Finding Quality Medical Care
In the best of circumstances, your parents or in-laws will have a family physician with which they have established a rapport and see at least annually. However, this may not always be the case. If you have had to move them nearer to you, for instance, they may have to find a new physician. There may be a variety of other reasons they need to find a new physician.
In some instances, due to reimbursement cuts and other issues with Medicare, physicians may discontinue servicing patients under Medicare. If the Medicare is an HMO plan, you may never see the same physician twice as physicians don't tend to stay in these organizations for long periods of time. If your parents have had a physician for a long time, they may lose him to retirement.
In many of these circumstances, the physician may have arranged for another physician to take over his practice and will transfer records. These situations don't always work out because older people in general have greater difficulty with change. But they may feel stuck because their physician handed their care over to this new person.
It is important to note and remember that no one is ever stuck with a physician. Even in an HMO, you can request to change your primary care practitioner. You can request to see another specialist if you don't like the one you've been to. If you live in a very small or rural community where access to health care is very limited, you may have few choices, but otherwise, you always have a choice.
Personalities and bedside manner are important factors. Gender and English as a first language may play an important role as well. This can be important if there are strong feelings of bias, modesty, and even difficulty hearing. It is important that your parents trust and are be able to communicate with their physician and other health-care team members.
Quality of medical care is also important. This is not always so easy to judge. Medicare has adopted policies for reimbursement as well as reporting quality issues for hospitals and home health-care agencies. Medicare is exploring the ability to rate and report on quality issues with physicians.
Unfortunately, some of the best practitioners are not always the most warm and friendly human beings. Many times this is due to having very busy practices. Time is money and Medicare and most insurance companies reimburse at rates that have driven physicians and other practitioners to limit their time with patients to only a few minutes. This makes it hard to get to know, trust, and connect with the practitioner.
Finding a quality physician can be a challenge. Word of mouth is often the most common factor. Either a physician recommends or refers your parents or a friend, neighbor, or coworker does. If the Medicare plan or other insurance has restrictions, you may have to investigate to find a member or network physician. This information is usually available on the Internet or by calling the Medicare or insurance-plan office.
You can find information on your state government's website regarding the licensure of a physician. Most also list whether there have been any malpractice issues or other medical-care issues with this physician. Your state's website address is usually the two-letter abbreviation for your state followed by “.gov.” For example,
Not all physicians will accept Medicare. If they do, they have to accept whatever rate Medicare will reimburse them at. They can only charge an additional 20 percent, which most Medicare supplemental plans will cover. If your parents have an HMO plan, they may have a copay of approximately $10–$20 per visit.
Other ways you can find a physician include asking your own physician for a recommendation. You can also call your local hospital and ask for the physician recommendation or referral department. Again, word-of-mouth contacts such as your local senior center can be good sources.
It is important to establish a medical-care connection as soon as possible, especially if you have relocated your parents or in-laws. Don't wait until they have a need to try to find a physician. It can take weeks to get an appointment with a good doctor if you are a new patient. Set up an appointment just to get acquainted and get medical records transferred. Then if the need arises, you have someone you can call. Should there be an emergency, there is a physician of record for the hospital to contact.
One thing to be aware of is whether or not the physician has a policy of not allowing the spouse or other family members to come into the office with the patient. Some physicians think that others create a distraction and take up more time. While this can be a valid point in some instances, it should be something to handle on an individual basis. Older patients often need someone in there with them because they don't hear well, they have memory issues, or they just don't always understand what the doctor said.
This kind of health-care illiteracy is an issue for more than 50 percent of the population. It is a bigger issue for the elderly. If this is the case with your physician, either find another physician or make arrangements to have a longer appointment time, but don't give in to being shut out of the office.
As health-care costs increase and the shortage of physicians grows, it becomes more and more commonplace for a physician to use a nurse practitioner (NP) or physician assistant (PA) to assist with patients' care. These are health-care practitioners specially trained to assess and treat patients. They work with the physician to provide quality care. In some instances, your parents may always be seen by the NP or PA and never or rarely see the physician. As with choosing a physician, if you don't like or trust the NP or PA, you may have to choose a different physician.
