How to choose a doctor at midlife

Until you hit midlife, your designated primary care doctor may not have mattered to you. But advancing years tend to usher in more medical complaints. You want a primary care physician (PCP) who helps you make the most of your health in midlife and beyond. So let’s talk about how to choose a doctor at midlife.

Your healthcare needs change as you grow older

Most younger women are more concerned with their choice of OB/GYN than whom they choose as a PCP. They visit their PCP only when they have something like the flu or a sinus infection. But as you get older, you may start to have issues with your weight, joints, cholesterol and other things.

The onset of menopause also may influence you to look for a different OB/GYN doctor. The doctor’s gender may become more important to you. Now that you’re no longer having babies, you might want someone more focused on the gynecology aspect of OB/GYN.

Not only are your body and healthcare needs changing. External forces like insurance mergers and premium increases may cause you to change doctors. For all these reasons, then, you need to know how to choose a doctor at midlife. Here are some tips to consider.

Basics to help you choose a doctor at midlife

There are a few factors you can use to narrow down your options and make the process of choosing a primary care doctor easier.

Insurance

Your employer may have switched insurance companies. Or your same health plan may have revised its list of “preferred providers.” At any rate, start with the doctors and clinics who work with your insurance. If you can find a PCP you like who also is a member of your insurance’s network, it will save you money. Plus it can reduce hassles of dealing with insurance company reimbursement.

If, on the other hand, you really click with a doctor outside of your insurance’s network, take a look at the total cost of continuing with this person. Does she charge more than your insurance pays for an office visit? Will her office submit claims for you, or do you have to pay in full and then deal with getting reimbursed? What about things like lab tests? Will your insurance cover these in a similar fashion to tests ordered by in-network doctors, or will you have to pay more for them?

Working with a PCP you trust and have a good relationship with is important. At the same time, you want to avoid surprises about potential costs you may incur by selecting a doctor who’s outside your insurance’s network. So gather the information that will help you choose a doctor at midlife.

Location

The doctor’s office location might not seem very important now.  But a time may come when you need to go in for more frequent visits. And then, having a doctor located 15 minutes away will seem much more convenient than one whose office takes an hour to reach.

It’s also of note that a doctor who’s located close to where you can get lab tests, X-rays, MRIs, prescriptions and so forth will save you time. This is one reason many patients prefer healthcare clinics to individual doctor offices (see below).

Gender, age and other demographics

While you might not have cared about your doctor’s gender in the past, it may matter more to you now. As I moved into my 40s, I switched my PCP from an older male to a younger female. I thought I’d feel more comfortable talking with her about personal issues. Even though I knew my prior physician was an excellent doctor, I felt embarrassed to discuss emotional or perimenopausal symptoms with him.

Another possible factor is your doctor’s age. All of my doctors used to be older than me. Now they’re mostly younger. And I like this. While I’m not interested to have a PCP just finished with her residency, I like working with a doctor who’s my age, or maybe ten years younger. They’ve had a good amount of experience in their field. But they also stay up-to-date with the latest medical innovations.

Not that older doctors don’t also keep up with medical advances. But I don’t want to be in the position of having my doctor retire about the time I’m turning 60. While I may have to change doctors again as life circumstances change, I want to avoid a situation where I know I’ll have to find a new PCP. It’s hard enough to choose a doctor at midlife – you want to avoid having to repeat the process if possible.

You also may have preferences about your doctor’s ethnicity. You may feel more comfortable with a doctor who shares a similar background with you. Or ethnicity may not matter to you at all. Take all these things into account as you narrow your choices.

Family Practice, Internal Medicine or Geriatrics?

Primary care physicians tend to come from one of three categories. Family practice doctors care for the whole family, from birth to death. Internists see patients from age 18 on. They’re a common choice to be your primary care doctor. Geriatricians, who often are internists with a subspecialty in geriatrics, are excellent matches for older adults. But you’re not there yet.

Internal medicine doctors often have additional subspecialties or interests. You can look at their web bios and ask about potential areas of interest. For example, some PCPs may specialize in women’s health issues. They take charge of your regular Pap smears and mammograms, referring you out to a gynecologist as necessary.

I chose a PCP like this a few years ago, as I thought it would reduce my total number of doctor visits. Also my insurance had designated my OB/GYN as “out-of-network.” For various reasons, then, it made sense for me to consolidate providers. You may have other reasons that influence how you’ll choose a doctor at midlife.

Accessibility to your primary care doctor

Besides a convenient location, you want a PCP with whom you can get an appointment when you need to see her. Most doctors’ schedules are tightly booked. Initial patient visits and regular exams usually have to be scheduled a month or more in advance. But if you have an urgent problem, you want to see your doctor today.

So look into how she handles time-sensitive issues. Does your PCP reserve any appointments for short-notice patients? Do doctors in her practice rotate taking “call” so patients can receive immediate attention if needed? Does she have a nurse or physician assistant who can help you right now? If warranted, can her nurse get you an appointment today or tomorrow? Or does she refer patients with immediate needs to her clinic’s Urgent Care or the local hospital’s Emergency Department?

Doctor’s receptionists usually act as gatekeepers who guard the doctor’s time. They can book you into an open slot on the computer schedule but can’t expand the doctor’s already-full calendar for that day. So don’t get angry with the receptionist – it won’t do you any good!

Instead, ask to leave a message for your doctor’s nurse. He or she often will evaluate the urgency of your request and work you into the schedule if needed.

Most of us acknowledge that our doctor is busy, but so are we. You may not want to select a doctor who routinely keeps you waiting for more than 15-30 minutes. Think about what matters to you.

Communication with your medical team

Related to how soon you can get an appointment is how easy it is to communicate with your doctor. Nurses can help you here.

Email

Also, see if your care team uses email for non-urgent questions. Many clinics now use HIPAA-compliant email (secure messaging that protects patient privacy). It’s often hard to reach people in person when you call. Email can save you and your doctor time in explaining test results, answering questions and so forth.

Doctor communication training

I wrote an earlier post that goes into detail on how to improve communication so you’ll help your doctor help you. Another interesting piece on how to talk with your doctor is Kate Bowler’s podcast interview with Alan Alda.

Alda, a seven-time Emmy Award winner, founded the Alan Alda Center for Communicating Science at Stony Brook College. He uses improvisational techniques developed during his acting career to help medical students improve their ability to listen to and interact with patients.

Interactions with your PCP

While your doctor’s schedule may be super-full, you don’t want her to rush through your appointment. Organize your questions to make the best use of your time together. But be aware of whether she’s listening to you. Notice whether she interrupts you after only a few seconds, or whether she waits for you to finish speaking. Set yourself up to succeed in partnering with your PCP.

US News & World Report lists “10 Questions Doctors Wish Their Patients Would Ask.” The article includes questions about why you’re taking a particular medicine, how many other patients the doctor has treated with your condition, and what the doctor does for his/her own wellness. It’s a good resource to consult as you plan to talk with your primary care doctor.

Coordination of care

Research shows that when medical specialists work together on a patient’s behalf, quality goes up and costs go down. The PCP is a natural choice to provide care coordination among providers. But current healthcare business models don’t always support PCP involvement in this way. You’ll have to make your own assessment.

The clinic model

Many insurance companies are contracting with large clinics. Here, at a minimum, a central building and computer system bring together your primary care doctor and specialists. In a large clinic, you can visit different specialists, get bloodwork, X-rays and so on – all in the same location.

But ask questions to see whether doctors in the same clinic truly coordinate their efforts.  Find out whether your PCP acts as a kind of central clearing house. Or whether it’s up to individual doctors to coordinate with each other.

Their principal means of coordination may be to review your electronic health record (EHR). If so, that’s better than nothing. But the clinic’s EHR is mainly a way for doctors to check test results and medications. And to document treatments for billing and “after-visit summaries.” But the EHR doesn’t put anyone in charge of your care – other than you, of course.

Concierge doctors

One response to patients’ desire for greater coordination of care is concierge medicine. A concierge doctor is usually a primary care physician who, in exchange for a retainer fee, offers patients a VIP type of experience. For example, a concierge doctor may:

• offer same-day appointments
• handle all your primary care needs and make referrals to specialists
• limit his/her practice to fewer patients so it’s easier to access your doctor’s time
• give you his/her cell number and make house calls

Concierge medicine is mostly an East- or West Coast phenomenon. Different concierge practices offer different services, and their fees vary accordingly. But overall, the concierge model bypasses common aspects of health plans like co-pays and deductibles.

You pay a monthly fee to your concierge doctor out-of-pocket. This covers your primary care. But you still use your health insurance for specialists, hospitalization and other charges.

A concierge doctor may make sense for you. Especially if you want more physician access and coordination among specialists. Concierge practices can provide information to help you estimate total costs and benefits before you make a switch.

Attitudes toward complementary medicine

A National Institutes of Health (NIH) study estimates that 30% of Americans use healthcare practices originating outside of mainstream Western medicine. Complementary medicine takes on different forms. But much of it falls into one of two categories: natural products and mind-body treatments.

Almost 18% of American adults use one or more “natural products” like vitamins and supplements. “Mind-body” treatments include chiropractic, massage, meditation, yoga, tai chi and qi gong.

Other complementary healthcare practices don’t fit either of the previous categories. Such practices include, for example, traditional Chinese medicine, ayurvedic medicine, naturopathy and homeopathy. These represent broader bodies of knowledge and in some cases, alternatives to Western medicine.

Western doctors vary in their acceptance of non-mainstream treatments. Some embrace all types of healing practices, while others tend to recommend practices that have already become standard in the US. For example, your PCP may suggest that you take certain vitamins and get regular massages to relieve muscle tension. But she may think acupuncture wastes time and money.

Chiropractic

Chiropractic is a dominant type of complementary medicine. In fact, 8% of Americans saw chiropractors in 2007, spending nearly $4 million out-of-pocket. The most common reason people seek chiropractic care is for back pain.

In fact, chiropractic is becoming part of mainstream Western medicine. Most insurance companies now offer chiropractic coverage.  The American Chiropractic Association estimates that up to 87% of the Americans with health insurance have coverage for chiropractic treatment. Yet like many aspects of health reimbursement, actually getting the insurance company to pay for chiropractic can be challenging. (Just ask my chiropractor!)

Integrative medicine

When providers combine conventional and complementary healthcare, the result is called “integrative medicine.” This type of approach to health and wellness is expanding across the US. People are finding, in short, that integrative medicine works.

This post, for example, discusses health benefits of meditation. Scientific studies have demonstrated that meditation and MBSR (Mindfulness Based Stress Reduction) help patients reduce pain, improve cardiovascular health and deal with chemo’s side effects.

In summary, ask a potential PCP about her attitudes toward complementary medical treatments. Especially about those that matter to you. While she may not recommend a treatment like chiropractic or acupuncture, she nonetheless can accept your choice to try it.

If you want to try a complementary treatment, you should be able to discuss this with your PCP. You don’t want to feel judged by your doctor. Keep looking until you find someone who will work with you to achieve your health and wellness goals.

Take charge of your health at midlife

To maximize your health at midlife, take matters into your own hands. Assemble a team of conventional and complementary healthcare providers who can help you feel your best now and into the future.

One of the key members of your medical team is your primary care physician. Ask around, study doctor bios and stats. Don’t feel bad about meeting with one PCP, then choosing a different one. You want to be comfortable with your decision.

Select a doctor who meets your personal criteria for:

• Basics like insurance, location, gender, age, ethnicity
• Accessibility for routine and emergency care
• Communication between you, her and her team
• Coordination of care with other medical providers
• Attitudes toward complementary medicine

Your goal in choosing a doctor at midlife is to find a partner who will help you enjoy the best health you can. Every decade that goes by, people are living longer and healthier lives. Why shouldn’t you increase your chances of being one of them?

 

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