Aniruddha Malpani, MD

The ideal doctor would be one who is : competent; compassionate with 	a caring attitude ; experienced; with a well-organized practice - and has all the time in the world for you! While 	you may never find someone who meets all these criteria, how can you find a good doctor to take care of you?

It's not easy finding Dr. Right- there's no guaranteed way to do it. 	The physician who's Dr. Right for you could be Dr. Wrong for your mother-in-law. But there are strategies for homing 	in on the doctor with whom you can develop the right chemistry for a life-time relationship.


 	First, find a primary-care doctor- this could be a physician, or a family doctor. Women can use the services of 	a gynecologist, and for your children you will need a pediatrician.

Your primary-care physician should be someone who will take care of you, 	and will coordinate and oversee your care, referring you to a specialist if needed. It is not a good idea to consult 	the "top" specialist for every problem, though this seems fashionable these days- for example, going 	to a neurologist for a headache. This can lead to your getting poor-care- specialist often order unnecessary tests 	(which are expensive and painful) to rule out rare diseases (after all, 	they are specialists, and they cannot afford to "miss" a diagnosis!).

The best time to find a doctor is when you don't need one! Ask your friends 	for recommendations. A good source of referrals can be nurses and other paramedical staff. If you have a friend 	who is a doctor, ask him for advice as well.

The yellow pages can be also be a useful source of possible names if 	you need to make a comprehensive list. Phone the doctors on your list. This might seem like a strange thing to 	be doing, but "telephone shopping" can provide you with a lot of useful information about the practice 	(such as office timings, fees, qualifications, hospital attachments, special interests).

If the receptionist cannot provide this information, ask to speak to 	the doctor or his assistant (please do this at a time convenient that you have been referred to him and need more 	information). Let your fingers do the walking! Finally, make an appointment to talk to the doctor in person- and 	please be prepared to pay for this! If you find your doctor is helpful and has time to listen to you, then you 	are on the right track.

At this first consultation, not only does the doctor get to know your 	medical problems and examine you, but you also get to know a lot about the doctor and this initial assessment is 	important:

Often patients will stick to one doctor, even when they are not happy 	with him, simply because their family has been going to him for years (remember, doctors age too, and he may not 	be as good as he once was!), or because "he knows my case"- but don't hesitate to change doctors if necessary.

Is the clinic located in a good building?

Is public access easy? What about the car parking?

Is the clinic itself comfortable? Has the doctor bothered to provide 		the basic amenities you need ( eg, drinking water, comfortable seating )?

What kind of reading material is kept in the waiting area? Old and torn 		magazines are a negative mark .

Patient educational literature and current issues of health magazines 		means the doctor respects your waiting time and uses it to educate you.

Is the office staff helpful? How do they answer the telephone?


 	The commonest complaint patients have about their doctors is that they are made to wait for ages! It is only because 	patients put up with it that doctors get away with this unpardonable behavior. After all, no doctor will remain 	very busy if all his patients decide that they refuse to wait for him!

Some patients seem to believe that the longer they have to wait outside 	the doctor's clinic, the better he must be, since he is so many patients to see. This is simply not true! No matter 	how busy the doctor, he can always space appointments, so that you never have to wait for more than 30 minutes 	to see him . If he consistently makes you wait longer than this, it means he does not respect you enough to value 	your time! This doctor is implicitly saying," I do not need you - I have more than enough patients to keep 	me very busy." Let his patients keep him busy, and find someone who respects you and your time more than he 	does.

Some doctors will deliberately overbook- the more patients they see, 	the better their income. While an occasional delay is unavoidable - since a medical emergency could require your 	doctor's immediate attention- if you are made to wait each time, something is seriously wrong with the doctor's 	attitude towards patients. For any delay, the office staff should have the courtesy to provide an explanation, 	and an alternative appointment.

As an example of efficient patient management, if the doctor's at the 	famous Mayo Clinic in the US make you wait for more than 30 minutes without an explanation, you can complain to 	the hospital manager who will rectify matters.


 	Are these convenient to you?
 	What happens on weekends and after office hours? Is he available for emergencies?
 	Does he have a partner who shares his responsibilities?


 	Does your doctor try to minimize your visits- for example, are blood samples collected in the clinic to be forwarded 	to a reliable laboratory, or are you sent to the laboratory yourself?
     Are basic services provided in the clinic itself? ( 	eg,, ECG in the case of a physician?)


 	Beware quacks! Find out what each abbreviation listed behind the doctor's name means- not all of them are legitimate 	degrees. For example, many doctor's will put FICA (USA) and FRSH (London) behind their names to give the impression 	that they have trained abroad. These acronyms are not qualifications- they are just memberships in a society abroad, 	which are open to anyone- even a barber- on payment of a nominal fee!


 	At which hospital does the doctor have admitting privileges? While attachment to a large hospital has benefits, 	if your doctor is attached to many hospitals ( as is common today), it might also mean that is so busy running 	around from one place to another that he has little time for you.

 	
 	Are his fees exorbitant? Just because he is more expensive than others does not mean he is better!


 	Are yours records well maintained? Are they filed so they can be retrieved in an emergency? 
 	Are they up to date, and complete?
 	Has your doctor taken the time and trouble to explain them to you so that you understand them?


 	Does your doctor take a careful history, asking you probing questions about your medical problem?
 	Does he do a careful physical examination? Remember, a careful clinical examination provides much more information 	than anything else!
 	Does the physician sit when talking to you? Talking while standing is a sure sign that he is too busy to listen!
 	Does he give you educational materials to read at home about your problem?


 	Does your doctor always prescribe drugs for all problems, even minor ones? Over 50 percent of problems that take 	you to the doctor are relatively minor and will resolve on their own, without any treatment - worry about a doctor 	who dispenses too much!

Does he bother to explain why you need them?

Does he insist that you get all your tests done only in a place he specifies, 		without giving you a good advice? If so, you should suspect his referral - he may have an ulterior motive?


 	When making decisions regarding your medical care, does your doctor explain them to you? Offer alternatives? Does 	he treat you as an intelligent person who can understand, and encourage you to participate in the decision - making 	process?


 	Does your doctor explain why he is referring you to another doctor? 
 	Does he contact the specialist and utilize his knowledge effectively to improve your care?

 
 	When he advises surgery, does he explain the risks and alternatives?


 	Does he explain why you cannot be treated outside hospital? Sometimes, hospitalizing you is in the doctor's best 	interests, rather than yours (Since all his other patients are in hospital, it's easier for him to take care of 	you here but it doesn't follow that it's the right place for you. Keep out of hospital if you can!).


 	Day care surgery is surgery that does not require Hospitalization. Operations performed on a day-care basis include 	hernia repair, laparoscopy, tonsillectomy, and cataract removal. The operation usually takes less than two hours; 	an recovery care is provided at home.

Day care surgery allows patients to recuperate at home . After all, why 	should you stay in hospital if you can go back to the comfort of your own bed at home with no risks? Day care surgery 	is much more patient-friendly and, if you are advised surgery, ask your doctor if you can get it done on a day-care 	surgery basis, rather than in a hospital.


 	Never be afraid to seek a second opinion. A good doctor will encourage you to do so if needed, and will welcome 	someone someone else's confirmation of his opinion- after all, there are no black and whites in medicine. A doctor 	who resents your request for a second opinion, or who makes you feel uncomfortable for asking for one, is likely 	to be unsound, and you should take his advice with caution.

How to be sure you are getting good care:


 	Ask yourself the following questions at the end of each visit, to keep a scorecard.

Did the doctor spend enough time with you?

Did he explain your condition so you could understand?

Do you know what you should do now? And not do?

Has he given you a follow-up appointment?

Patients who know how to make the most of their doctor get better medical 	care- it's that simple! The doctor-patient relationship is very special- it's personal, it's private and it's different 	for every person. It is unique- and since it is the ultimate one-on-one relationship, where you confide in your 	doctor and entrust him with your life, you must find a doctor you can trust and be comfortable with. You need to 	work as a team with your doctor.

In order to foster this relation, treat it with care and respect. Don't 	forget to say "Thank you" when you get better- a doctor gets fed up of seeing patients with complaints 	all day long, and it's nice for him to hear a patient say he is better thanks to the doctor's care. Unfortunately, 	this is something we often forget- and patients tend to remember the doctor only when ill. Saying you're better 	also makes your doctor remember you as a person and treat you as a special patient - and getting VIP attention 	from you helps to improve your medical care!

There is no one doctor who is Dr. Right for everyone - there is a special 	chemistry sometimes - but you need to hunt for the doctor who is right for you, depending upon your temperament, 	personality, and perhaps age and sex. Patients have different personalities - some need to be told what to do while 	others want all their questions answered - so obviously they will need different types of doctors. Each patient 	will find the doctor he deserves!

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The ideal doctor would be one who is : competent; compassionate with a caring attitude ; experienced; with a well-organized practice - and has all the time in the world for you! While you may never find someone who meets all these criteria, how can you find a good doctor to take care of you?

How to Find Dr Right!

I had an interesting email come in the a few weeks ago from a woman looking 	for advice on finding a doctor:

I got your email from OB-GYN net and they said I should ask you my question. 	I am pretty sure that I am pregnant, but we are unsure about how to choose a good doctor. I live in NC, but just 	want some tips to make sure I get a good doctor. Do you have any tips that you can share with us? I would appreciate 	any advice that you could give to me. Thank you for any help you can give.

I decided that this was a good question for the OBGYN Forum, OB-GYN-L. 	The answers were interesting . I called my message " How to Pick a Doctor". Mark Lawson of Lubbock correctly 	pointed out that you "pick" cotton and "choose" a doctor. But ultimately we gals in the south 	just want to pick a doctor we cotton to. ;-) Here is some of the good tips I received:

We must note that a "good" doctor was specified. Which raises 	the question, what constitutes a "bad" doctor? Should we have record of his academic grades through medical 	school? Since most medical examinations end in honours, pass or fail should "good" be further qualified. 	Does good mean honours graduate? Academic excellence does not necessarily translate into "good" clinical 	skills or "good" people skills. Good surgical skills, good diagnostic skills, good clinical acumen, good 	patient relations, good listener.... Should we look at competence then. Competence does not translate into "good". 	I think that you have hit the nail on the head. Exactly what is this entity "a good doctor"? I think 	the Hippocratic oath tried to define it. Simply put: A "good" doctor ensures that his or her patient 	receives the best medical care at all times.

Call L&D (labor and delivery) and ask to speak to the L&D 	charge nurse, be diplomatic, tell her you're new in town and wondered if she would know of a good physician, **aside** 	contrary to stated beliefs elsewhere, this does not force her to consider the "bad" rather she feels 	proud to exhibit her altruistic nature **end aside** ask her for several references, maybe three, she is not in 	a position to play favorites... usually she will name three....(her favorite is #2 I've heard tell) 3)Call back 	and ask the question of the other 2 L&D charge nurses during their shifts.... (7-3)(3-11)(11-7)... if any of 	the referrals match that might be your person... Still remember, how you get along with your physician is a key 	factor, but we have heard good things about this technique....

A variation on (Mark’s) theme that I often use is to recommend a call 	to the chief resident at a teaching hospital, and ask her/him the same questions.

This is very interesting and I have to say I have been asked this 	question myself on many occasions by friends/acquaintances/relatives who were going somewhere else for Ob care, 	specifically where I did not personally know any of the docs.

My standard answer has been very similar to Mark Lawson's…I believe 	it says quite a bit when the nurses who *see you doing your thing* on a daily basis vote with their feet. As most 	know it helps to be a good surgeon etc., but the art of *practicing* medicine involves so much more. So talk to 	the people who see you being a practitioner every day...

My fail proof method of finding a good Dr. in a new town is to call 	the chief resident on the service which is needed and ask him/her who she/he would see if they had the problem. 	If no residency program in town, check with the medical society.(not near as good as first method only requirement 	here is membership)

And then in my nightly Net surfing I ran into an article addressing this 	very topic. "Choosing an Ob-Gyn" by Susan Feightner.

She agrees with the doctors methods and has some very detailed advice 	on what type of questions to ask before you make a final decision.

It all made me stop and realize how most of us don’t spend enough time 	making this decision an informed one. We should because the relationship between a woman and her Ob/Gyn is usually 	a long one and impacts many of our major life events.

I sent all the opinions off to the lady with the question and here is 	her reply:

I wanted to say Thank you so much for all your help. We had no idea 	where to start, but I have an appointment on Friday with a doctor, but will only be talking and looking things 	over to make sure I like the place. He owns the Birthing Center here, but is just a doctor too. I want to make 	sure the option of drugs is there if I want them. We had only a few that we could choose from that our insurance 	company recommends, so I hope I picked the right one.

Certainly armed with all the good advice of the physicians she’s off 	to a good start.

Now if we could only figure out a way for doctors to only pick the "good" 	patients we’d really be on to something! ;-)

If you have questions or comments about this article, please post them 	to the 

I had an interesting email come in the a few weeks ago from a woman looking for advice on finding a doctor:

Aniruddha Malpani, MD

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How to Find Dr Right!

Choosing a Doctor