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Q&A: How do I choose a doctor?

Choosing a doctor

The percentage of Americans with health insurance has increased to 88.1 percent of the population in the first quarter of 2015, according to Gallup. That's a jump of over 5 percentage points since the end of 2013.

Whether you're a newbie to the health care system or you've had health coverage for a long time, how do you know if you're seeing the right type of doctor? We asked Dr. Wayne J. Riley, president of the American College of Physicians, the country's largest medical specialty society, to unpack the differences. Riley is a clinical professor at Vanderbilt University School of Medicine.

Q. What's the difference between a primary care doctor, a family medicine doctor, and an internal medicine doctor?

A. A primary care physician (PCP) is the physician you see initially, and then on an ongoing basis. It's a broad term. For a child or adolescent, it could be a pediatrician. For an adult, it could be a family medicine physician, or it could be an internist -- an internal medicine doctor. Even an obstetrician can be a PCP for some women.

But underneath the PCP "umbrella" is where you'll find family medicine doctors and internal medicine doctors. A pediatrician is a family medicine doctor. They take care of children from birth until adolescence. My last visit to my pediatrician was for a physical before I went off to college.

A family physician is in a sense, more of a generalist. They care for children, assist in childbirth, and in some cases -- especially in rural practice -- they perform minor surgeries.

An internal medicine doctor is more specialized, trained solely in the care of adults. In fact, working with adults is our value proposition. We're the experts and specialists in adult medicine -- exclusively.

As an internist, the youngest patient I'll accept is 16, and I have patients all the way from there until the end of the lifespan. Our residency training focuses on taking care of adult patients, which means treating a variety of multiple-system issues and conditions such as diabetes, heart disease, high blood pressure, arthritis, respiratory problems and so on. Our training includes exposure to rheumatology, pulmonary medicine, cardiology, endocrinology and infectious diseases. Thus, we receive very intensive training in organ system-based conditions that commonly affect adults.

Dr. Wayne J. Riley

Q. What if you're an adult with several ongoing chronic medical conditions?

A. Family medicine doctors and internal medical doctors both can treat adults with medical issues. But again, the family medicine doctor's training is divided between taking care of children and women of childbearing age and performing minor surgical procedures -- in addition to learning about taking care of adults.

Q. Conversely, what if you're a 'low maintenance' individual? Does that make any difference as to what type of doctor to choose?

A. For example, if your main medical need is an annual physical, you could be very competently seen by a family physician or nurse practitioner. The nurse practitioner and physician assistant are called primary care providers, which is a broader term in addition to the PCP.

Q. Any advice if someone's trying to choose a PCP for the first time or for someone who's considering switching doctors?

A. The first thing to do is look at the rules and doctors you can see in your health plan. You should get, or you should ask for, a directory specific to your health plan or coverage provider.

The second thing is to look at the convenience factor. Are they close to you and your family's work? Home? School? This is a more subjective factor.

More patients desire access to their doctors through social media, and many health care systems enable emails between doctor and patient. If you prefer to email, it's best to find a doctor willing to do that. Some are more comfortable with that approach than others.

Third, once you decide on a doctor, ask yourself if it's one you can build a therapeutic relationship with. Can you see them when you need to see them at their office or when you're in the hospital? Today, you're likely to find shared decision-making to be the way you and your doctor arrive at decisions. That means you and your doctor collaborate together regarding options available to you.

Sometimes your doctor might seem serious or brusque. Some aren't as warm and fuzzy as others, but they're still excellent doctors. Don't be dismissive just because he or she is quiet or doesn't smile, for example. He or she still could be a terrific doctor.

Keep in mind that the patient-doctor relationship is one that involves human interaction. The doctor needs you to be a full participant in your health care. That includes bringing up issues in a timely manner, letting your doctor know your medical situation as best you can, and working in a mutually respectful relationship. That should lead to better outcomes.

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