> WHICH DOCTOR TO CHOOSE?
Going to the doctor is easy. You simply go to the nearest hospital or medical center, ask the nurse on duty, and she will immediately assist you to a doctor that suits your ailment. Of course, you will just be meeting with whoever is available at the moment. But choosing a doctor, well, that is the confusing part. Know that there are different types of doctors for different types of conditions.
Dealing With Your Doctor
The Physical Exam
The Need for Medical Tests
Common Tests for Screening Healthy People
Your Friends at the Hospital
The HMO: Linking the Patient and the Doctor
With the many ailments and illnesses that plague man today, a doctor's job has expanded from just a simple general check-up to looking after specific body parts or organs. Hence, the field of medicine has branched out into several sub-types that target on specific areas of the body. With these branches are the different types of doctors that see into problems arising from these areas. It is important for us to know our doctors and what his specialization is.
The list of Special Doctors are just some of the specialists you would need and meet when choosing the best doctor that fits your particular need. However, knowing one's specialization is merely a step in choosing the right doctor. There are still many factors to consider in choosing Dr. Right.
Besides having a preference for a man or a woman, or picking a doctor whose office is in a convenient location, how are you supposed to choose? What's worse, choosing a doctor happens to be a very important decision you have to make, as you would be entrusting your life to him/her. Besides, you would want someone who is not just competent, but warm and compassionate as well.
Pointers to Choose the Doctor That Would Be Right For You:
In the event that you hear anything negative about a doctor you are considering, ask about it and give the doctor a chance to explain his side. Note that before committing to a doctor, you should always have a one-on-one interview with him/her. By getting to know your doctor personally, you will be ensured that the one you will choose will truly be to your liking.
- Choose someone recommended by a friend, relative or colleague. This way, you will somehow know that you are going to "click" with the doctor you would choose.
- Ask around from someone in the medical profession. A nurse working in a hospital would surely have an idea who the best doctor in her hospital would be.
- Once you have narrowed down your choices, you can do a little background checking, e.g. education and training, board certification, licensing and discipline, hospital affiliation, commercial background profiles or malpractice suits. You can get these pieces of information by asking around.
Dealing With Your Doctor
Many people often get nervous whenever they are set for an appointment with their doctors. This is quite normal. In order to make your visits to the doctor more meaningful and smooth, you can follow a few steps before you go on to your next visit. With these strategies, doctors may be more open in trying new and better treatment methods and identify other health problems that might have been overlooked.
Keep a daily record or journal of events related to your health care. You don't need to jot down something everyday, just the important events related to your health. This includes:
Educate yourself. Read about as much as you can about your ailment and the treatments available.
Prioritize appointment objectives. Before the appointment, list down things you wish to address the doctor. Remember that your doctor is busy and won't have time to answer all of your questions.
Be assertive during the appointment. Avoid being passive and being too aggressive.
Understand your illness and symptoms, but leave the final diagnosing to the doctor. Remember that if you are not satisfied with his diagnosis, you can always get a second opinion.
In cases of physical and lab exams, and prior to surgery, go to your appointment about an hour before your scheduled appointment. Also follow instructions carefully, especially those pertaining to specific diets that some tests may require.
- Previous blood test results
- Dates of shots taken
- Medications taken
- Dates and location of diagnostic procedures including their results
- Unusual symptoms
The Physical Exam
These days, where medicine has been highly dependent on modern technology, doctors still rely on their senses to detect slight physical changes that may indicate a disease. During your visit to the doctor, you may notice your doctor doing these things to your body that are considered part of your routine check-up.
Auscultation - The doctor listens to your heart, abdomen, and lungs through a listening instrument called a stethoscope. Certain diseases produce sounds that are distinct only to them.
Palpation - With the palm of his hand, your doctor applies pressure on your abdomen, neck or chest, feeling for abnormal masses, enlarged organs, or areas of tenderness.
Percussion - The doctor performs a series of tapping motion over your chest, abdomen and back, listening for a dull sound that may indicate a disorder inside your body.
Reflex Test - This is done my tapping the front of a bent knee with a reflex hammer. Your knee normally makes a jerking motion, indicating that the nerve circuit between the central nervous system and the muscles controlling the knee is functioning normally.
The Need for Medical Tests
How necessary is a medical test in a physical exam of an individual? Are all these tests necessary every time you have a check-up? In the United States, experts say the at least $30 billion is spent on medical tests. Half of this amount, they say, was simply unnecessary. To know whether you need to undergo all the checks or not, here are some pointers you may need to ask your doctor before you schedule your next physical exam.
What do you hope to know from the test? A test is normally advised by your doctor to help him verify whether his suspicions regarding your state of health are correct or not. The results of these tests aids a doctor in finding a treatable disease, rule out a disease for which you show symptoms of or are at risk, or monitor an illness and its treatment.
Are there any other ways? If a condition is not that serious or may not be treated during its early stages, simple monitoring and observation over a period of time will do just fine. Another alternative is by taking simpler, cheaper tests that may give you an almost accurate result as compared with mere observations.
What risks do you have to face? A test is generally safe, unless it involves radiation. Normally, people undergoing X-rays or other tests that involve radiation, and other "invasive" tests or those that involve introduction of something into the body, i.e. an instrument (e.g. endoscope), or substances (e.g. drug substances) are face more risk.
How much will it cost? For some tests, clinics may only charge you with a laboratory fee. Others may require paying the specialist and other hospital bills. Normally, doctors can tell you an estimate of how much a test will cost, although you will have to arrange with your insurance company directly to find out whether or not it covers a particular test's cost.
Aside from these basic questions, you need to ask your doctor how the tests will be performed and what it involves. Most tests take several minutes and do not cause pain or discomfort. Others may take hours, require X-rays and other "invasive" tests, whereas some may require taking a sedative or receiving a local or general anesthetic, which may produce unpleasant side effects. There are also some tests that require special diets and food restrictions before they are conducted.
You also need to know where the test will be conducted and who will be performing the test. There are quite a few tests done inside the doctor's office, while most others are done in a separate clinic, laboratory or a specialist's office. There are some hospitals that do administer tests on an in or outpatient basis. The person performing the test could be your doctor, a technician or aide, or a specialist.
Common Tests for Screening Healthy People
A very essential part of a doctor's preventive care is a series of simple screening tests that can detect diseases (or the potential for a person to develop it) before visible symptoms start to appear. The kind, the date and the manner by which a test will be given normally depends on your age, health, personal and family medical history, and your doctor's preference.
The following are some screening tests that your doctor may request you to take in connection with a routine physical exam.
Blood Pressure Test - The BP Test is done to check for hypertension, or chronic high blood pressure. Blood pressure readings are given as systolic over diastolic pressure, e.g. 120/80. This is often taken with an instrument called a sphygmomanometer. An inflatable cuff attached to a pressure gauge is wrapped around the upper arm and inflated until blood flow stops. Listening through a stethoscope positioned just below the cuff over the brachial artery, the doctor or nurse deflates the cuff until the sound of blood surging through the arteries is heard. This records the systolic pressure. When the cuff is further deflated, the sound of blood flowing slowly dies down. This is when diastolic pressure is recorded. Experts recommend that this test be done every 2 years if blood pressure is below 140/85, or yearly if last diastolic reading was 85 to 89.
Blood Test - There are many blood tests available in the medical field. However, the most common of these blood tests is the complete blood count (CBC). This test measures the number and proportion of blood components primarily done to screen for anemia (low red blood cell count). Another frequently performed blood test is the measurement of cholesterol levels in the blood. These tests are performed by extracting blood from the patient, after which the collected blood is analyzed in a laboratory using chemical means and via computer analysis. Experts tell us to have a CBC every 5 years before the age of 65 and every 2 years thereafter. Cholesterol levels should be monitored every 5 years; more often if the results read more than 200.
Chest X-ray - Chest x-rays detect infections (mostly pneumonia), tumors and other disorders of the lungs, chest cavity, and rib cage. People who normally take this are those suspected of having lung problems or those who are considered as heavy smokers. Just make sure that before taking this very quick test, you have to remove all jewelry, dentures and other objects that can produce object on the film and create confusion in interpreting the results.
Electrocardiogram (ECG or EKG) - This test detects abnormal functioning of the heart by recording the electrical impulses that set off contractions of heart muscles. The test is normally done by attaching electrodes on the body with conductive gel. These electrodes are attached to a recording machine that displays the heart's electrical activity as a tracing on a screen or a strip of paper. There are two variations of this test. A resting ECG is a relatively good indicator of the heart's history, though it may not predict future problems. An exercise ECG is given while the patient is exercising, normally on the treadmill. Otherwise known as the stress test, exercise ECK is used to help diagnose chest pain, assess the heart's functional capacity, and to determine exercise tolerance.
Fecal Occult Blood Test - Often times, our stool tells us if we are sick or not. The fecal occult blood test detects the presence in the stool of occult (hidden) blood, which can be a sign of a number of ailments, e.g. hemorrhoids, polyps, cancer. Patients normally provide the stool sample before a scheduled check-up; the sample should be placed in a sterilized bottle to avoid false readings.
Mammogram (breast X-ray) - This is done to test for the possibility of breast cancer at an early stage before it become apparent through self-examination. A patient normally asked to strip down to her waist wearing a lead apron to protect her reproductive organs. She then places one breast at a time on an X-ray plate. The breast is compressed against the plate, which may cause a little discomfort to women and several angles of the breast are taken. A mammogram is usually recommended for women between the ages 35 and 39, or every two years for women from 40-50 and yearly thereafter.
Pap (Cervical Smear) Test - This test helps detect cancerous and pre-cancerous cells in the cervix before signs of advanced cancer become visible. These tests should be taken thrice, once year apart starting at age 18. It is performed every 3 years thereafter. This test is usually performed as part of a woman's pelvic exam where a spatula is used to gather cells from the cervix through scraping. Cells are analyzed in a laboratory and are sent back to the doctor for patient evaluation. The test is generally painless, usually taking only 5 minutes of your time.
Urinalysis - Aside from the stool, the urine also provides valuable information about the state of health of the body as a whole and the kidneys in particular. This test screens many infections and diseases, e.g. liver, kidney, and urinary tract disorders and diabetes. The patient is often asked to urinate into a clean, dry container at home or at the doctor's office. Random sampling is done and chemical analyses are performed. Experts agree that individuals should have their urine checked every 2 to 5 years before the age of 65, and yearly thereafter.
Your Friends at the Hospital
Whenever you enter a hospital, you will see that not all the people who work there are wearing white coats or donning stethoscopes around their necks. Who could they be? Understand that a hospital is not a place where only doctors work. Each hospital has its own organization and staffing system. As a result of this, titles and responsibilities of the medical work force may vary from hospital to hospital. Aside from the medically inclined people who are responsible for a patient's day-to-day care, a hospital also employs many others in administrative, financial, and housekeeping capacities.
It is always good to know that there are three major divisions of hospital employees: the medical staff, the nursing care and others. Summarized below are the different people you will meet in a hospital on a typical day.
- Attending Physician - Medical doctor who takes charge of patient care. This doctor orders all treatments, medications, tests and procedures and is normally the patient's primary physician or surgeon.
- Consultant - Specialist called in by the attending physician to give opinions or verify suspicions through tests or procedures.
- Resident - A qualified medical doctor under training in a specialized field after finishing basic medical school. Residency normally takes 3 to 7 years to finish. First year residents are also known as interns.
- Senior Resident - A qualified medical doctor in his final year of specialization. Supervised by the attending physician, this doctor has the most responsibility for a patient's care.
- Medical Student - A student taking up medicine at the school affiliated with the hospital in his third or fourth year.
- Physician's Assistant - Healthcare worker who helps the physician by performing routine procedures, e.g. taking medical histories and blood pressure. He may work for a doctor rather than for the hospital.
- Head Nurse - In many hospitals, the registered nurse with the greatest nursing responsibility on a floor, ward or a special unit, e.g. intensive care or emergency room. She sees to it that all the patients' needs and doctors' orders on her area of responsibility are met accordingly.
- Charge Nurse - A registered nurse in charge of the floor, ward, or unit for a particular shift. She may take the place of the head nurse during evenings and night shifts.
- Primary Nurse - Also known as the team leader, she is the registered nurse in charge of a patient's nursing care; she coordinates tests, procedures and treatment.
- Staff Nurse - Registered nurse who works with the Primary Nurse or substitutes for her during other shifts.
- Specialized Nurse - A registered nurse who had completed advanced training to specialize on one are, e.g. intensive care, pediatrics, anesthetics, or assisting at surgery.
- Practical Nurse - Normally a licensed practical nurse (L.P.N.) who gives bedside care, e.g. changing dressings, recording vital signs, administering medications, etc. She can also serve as a scrub nurse in an operating room.
- Private Duty Nurse - A registered or a licensed practical nurse employed by a patient; she is not a member of the hospital staff but practices privately.
- Nursing Student - A student taking up nursing in a school affiliated with the hospital.
- Nurse's Aide or Orderly - Healthcare giver who assists the patients in common chores, e.g. bathing, eating, walking, and getting around the hospital.
- Ward Secretary - A non-nurse who is seated inside the nurse's station taking charge of keeping the records. She also orders tests and supplies for the station.
- Counselor - Hospice worker, alcohol or drug abuse counselor, minister or other person who gives patients pieces of advice to help them reestablish a sense of well being.
- Medical Social Worker - A staff member of the hospital who assists patients with financial, family, and work-related problems brought about by the illness. He may work in coordination with post-hospital health care.
- Medical Technologist - Healthcare specialist who conducts laboratory tests and administers some diagnostic tests and assists with others.
- Therapist -Physical, occupational, recreational, speech, or other specialist who helps the patient recover strength, flexibility and skills they need to return to leading a normal life after a bout of illness.
- Paramedic -Auxiliary medical person who responds to emergencies outside the hospital and performs first aid and other emergency procedures while rushing the patient to a nearby hospital.
- Patient Representative -Administrative worker who handles patients' complaints about the hospital in general, patient care, food, regulations, and other matters.
- Volunteer -Unpaid assistant who functions as a nurse's aid and comforts and consoles patients. A volunteer may also perform administrative tasks.
The HMO: Linking the Patient and the Doctor
During normal check-up, you go to the doctor, talk to him, ask for some medical opinion on matters that concern you and your health, and walk out the door straight to the cashier. Doing this always can often leave you flat broke. It is no joke paying for good health. This is one of the many reasons why people refuse to seek medical attention whenever necessary.
In order to break this financial barrier between the patient and his doctor, several companies have developed a way of paying for your medical needs through policies or health plans. No two health plans are exactly the same. But the plans available from non-government insurers fall into three groups - traditional fee-for-service health insurance plans, health maintenance organizations (HMOs), and preferred provider organizations (PPOs).
There are different kinds for each type of insurer. Although health insurance can be purchased individually, most people are often encouraged to join group plans offered by their employer, union, or other affiliated group. Before, employers pay all or most of the premiums, but the steep rise in insurance costs prompted many employers to shift majority of the financial burden to the employee.
The traditional health insurance plans are quite expensive but give you the widest range of doctors, treatments and hospitals to choose from. They are based on fee-for-service arrangements in which hospital/medical bills are submitted to the insurance company, which pays a certain percentage of the total cost. Often, one needs a separate policy to cover hospital expenses, surgery, and various medical costs, e.g. doctor's fee, outpatient treatments, dental care, and prescription drugs. Increasingly, these plans are placing restrictions on policy-holders by limiting the payments for certain conditions and by requiring second opinions from insurance-company doctors for hospitalization and for expensive procedures and treatments. Other plans provide a lump-sum payment for hospitalizations, which is often less than the actual cost to the patient.
Health maintenance organizations are forms of prepaid health care. Your medical care is being provided by an HMO staff and by affiliated doctors, hospitals, and clinics for a fixed monthly fee. There is normally no deduction in this arrangement. The HMO provides specialists for consultations or surgery, pays hospital expenses, covers the cost of examinations and tests, outpatient treatments, and usually prescription drugs. Dental care is normally covered, however, by a separate policy. HMOs are more likely to pay for preventive care as compared to traditional plans.
HMOs are generally less expensive than traditional health insurance, but they do restrict your choice to doctors and specialists contracted by the HMO and all treatments must first be approved by your primary doctor. Some "open" HMOs will pay a percentage of an outside doctor's fees.
Before choosing an HMO, here are a few pointers you might want to consider:
Patient Satisfaction. Your HMO should provide you a way of getting your feedback as to the degree of satisfaction or dissatisfaction brought about by their service.
- Cost Containment and Physician Incentives. Ask exactly how they reward their doctors for cost containment. Make sure that the system won't keep you from having needed tests or seeing a specialist.
- Among the methods HMO uses to control costs, do they, directly or indirectly, provide any kind of financial and/or job security incentives (negative or positive) to any of their physicians to limit diagnostic tests and referrals to specialists?
- Detail their cost control methods as they affect their physicians and other medical care providers.
- Physician Credentials. Ensure that a competent, well-trained physician will always treat you.
- Medical Necessity. Know up front who decides what is "medically necessary" in my case.
- Appeal Procedures. Know the appeal procedures and the length of time it will take them to reply.
- Choice of Physicians. Ensure that you will have free choice of physicians within your Plan. Also ask who pays, and how much, if you want to see a doctor outside your Plan.
- Revenue Breakdown. Know the percentage of their revenue that actually goes to treat patients as compared with marketing, administration and profit.
- Prescription Drugs. Describe how the HMO decides what drugs to provide for their patients. You need to be sure that you can get the best drug for my particular medical problem.
- Access to Specialists. Know how does your HMO decide when you should get to see a specialist.
Emergency Care. You should be able to get prompt care in a medical emergency.
A preferred provider organization is a cross between traditional health insurance and an HMO. In a PPO, the insurer generally provides you a list of the doctors, hospitals and other healthcare providers affiliated with their company and who have agreed to charge a lower fee than the going rate in return for assured number of patients. If you pick a provider from the list, the insurer pays the cost entirely. If you go to someone else who charges more, you have to pay the additional cost. Before you can be admitted to a hospital for confinement or receive a very expensive treatment, PPOs usually require a review and approval by their doctors. PPOs are less expensive but are less flexible than traditional fee-for-payment insurance policies; more expensive but more flexible than HMOs
Remember that health is wealth. In whatever medical situation you are in, always seek the best medical attention. It is only you who can ensure this by taking extra measures in ensuring that the doctor or the medical insurer you choose is just right for you. After all, it is your health you are safeguarding.
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