Senior Health - Choosing a Doctor

Mrs. Wiley had a big surprise the other day when she called her doctor to make an appointment. The receptionist told her that Dr. Horowitz was retiring at the end of the year. After all this time - after decades of flu, bladder infections, and that nasty broken wrist; after helping her through the menopause - now this desertion! Mrs. Wiley didn't know what she would do to try and find a new doctor.

Uncle Willy was grumbling to his nephew Matt. This new managed health insurance plan seemed like a good idea at first, but now he wasn't so sure. What's a primary care doctor anyway? Can't he just continue to see Dr. Bissell for his arthritis? Matt sighed wondering how he was going to help Uncle Willy find a whole new set of doctors.

Stories like these are becoming all too common. Finding good medical care can be tricky at any age but for older people this task may be even tougher. Yet, it is important to have a primary care doctor who knows you and all of your health problems. Even if you see other doctors for certain health conditions, for example, a heart specialist (cardiologist) for heart disease, your primary care doctor is needed to work with those specialists and coordinate all of your health care.

Choosing a doctor is one of the most important decisions anyone can make. The best time to make that decision is while you are still healthy and have time to really think about all your choices. If you have no doctor or are thinking of changing doctors, the following ideas may help you find a doctor who is right for you.

What Should You Look for in a Doctor?

Of course you want a doctor who is well trained and competent. A doctor who knows you well may be better able to help you prevent some health problems and manage those that do come up. In choosing a doctor some other things to think about are:

• Board certification. Board certified doctors have extra training after medical school to become specialists in a field of medicine such as family practice, internal medicine, or geriatrics.
• Communication style. Because communication is key to good health care, you want a doctor who will listen carefully to your concerns, answer your questions, and explain things clearly and fully.
• Type of health insurance - does the doctor accept Medicare predetermined payments? See sidebar on managed care for more information.
• The location of the doctor's office, will it be easy for you to get there?
• Where patients get lab work done - in the doctor's office or somewhere else?
• Whether the office staff will process your medical insurance claims for you.
• Which hospital the doctor uses to treat patients.
• Whether the doctor works with a group of other doctors. If so, who are the others and what are their specialties?
• Who covers for the doctor if he/she is out of town or not available?
• Whether, with your permission, the doctor will share information with a family member.
• Which languages the doctor speaks.

A good first step is to make a list of the things that matter most to you. Then, go back over your list and rank them in order of importance.

What Type of Doctor?

For your primary care doctor, you might want a general or family practitioner, an internist, or a geriatrician.

• General practitioners provide health care for a wide range of medical problems. They do not focus on any one area of medicine.
• Family practitioners are similar to general practitioners, with extra training to focus on health care for all family members, regardless of age.
• An internist is a doctor for adults. Some internists take additional training to become specialists. For example, cardiologists are internists who specialize in diseases of the heart.
• Geriatricians specialize in the care of older adults. A geriatrician is trained in family practice or internal medicine, but has additional training in caring for older people.

How Does Managed Care Affect Your Choice of Doctors?

Most people age 65 and older are eligible for Medicare hospital insurance (Part A). They also can enroll in Medicare medical insurance (Part B) for a monthly fee. Medicare medical insurance helps pay for visits to the doctor. It also covers many other medical services and supplies not covered by Medicare's Part A.

Many older people use Medicare's original fee-for-service health insurance program. Under this program, you may see any doctor or health care provider you choose. You usually pay Medicare's deductible and co-insurance, along with any other charges not covered by Medicare. Medicare pays the rest. Under this plan, you handle bills and payments.

Another option is a Medicare managed care plan. When you enroll in a managed care plan, you choose your doctor from a list of primary care doctors who are part of that plan's network. Your primary care doctor then coordinates all of your health care needs. If you do not choose a primary care doctor, the managed care plan will assign one to you.

In some managed care plans, you can see a doctor outside the network, but it will cost you more money. Also, you may have to pay a co-payment for some services and visits.