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Castle Connolly Medical Ltd. America's Trusted Source for Identifying Top Doctors The Best in American Medicine |
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| USING THIS SITE TO FIND A TOP SPECIALIST |
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This site is organized and planned to be as user-friendly as possible. Still, as with anything as complex as
medical specialties, subspecialties and the myriad of diseases and problems that specialists treat, there needs
to be a system to organize the physicians' names, the diseases and problems they manage and their special expertise. To organize the specialists in this site, we have followed the American Board of Medical Specialties (ABMS) format. The ABMS is the authoritative body for the recognition of medical specialties. Without the ABMS as the official controlling body there would be hundreds of unregulated medical specialties. The ABMS recognizes twenty-five specialties and more than ninety subspecialties. The listing of ABMS specialties and subspecialties can be found here. In addition to ABMS recognized specialties, there are at least one hundred other groups calling themselves "medical specialists" that are not recognized by the ABMS. Some of these groups are working toward recognition and have exams and other standards for membership. Others are organizations of physicians interested in a particular problem or area of medicine that exist to exchange information but have no intention of seeking ABMS recognition. Some groups calling themselves "boards" really have little authority or meaningful standards. Thus, while a physician may state he/she is, for example, a specialist in cosmetic surgery, there is no ABMS recognized specialty by that name. Therefore, you have no idea whether this physician has any special training and expertise or is simply trying to recruit paying patients to a lucrative aspect of surgical practice. You can get information on a doctor's credentials from the doctor, from the doctor's hospital (Medical Affairs Office) or from your health plan if a doctor is in the network. You can also get this information from numerous Web sites, including www.castleconnolly.com. You can check on a physician's board certification by calling the ABMS at (866) 275-2267 or by logging on to its Web site at www.abms.org. If you seek a particular type of specialist or subspecialist, refer to the section of this site covering that medical specialty or subspecialty. There you will be able to further restrict your search to a specific geographic region. Choosing An Appropriate Specialist It may seem that choosing the correct specialist to treat a particular medical problem is simply a matter of finding a top doctor in a specific medical specialty. For treatment of a problem with your vision, you would choose an ophthalmologist. A skin or hair problem would require treatment by a dermatologist and a broken bone would need the care of an orthopaedic surgeon. Sometimes, however, the type of specialist needed may not be obvious. For example, back surgery may be performed by either an orthopaedic surgeon or a neurosurgeon. Different aspects of sports medicine, as another example, are practiced by orthopaedic surgeons who treat sports-related injuries in both adults and children, pediatricians who treat only children or internists and family practitioners whose focus is on prevention of injuries. In some cases, several specialists with expertise in different areas of medical practice all become involved in treating the same patient's health problem. For example, a person with diabetes might need care from an endocrinologist, a cardiologist and an ophthalmologist. In other situations, doctors trained in different specialties may use varied approaches or differing therapies to manage a disease or condition. Such is the case, for example, with prostate cancer: a patient could be treated by a urologist, a medical oncologist, or a radiation oncologist. The urologist might provide the patient with a surgical treatment option, while the medical oncologist would treat the patient with chemotherapy and the radiotherapist would use radiation therapy and/or radioactive seed implantation. All approaches could be successful, or one might be preferable to another, depending on the patient and his condition. Therefore, a wise patient will thoroughly explore all options before making a choice. Finding the right specialist is also important in terms of the quality of your care. For example, many orthopaedic surgeons will operate on hands, but it is clearly preferable to have someone trained and certified specifically in hand surgery (a subspecialty of both orthopaedic surgery and plastic surgery) to perform that delicate surgery. Similarly, a dermatologist may indicate that his/her practice includes cosmetic surgery; however, there is no approved ABMS dermatology subspecialty or fellowship training in cosmetic surgery. While many dermatologists do pursue additional training in cosmetic surgery, it should be understood that dermatologic practice is limited to cutaneous procedures ranging from the removal of skin tumors to laser resurfacing. On the other hand, some board certified otolaryngologists have additional training that enables them to perform cosmetic surgery procedures on the head and neck. Choosing the right type of specialist is as important as selecting the right doctor. For example, the diagnosis of melanoma, a very serious, potentially life threatening form of skin cancer, is missed in many cases. Therefore, if you have a skin lesion that might possibly be melanoma, you should be certain that the pathologist reading your slides is board certified in the subspecialty of dermatopathology. These examples illustrate this important principle: always seek the best healthcare. Look for the best-trained doctors, not those who simply can do the job. That doesn't mean that you need to consult a doctor listed in this site every time you have a health problem. It does mean you should be certain that the physicians who care for you, whether in your community or at a world-class medical center, are trained appropriately and are qualified to provide the care you require. Remember, when it comes to healthcare no one wants second best! Given this complexity, how do you find the right specialist to provide your care? The first and most important person to look to for guidance is your primary care physician. He/she will assess your medical condition, determine the appropriate type of specialist to recommend and perhaps refer you to a specific doctor or doctors. You should always ask your primary care physician why a particular specialist is being recommended, since that specialist may be a colleague in your doctor's medical group or may be the only (or the most conveniently located) specialist of the type in your health plan. Ask how well your primary care physician knows the specialist, whether they have a long-standing professional relationship and if other patients referred to the specialist had successful outcomes. Be sure to ask for several recommendations, if possible, to provide you with some choice among specialists. If you do not have a primary care doctor, try to learn as much as you can about your medical problem and the type of specialist best suited to treat it. However, keep in mind that many diseases or conditions present with symptoms that often are indistinguishable from those of other diseases or conditions, making them difficult to diagnose precisely even for physicians armed with the results of diagnostic tests. Judging The Qualifications Of A Physician The specialists listed on www.CastleConnolly.com are clearly among the best in the nation and have been identified through a rigorous research process and thorough screening by the Castle Connolly research team. Through our extensive surveys and research we have done much of the work in finding a top referral specialist for you. But how do you judge the qualifications of a physician who may not be listed in this site? If you are trying to find a specialist on your own, how should you go about it? How can you tell when a physician has the appropriate training in a specialty and how do you distinguish what is meaningful and what is not from among all those plaques and certificates on a doctor's wall? The following will outline that process for you. In fact, what is written here reflects much of the logic that underlies the selection of physicians for this site. The following material will help you not only in finding a top specialist in this site, but it also should be helpful to you in choosing among the many specialists, primary care doctors and other physicians that you will need to consult throughout your life. The reality is that few of us see only one doctor in our lifetime. Each of us may be cared for by a primary care physician, an ophthalmologist, an orthopaedic surgeon, a dermatologist, a surgeon or a number of other specialists. The choices can be many and they can be among the most important choices that we make in our lives. Education Your review of your prospective doctor's education and training should begin with medical school. While you may feel that the institution at which someone earned a bachelor's degree could be an indication of the quality of the doctor, most people in the medical field do not believe it plays a major role. A degree from a highly selective undergraduate college or university will help an aspiring doctor gain admission to a medical school, but once there, all students are peers. However, the information on undergraduate colleges, if important to you, is available in The Official ABMS Directory of Board Certified Medical Specialists® and other medical directories. American medical schools are highly standardized, at least in terms of basic quality. A group known as the Liaison Committee for Medical Education (LCME) accredits all U.S. medical schools that grant medical degrees (MDs) and osteopathic degrees (DOs). Most also are accredited by the appropriate state agency, if one exists, and by regional accrediting agencies that accredit colleges and universities of all kinds. Furthermore, U.S. medical schools have universally high standards for admission, including success on the undergraduate level and on the Medical College Admissions Tests (MCATs). Although frequently criticized for being slow to change and for training too many specialists, the system of medical education in the United States has insured high quality in medical practice. One recent positive change is a strong effort in most medical schools to diversify the composition of the student body. While these schools have been less successful in enrolling racial minorities, the number of women in U.S. medical schools has increased to the point that women now make up about 50 percent of most classes. In certain specialties preferred by women medical graduates (pediatrics, for example) it is possible that in coming years the majority of specialists will be female. Most doctors practicing in the United States are graduates of U.S. medical schools, but there are two other groups of doctors who make up a relatively small portion of the total physician population. They are (1) foreign nationals who graduated from foreign schools and (2) U.S. nationals who graduated from foreign schools. (Canadian medical schools are not considered foreign). Foreign Medical Graduates Foreign medical schools vary greatly in quality. Even some of the oldest and finest European schools have become virtually "open door," with huge numbers of unscreened students making teaching and learning difficult. Others are excellent and provided the model for our system of medical education. The fact that someone graduated from a foreign school does not mean that he/she is a poor doctor. Foreign schools, like U.S. schools, produce good doctors and poor doctors. Foreign medical graduates must pass the same exam taken by U.S. graduates for licensure, but the failure rate for foreign graduates is significantly higher. In the first year of using the new United States Medical Licensing Exam (USMLE), 93 percent of U.S. medical school graduates passed Step II, the clinical exam, as compared with 39 percent of the foreign graduates. It is clear that the quality of foreign schools, if not individual doctors, is not the same as U.S. medical schools, at least as measured by our standards. Nonetheless, many communities and patients have been well served by foreign medical graduates practicing in this country—often in areas where it has been difficult to attract graduates of American schools. In fact, almost one-third of physicians practicing in the U.S. are foreign trained. In addition, many foreign medical schools and their teaching hospitals are world renowned for their leadership in medical care, research and teaching and many of the technologies and techniques we utilize in the U.S. today have been developed and perfected in foreign countries. Residency Most doctors practicing today have at least three years of postgraduate training (following the MD or DO) in an approved residency program. This not only is an important step in the process of becoming a competent doctor, but it is also a requirement for board (specialty) certification. Most people assume that a prospective doctor needs to complete a three-year residency program to obtain a medical license. That is not an accurate assumption! New York State, for example, requires only one postgraduate year. However, since all approved residencies last at least three years and some, such as those in neurosurgery, general surgery, orthopaedic surgery and urology, may extend for five or more years, it is important to know the details of a doctor's training. Licensure alone is not enough of a basis upon which to make a decision. Without undertaking extensive and detailed research on every residency program, the best assessment you can make of a doctor's residency program is to see if it took place in a large medical center whose name you recognize. The more prestigious institutions tend to attract the best medical students, sometimes regardless of the quality of the individual residency program. If in doubt about a doctor's training, ask the doctor if the residency he/she completed was in the specialty of the practice; if not, ask why not. It is also important to be certain that a doctor completed a residency that has been approved by the appropriate governing board of the specialty, such as the American Board of Surgery, the American Board of Radiology, or the American Osteopathic Board of Pediatrics. If you are really concerned about a doctor's training, you should call the hospital that offered the residency and ask if the residency program was approved by the appropriate specialty group. If still in doubt, consult the publication Directory of Graduate Medical Education Programs, often called the "green book," found in medical school or hospital libraries, which lists all approved residencies. Board Certification With an MD or DO degree and a license, an individual may practice in any medical specialty with or without additional training. For example, doctors with a license but no special training may call themselves cardiologists, pediatricians or gynecologists. This is why board certification is such an important factor. The American Board of Medical Specialties (ABMS) recognizes 25 specialties and more than 90 subspecialties. Visit www.abms.org or call 866-275-2267 for more information. Eighteen boards certify in 106 specialties under the aegis of the American Osteopathic Association (AOA). Visit www.osteopathic.org or call 800-621-1773 for more information. Doctors who have qualified for such specialization are called board certified; they have completed an approved residency and passed the board's exam. While many doctors who are not board certified do call themselves "specialists," board certification is the best standard by which to measure competence and training. Throughout this site a description of each specialty and subspecialty is provided as an introduction to the listing of physicians in that specialty. You can be confident that doctors who are board certified have, at a minimum, the proper training in their specialty and have demonstrated their proficiency through supervision and testing. While there are many non-board certified doctors who are highly competent, it is more difficult to assess the level of their training. While board certification alone does not guarantee competence, it is a standard that reflects successful completion of an appropriate training program. If it is impossible to find a doctor in your area who is board certified in a particular subspecialty, for example, geriatric medicine or sports medicine, at least be certain the physician is board certified in a related specialty such as internal medicine or orthopaedic surgery. Board certified doctors are referred to as Diplomates of the Board. Some of the colleges of medical specialties (e.g., the American College of Radiology, the American College of Surgeons) have multiple levels of recognition. The first is basic membership and the second, more prestigious and difficult to obtain, is status as a Fellow. Fellowship status in the colleges is meaningful and is based on experience, professional achievement and recognition by one's peers, including extensive experience in patient care. It should be viewed as a significant professional qualification. Board Eligibility Many doctors who have been more recently trained are waiting to take the boards. They are sometimes described as "board eligible," a common term that the ABMS advocates abandoning because of its ambiguity. Board eligible means that the doctor has completed an approved residency and is qualified to sit for the related board's exam. Each member board of the ABMS has its own policy regarding the use and recognition of the board eligible term. Therefore, the description "board eligible" should not be viewed as a genuine qualification, especially if a doctor has been out of medical school long enough to have taken the certification exam. To the boards, a doctor is either board certified or not. Furthermore, most of the specialty boards permit unlimited attempts to pass the exam and, in some cases, doctors who have failed the exam twice or even ten times continue to call themselves board eligible. In osteopathic medicine, the board eligible status is recognized only for the first six years after completion of a residency. In addition to the approved lists of specialties and subspecialties of the ABMS and AOA, there are a wide variety of other doctors and groups of doctors who call themselves specialists. At present there are at least 100 such groups called "self-designated medical specialties." They range from doctors who are working to create a recognized body of knowledge and subspecialty training to less formal groups interested in a particular approach to the practice of medicine. These groups may or may not have standards for membership. There is no way to determine the true extent of their members' training and neither the ABMS or the AOA recognizes them. While you should be cautious of doctors who claim they are specialists in these areas, many do have advanced training and the groups at least offer a listing of people interested in a particular approach to medical care. Rely on board certification to assure yourself of basic competence, and use membership in one of these groups to indicate strong interest and possible additional training in a particular aspect of medicine. A list of these self-designated medical specialties may be found here. Recertification A relatively new focus of the specialty boards is the area of recertification. Until recently, board certification lasted for an unlimited time. Now, almost all the boards have put time limits on the certification period. For example, in Internal Medicine and Anesthesiology, the time limit is ten years; in Family Practice, six, and under some circumstances, seven years. These more stringent standards reflect an increasing emphasis on recertification by both the medical boards and state agencies responsible for licensing doctors. Since the policies of the boards vary widely, it is a good procedure to ask a doctor if certification was awarded and when. If the date was seven to ten years ago, ask if he/she has been recertified. Unfortunately, many boards permit "grandfathering," whereby already certified doctors do not have to be recertified, and recertification requirements apply only to newly certified doctors. Even if recertification is not required, it is good professional practice for doctors to undertake the process. It assures you, the patient, that they are attempting to stay current. Many states have a continuing medical education requirement for doctors. These states typically require a minimum number of continuing medical education (CME) credits for a doctor to maintain a medical license. Seven states require 150 CME credits over a three-year period. Osteopathic doctors are required to take 120 hours of CME credits within three years to maintain certification. Fellowships The purpose of a fellowship is to provide advanced training in the clinical techniques and research of a particular specialty. Fellowships usually, but not always, are designed to lead to board certification in a subspecialty such as cardiology, which is a subspecialty of internal medicine. Many physicians listed in this site have had fellowship training. In the U.S. there are a variety of fellowship programs available to doctors, which fall into two broad categories: approved and unapproved. Approved fellowships are those that are approved by the appropriate medical specialty board (e.g., the American Board of Radiology) and lead to subspecialty certificates. Fellowship programs that are unapproved are often in the same areas of training as those that are approved, but they do not lead to subspecialty certificates. Unfortunately, all too often, an unapproved fellowship exists only to provide relatively inexpensive labor for the research and/or patient care activities of a clinical department in a medical school or hospital. In such cases, the learning that takes place is secondary and may be a good deal less than in an approved fellowship. On the other hand, any fellowship is better than none at all and some unapproved fellowships have that status for a valid reason that should not reflect negatively on the program. For example, the fellowship may have been recently created, with approval being sought. To check that a fellowship is an approved one, call the hospital where the training took place or call the medical board for that specialty. Some physicians may have completed more than one fellowship and may be boarded in two or more subspecialties. Also, some physicians may pursue fellowship training and subspecialty certification, but then choose to practice in their primary field of certification. For example, a doctor who is board certified in internal medicine also may have obtained board certification in cardiology, but may choose to practice primarily internal medicine rather than cardiology. For the most part, the physicians in this site practice in their subspecialties. Professional Reputation There are doctors who meet every professional standard on paper, but who are simply not good doctors. In all probability the medical community has ascertained that and, while the individual may still practice medicine, his/her reputation will reflect that collective assessment. There are also doctors who are outstanding leaders in their fields because of research or professional activities but who are not particularly strong, or perhaps even active, in patient care. It is important to distinguish that kind of professional reputation from a reputation as a competent, caring doctor in deliver-ing patient care, or in the case of this site, as an outstanding practitioner in a given specialty. Hospital Appointment Most doctors are on the medical staff of one or more hospitals and are known as "attendings;" some are not. If a doctor does not have admitting privileges or is not on the attending staff of a hospital, you may wish to consider choosing a different doctor. It can be very difficult to ascertain whether or not the lack of hospital appointment is for a good reason. For example, it is understandable that some doctors who are raising families or heading toward retirement choose not to meet the demands (meetings, committees, etc.) of being an attending. However, if you need care in a hospital, the lack of such an appointment means that another doctor will have to oversee that care. In some specialties, such as dermatology and psychiatry, doctors may conduct their entire practice in the office and a hospital appointment is not as essential, or as good a criterion for assessment, as in other specialties. While mistakes are made, most hospitals are quite careful about admissions to their medical staffs. The best hospitals are highly selective, so a degree of screening (or "credentialing") has been done for you. In other words, the best doctors practice at the best hospitals. Since caring for a patient in a hospital is often a team effort involving a number of specialists, the reputation of the hospital to which the doctor admits patients carries special weight. Hospital medical staffs review their colleagues' credentials and authorize performance of specific procedures. In addition, they typically review and reappoint their medical staff every two or three years. In effect, this is an additional screening to protect patients. It is especially true of hospitals that have what are known as closed staffs, where it is impossible to obtain admitting privileges unless there is a vacancy that the administration and medical staff deem necessary to fill. If you are having a surgical procedure and are concerned about the doctor's skill or experience, it may be worthwhile to call the Medical Affairs office at the doctor's hospital to see if he/she is authorized to perform that procedure in that hospital. The reasons for a hospital's selectivity are easy to understand: no hospital wishes to expose itself to liability and every hospital wants to have the best reputation possible in order to attract patients. Obviously, the quality of the medical staff is immensely important in creating that reputation. Physicians listed in this site are primarily on the staffs of major medical centers, usually teaching hospitals, and leading specialty hospitals, e.g. children's, cancer, heart, psychiatric, etc. There are many excellent physicians on the staffs of community hospitals that call themselves "medical centers," but they are not physicians who typically attract complex cases and referrals from outside their area. To learn about a hospital visit its website. It is also useful to review a hospital's accreditation status under the Joint Commission on the Accreditation of Healthcare Organizations at www.JCAHO.com. A new website created by the federal government, www.hospitalcompare.com, offers some measures of comparative hospital quality and may be of interest as well. A last and very important reason why a hospital appointment is an essential requirement in your choice of doctor is that some states permit doctors to practice without malpractice insurance. If you are injured as a result of a doctor's poor care, you could be without recourse. However, few hospitals permit doctors to practice in them unless they carry malpractice insurance. This not only protects the hospital, but the patient as well. Medical School Faculty Appointment Many doctors have appointments on the faculties of medical schools. There is a range of categories from "straight" appointments, meaning full-time appointment as professor, associate professor, assistant professor or instructor, to clinical ranks that may reflect lesser degrees of involvement in teaching or research. If someone carries what is known as a straight academic rank (i.e. "professor of surgery," without clinical in the title), this usually means that the individual is engaged full-time in medical school research, teaching activities and patient care. The title "clinical professor of surgery" usually indicates a less direct involvement in medical school activities such as teaching and research. Doctors who are full-time academicians may be in the forefront of new techniques and research, but they are not necessarily better doctors. Nonetheless, you would be assured that they have the support of other faculty, residents and medical students. When you are seeking a subspecialist, a doctor's relationship to a medical school becomes more meaningful since medical school faculties tend to be made up of subspecialists. You are less likely to find large numbers of general or primary care practitioners engaged full-time on a medical school faculty. The newest approaches and techniques in medicine, for the most part, are explored and developed by medical school faculties in their laboratories and clinical practice settings. This is where they practice their subspecialties, as well as teach and conduct research. Such leading specialists are not necessarily better doctors than community doctors; rather, they are trained to provide a different kind of medical care. Obviously the type of medical care users of this site are seeking is that different kind of care available primarily from top subspecialists at leading hospitals and medical centers. Medical Society Membership Most medical society memberships sound very prestigious and some are; however, there are many societies that are not selective and which virtually any doctor can join. In addition, membership in many of the more prestigious societies is based on research and publication or on leadership in the field and may have little to do with direct patient care. While it is clearly an honor to be invited to join these groups, membership may be less than helpful in discerning whether a doctor can deliver the excellent clinical care you require. Experience Experience is difficult to assess. Obviously, in most cases, an older doctor has more experience; on the other hand, a younger doctor has been more recently immersed in the challenge of medical school, residency, or even a fellowship, and may be the most up-to-date. If a doctor is board certified, you may assume that assures at least a minimal amount of experience, but since it could be as little as a year, check the date of graduation from medical school or completion of residency to know precisely how long a doctor has been in practice. There is a good deal of evidence that there is a positive relationship between quantity of experience and quality of care. It may be that, the more a doctor performs a procedure, the better he/she becomes at it. That is why it is important to ask a doctor about his or her experience with the procedure that you need. Does the doctor see and treat similar cases every day, every week or only rarely? Of course, with some rare diseases, rarely is the only possible answer, but it is relative frequency that is critical. Major metropolitan areas, especially New York and San Francisco, became leaders in the treatment of AIDS because of the number of patients seen in those metropolitan areas. Doctors in the suburbs of New York City (especially in New York's Westchester, Nassau and Suffolk counties) and in Fairfield County, Connecticut became leaders in the research and treatment of Lyme disease because that region is the epicenter of the disease. In some states, data is available on volume or numbers of certain procedures performed at hospitals. For this information in New York you can call the Center for Medical Consumers, a non-profit advocacy organization, or visit its web site at www.medicalconsumers.org. For volume and outcome information in other states, visit the web site of Health Care Choices at www.healthcarechoices.org. The federal government has posted outcome data for hospitals, but for a limited number of procedures, on a website www.healthcarecompare.com. There is a good deal of controversy, however, on the validity and usefulness of such data. Opponents cite the fact that some of the data is produced from Medicare patient records only and, thus, is based solely on an elderly population that does not represent the total activity of a hospital or doctor. Proponents of the use of such volume data agree that it is not perfect, but suggest it can be one useful criterion in selecting the best places to receive care for these specific problems. The one type of experience you should specifically want to know about is that dealing with any special procedure, particularly a surgical one, that has recently been developed and introduced into practice. For example, in the 1980's many doctors using laparoscopic cholecystectomy, a then new surgical technique for removing gallbladders, experienced a high percentage of problems because they were not properly trained. This prompted the American Board of Surgery to announce new standards for the training of surgeons using this technique. Do not hesitate to ask about your doctor's training in a procedure and how frequently and with what degree of success he/she has performed it. Practice may not lead to perfection, but it does improve skills and enhance the probability of success. In some cases, relatively young doctors have recently completed residency or fellowship training under recognized leaders who have developed new approaches or techniques for dealing with a particular problem. They may have learned the new techniques from their mentors and may be far ahead of the field (and ahead of more senior and distinguished colleagues) in using those approaches. So age and experience must be considered and weighed along with other factors when choosing a physician. Second Opinions Second opinions are a valuable medical tool, too infrequently used in many instances and overused in others. Clearly, you do not want to seek another doctor's opinion on every ailment or problem that you face, but a second opinion should be pursued in the following situations: • before major surgery • if the diagnosis is serious or life threatening • if a rare disease is diagnosed • if a diagnosis is uncertain • if the number of tests or procedures recommended might be excessive • if a test result has serious implications (e.g., a positive Pap smear) • if the treatment suggested is risky or expensive • if you are uncomfortable with the diagnosis and/or treatment • if a course of treatment is not successful • if you question your doctor's competence • if your insurance company requires it Most doctors will be supportive if you request a second opinion and many will recommend it. In many cases, insurance companies will pay for second opinions, but check ahead of time to make sure your insurance plan does cover them. In an HMO you may have to be more assertive because one way HMOs control costs is by limiting second opinions. Often, the opinion of a second doctor will confirm the opinion of the first, but the reassurance may be worth the time and extra cost. On the other hand, if the second opinion differs from the first, you have two alternatives: seek the opinion of a third doctor, or educate yourself as much as possible by talking to both doctors, reading up on the problem, and trusting your instincts about which diagnosis is correct. Office And Practice Arrangements Although clearly not as important as training or reputation, a specialist's office and practice arrangements often are of significance to patients. Practice arrangements include office hours, office location, billing procedures and accessibility among the many factors that result in how well the office is run. Some specialists only will see new patients who are referred to them by another doctor. Therefore, you may need to have your treating physician contact the specialist's office to arrange for your initial visit. Your health plan may also require that your primary care doctor provide a referral. If English is not your first language, it may be advisable to determine whether someone in the specialist's office speaks your primary language or if a translator can be present during appointments. This will ease communication and assure that all questions, responses and instructions are understood. Accessibility of the specialist's office may be a concern if you are wheelchair-bound, are elderly or cannot climb stairs or negotiate narrow corridors. Convenient parking may also be important to you. Other arrangements that may need to be made in advance of your first visit or discussed with the specialist's office staff concern payment. You may wish to ask the following: • Does the specialist accept your health insurance coverage? • Is the specialist within your plan's network and will you need to pay a co-payment? Or, is the specialist out-of-network and will you have to pay for your care out-of-pocket, meet a deductible or submit a form for reimbursement? • Are credit cards an acceptable mode of payment? • Does the specialist accept Medicare, Medicaid or no-fault insurance? Does the specialist treat workers' compensation cases? • If you are a non-resident of the United States, will you need to arrange for the transfer or exchange of currency to pay the specialist's fee? When you are choosing a top specialist, these issues may be of lesser or greater importance, depending on the problem and type of care warranted. If you are traveling a great distance to have a specific procedure performed by a top specialist at a major medical center, continuing long-term monitoring or follow-up care by that physician may not be required or may not be feasible and such things as office practice arrangements are of less importance. On the other hand, if you have a chronic problem that needs to be monitored with follow-up care provided by the same top specialist, then such issues as accessibility of the doctor's office, appointment hours, waiting times and courtesy and professionalism of the staff become more significant. Personal Chemistry One element of the doctor-patient relationship that we stress in our guides is chemistry between doctor and patient, a part of which is often referred to as a doctor's "bedside manner." While this factor is of major import in a long-term relationship such as one you would have with your primary care physician, it is of less importance when you see a specialist only once or twice. However, since many people using this book may have chronic conditions that require ongoing care, it is important to give the matter some consideration. It is vital that there is a sense of mutual trust and respect between patient and doctor; a judgment that individuals must make for themselves. Among the many talented doctors listed in this guide, there are very likely some to whom you would relate well and others with whom you may not feel as comfortable. Patients prefer doctors who listen, demonstrate concern, are responsive to patient needs and spend sufficient time with them. The qualities of physicians in this regard, even the excellent ones in this guide, vary immensely. You, the patient, are the only one who can assess these qualities because individuals react differently to various personalities. It is important for you to carefully judge your feelings towards a physician, especially if you are embarking on a long-term relationship. You should feel you can be open, trusting and responsive to your physician and that your relationship will be a positive one. Otherwise, find another doctor, since not doing so could adversely affect your care. Once you have used this guide to identify the top specialist(s) best suited to treat your condition, there is much you can do to maximize the value of your first visit. |
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