Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

Ask 10 people if they know where to get information on buying a new car, and probably 9 of them would say "yes." But if you asked those same 10 people if they know how to choose a doctor, I bet very few would agree.

Finding a doctor might seem easy. Popular magazines, Web sites, and other media regularly publish lists of "top doctors." You may also receive newsletters and mailings from doctors in your area or get helpful recommendations from friends and colleagues.

However, finding a physician who provides high-quality care and who meets your needs isn't—and shouldn't be—a snap decision. Finding a doctor who can communicate and is willing to partner with you in decisions about your health can be hard work, but it is worth the effort.

The first question you should consider is whether you need a primary care or a specialty doctor.

A primary care physician is a doctor who diagnoses and treats a wide range of common illnesses and conditions. Primary care doctors also provide patient education, offer advice on preventing disease, and coordinate care if a specialist is needed. Primary care doctors may be certified, which means that they have special skills in different areas, such as family or internal medicine.

Because primary care doctors tend to have heavy workloads, getting an appointment with one can be difficult.

A specialty doctor, or specialist, has advanced training in a certain area of medicine focusing on a particular disease, condition, or procedure. Common types of specialists are allergists, cardiologists, and surgeons. General specialists also can refer patients with complex diseases to doctors with even more expertise.

Before you make an appointment with either a primary care or specialist doctor, find out whether your health plan includes that doctor in its approved list of providers. Not all plans include the same doctors in their network. If they don't, you could end up paying the full cost of the visit.

To be safe, find out whether your doctor is in good standing with State agencies that grant medical licenses to physicians. You can do this through a Web site called DocFinder. This site reports whether disciplinary action or criminal charges have been filed against doctors. Information reported to DocFinder comes from individual State medical and osteopathic boards. State boards are another good source of information on physicians in your area.

Even if the doctor you choose is right for your condition, is covered by your health plan, and is in good standing with State agencies, that doesn't mean he or she is your best choice. Find out if the physician:

  • Clearly answers questions about your condition and treatment plan. If there isn't enough time to answer your questions during the appointment, find out if the office will contact you later. Or ask whether there is a good time to call with any followup questions. To get the most from your medical appointment, use the Agency for Healthcare Research and Quality's (AHRQ's) Question Builder tool on our Web site.
  • Uses a hospital whose location and quality you feel comfortable with, in the event you need hospital care. Learn more about the quality of care at many hospitals from the Federal Government's Hospital Compare Web site.
  • Performs routine X-rays and lab services in the office. If not, you may need to travel to a different location for services.
  • Handles insurance claims at the office. If not, you may have to pay for services upfront and file the claims on your own.

Finding the right doctor might not be as easy as choosing your next car. But the effort you put into it can pay rewards for a lifetime.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
podcast How to Choose a Doctor (Healthcare 411 radiocast, 1 minute)   (Transcript)  Podcast Help

podcast How to Choose A Doctor (Healthcare 411 audio feature, 4 minutes ) (Transcript)

Agency for Healthcare Research and Quality
Questions and Answers About Health Insurance: A Consumer Guide
http://www.ahrq.gov/consumer/insuranceqa/

Agency for Healthcare Research and Quality
Questions Are the Answer: Build Your Question List
http://www.ahrq.gov/questions/qb/

Hospital Compare
A quality tool for adults, including people with Medicare
http://www.medicare.gov/hospitalcompare/search.html

American Academy of Family Physicians
Primary Care
http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html

Administrators in Medicine (AIM)
DocFinder
http://www.docfinder.org/

Current as of July 2008
Internet Citation: Tips To Help You Find a Good Doctor. July 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/071508.html