. You may feel no one will know your body in the same way. Never again will you get the same special attention or care.
These fears are natural. Anyone we have such an intimate relationship with for so long is bound to seem irreplaceable. The truth is that transference is transferable. Provided you make a determined search, you can find a doctor you will eventually feel just as enthusiastic about. But you must choose wisely. Make selecting a replacement a special project. What other investment of time is more important? (Once again, it may be helpful to enlist another person in following the next suggestions, a competent “buddy” who can work with you – or even take over the job – in making this project succeed.)
Develop a list of names. Question friends and relatives, but give most weight to recommendations by doctors or other health-care professionals. They will be better able to evaluate candidates’ skills. You can feel more confident that someone they suggest is competent, not just affable.
Check the credentials of each person on your list. What training and education does the doctor have? Does he or she have an academic appointment at a medical school? What hospital is the physician affiliated with, and what is its reputation? To get these facts, either call the doctor’s office directly or ask your county medical society.
Expense. Find out the doctor’s fees and when payments are due. If your financial situation is tight, would it be possible to arrange a special payment schedule to fit your budget? Find out if the doctor accepts Medicare (or if you are eligible, Medicaid), and if so, for what services. Will the office bill Medicare and your insurance carrier directly?
Medicare will pay only for the services of licensed physicians. Your doctor may bill Medicare directly, or you may pay and then be reimbursed by Medicare. Whatever arrangement you have with your doctor, after you pay the yearly deductible, Medicare pays 80 percent of what it deems the “reasonable charge,” and you pay the other 20 percent. If your doctor charges more than the “reasonable charge,” you are responsible for the additional amount.
If feasible, choose a doctor who takes what is called “Medicare assignment.” This means that even if his normal fee is higher, he agrees not to charge you more than Medicare will cover. Those who accept Medicare assignment also submit claim forms directly to Medicare, which will save you time. Unfortunately, however, it is increasingly hard to find a doctor who does accept assignment. Because of Medicare’s stingy reimbursement rates, nationwide 72 percent do not.
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General Health
