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USNEWS：如何找到合适的美国医生
USNEWS：早餐吃蔬菜的12种方法
2018年11月28日
名医：Dr. Vahid Afsharkharghan, MD(University of Texas MD Anderson Cancer Center)
2018年11月28日
By Angela Haupt
FINDING THE RIGHT doctor isn’t easy—and it shouldn’t be. When you put your life in someone else’s hands, you need to feel confident that this is an individual with enough smarts, qualifications, and skills to give you the care you deserve. You should shop for a doctor “the same way you interview a lawyer or an accountant,” says Don Powell, president of the American Institute for Preventive Medicine, a nonprofit organization that promotes healthy behavior. He notes that you could be starting one of the most important professional relationships you ever have. “People know more about how to buy a car than they do about selecting a doctor,” says Powell. It’s not so much a matter of labeling a doctor as “good” or “bad”—you want to go beyond just weeding out physicians who have gotten themselves into professional or legal hot water. It’s about comfort level; whether a particular doctor is good for you. Smart questions and a little healthy skepticism can help you find Dr. Right.
[Find a Top Doctor near you.]
Evaluating a Doctor: What to Consider
What kind of care are you looking for? A primary care doctor helps keep you healthy, provides a home base for all your medical needs, and is your go-to when you’re sick. A specialist has a deeper but narrower skill set, and may serve only a short-term purpose, like diagnosing a problem or designing a treatment regimen. Experts suggest starting with a primary care doctor who can then help direct you to the most appropriate specialist or sub-specialist (think cardiologist for a possible heart problem or a cardiac electrophysiologist for a heart rhythm problem), should the need arise.
Having roughly determined the general category of physician, the next step is to ask yourself what blend of experience and personality traits are important to you so that you and the doctor will be a good fit. It’s a mix that obviously depends on the relationship you will have with the doctor. If it’s long-term, such as one with a primary care doctor or with a specialist who sees you for an ongoing condition, personality and demeanor will carry more weight than if it’s a one- or two-time encounter with a specialist or surgeon.
You’ll want to be alert for warning flags, which are more likely to be cautionary yellow than stop-now red. Where a doctor went to medical school and did his residency training are good to know. (Resources like U.S. News’s Top Medical Schools shed light on program quality.) But how much emphasis to place on a doctor’s schooling is contentious. Some medical experts believe that the best medical schools produce better doctors by being more selective and training the future physicians more rigorously. Others say education is only a consideration if it raises one of those yellow flags. “Some people go out of the country as a roundabout way to get a medical degree,” Powell says. “Is that person less competent, or is there a reason why [he] couldn’t get into a U.S. medical school? Maybe not, but it’s another question to ask. And if the doctor isn’t willing to answer, that says something.”
Once the candidates are narrowed down to a manageable number, Google is your friend. Most doctors have at least some degree of online presence that can give you valuable insights. “You can tell how transparent a doctor is based on how friendly his site is,” says internist Kevin Pho of Nashua, N.H., a popular medical blogger. “What kind of communicator does he appear to be? Does it seem like he’s available via E-mail?” Any research papers he’s authored and displays might give you an idea of special interests and strengths, too. But a website is just one evaluation tool, not a deal-breaker. A doctor who doesn’t have one could be the one you want.
[Visiting Your Doctor Online Is a Virtual Reality]
If a doctor’s gender makes a difference to you, there may be more to think about than just personal preference: Studies have found that female doctors may do a better job than their male peers of providing basic preventive services to both men and women. Evidence suggests that women do prefer care from female doctors, particularly if they need screening tests for breast, cervical, or colon cancer. (Male patients are more open to a physician of either gender.)
As for age, older doctors obviously have more experience to bring to the examining table and younger ones may be more savvy about advances and more open to new techniques, but that doesn’t readily translate to conclusions about which ones are likelier to be better doctors. It’s your call.
It’s smart—and completely within your rights—to set up an introductory phone call with any doctor you’re considering. Most doctors will make time to do this, experts say. Does he or she sound like someone you could relate to? “People sometimes think this is a binary decision—you gather information, you pick one of the doctors, and then all the dominos fall into place,” says Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “Choosing a doctor is step one. Working with [him or her] is the rest of the process.” A few leading questions can shed light on a doctor’s decision-making style, and whether she works with patients to design a treatment plan or whether she feels strongly that she’s the doctor and what she says goes. For example: “Can I weigh in when I have ideas about my care?” Neither approach is right or wrong.
Finding the Best Primary Care
Everyone needs a doctor trained in treating and managing the usual run of medical problems, from colds to migraines, as well as chronic conditions like diabetes and high blood pressure. He will assess your symptoms and, if necessary, direct you to the right specialist. If he’s doing his job correctly, he’ll also coordinate your care, communicating with other doctors you see and making sure nothing slips through the cracks. Internists, who treat adults ages 18 and over, are the broadest category of primary care providers. Some women choose their gynecologist as their primary care doctor. Geriatricians specialize in older people. Family practitioners see both children and adults; in small towns, their services often include obstetrics and minor surgery. Pediatricians, of course, treat kids. Besides M.D.’s, nurse practitioners and physician assistants are reasonable options for healthy patients who are interested in wellness care and counseling.
Most often, patients look for a primary care physician by asking family and friends for suggestions, and experts say that’s fine for starters. But finding out why your brother or aunt likes the doctor is critical. “One of my family members chose a doctor based on a friend’s recommendation,” Clancy says. “Then she found out that her friend preferred a patriarchal figure who gives orders. That relationship did not work out.”
Online resources claiming inside information on physicians are abundant, but most simply list easily attainable contact information and facts about the physician’s medical education, board certification, and possible disciplinary actions. U.S. News’s Top Doctors, a compendium of more than 27,000 physicians nationwide, can identify doctors recommended by their peers based on their clinical skills, including how well they relate to patients, and other qualifications such as education, training, hospital appointments, and administrative posts. Top Doctors is linked up with the U.S. News Best Hospitals rankings so you can see which physicians are at the nation’s best hospitals, and narrow the field by specialty or location.
There also are websites like HealthGrades.com or RateMDs.com where patients can post reviews of their doctors. Proceed with caution. A typical primary care provider may have several thousand patients, and very few doctors on such sites are rated by more than a tiny handful. “A lot of doctors don’t have a representative set of ratings,” Pho says. “If you see a doctor with two or three ratings, they’re likely going to be very negative or very positive, and I’m not sure how accurate that is.”
Suppose you need hospital care at some point, as most people do even if it’s only for a routine outpatient procedure. If you’re young and healthy, the hospital a doctor is affiliated with might not matter much, but if you have a problematic medical history or you’re moving into old age, it could be significant. Would you prefer to be close to home, or are you open to a better hospital farther away, if that’s where your doctor has admitting privileges? If you have knee problems, for example, a hospital that does a high volume of joint replacements and has a good track record would be a candidate. You can find out any doctor’s hospital affiliations by calling his office or by asking the hospital, which has a database of affiliated primary care physicians and specialists.
Calling the office will also give you a chance to avoid discovering after the fact that it’s run like a car that desperately needs a tuneup or like a restaurant with a surly wait staff. Spending five minutes on the phone with the receptionist will tell you how far in advance you need to make appointments, the length of a typical office visit, and whether the doctor usually sticks to the appointment schedule or is two hours behind by noon. “If you hear that the doctor is very busy and doesn’t keep to his schedule well, and if you’re someone who needs to come in and be seen without a long wait, you’ll know right away that it won’t be a good fit,” says Howard Beckman, a clinical professor with the University of Rochester Medical Center in New York. Some doctors understand that their patients’ time is important, and some even offer gifts or money back for enduring excessive wait time. While that’s by no means the norm, an office that doesn’t value timeliness or efficiency may be a deal breaker.
How the office is organized will affect your convenience, too. You’ll want to know whether lab work or X-rays can be done in the office, or if you’ll need to go elsewhere. If the doctor is totally booked, can you see someone else in the practice? Are Saturday hours available? What time does the practice open and close, and how will those hours jibe with your schedule? Is he available via E-mail, as an increasing number of physicians are?
Finding a Specialist
Over time, most people will need care that’s more specialized than a primary care doctor can provide, either for a difficult chronic problem (like osteoarthritis or intractable pain)—or because of a condition or test results that demand immediate attention (like a suspicious mammogram or blood in the urine).
Primary care doctors generally make reasonable referrals, so the specialist your doctor recommends should be the default choice if you don’t want to keep hunting. But a doctor isn’t a good fit simply because he’s endorsed by another physician. A better tactic would be to ask your primary care doctor for the names of two specialists, and why he might recommend one over the other. Is it based on convenience or reputation? Especially when the referral could be for a serious medical problem, you can get right to the bottom-line opinion by asking: “Would you go to him? Would you send your mother to him?” Posing another question or two will tell you whether the specialist communicates well with primary care doctors; if so, your care will likely be better coordinated. “Say to the doctor, ‘When you send people to this person, does he or she keep in touch with you?” says Washington, D.C.-based family physician Kenny Lin, a blogger on family medicine for U.S. News. “And ask what other patients have said about the doctor.”
[9 Signs You Should Fire Your Doctor]
Experts consider board certification one of the best indicators of competency and training. A study published in the Archives of Internal Medicine in 2010, for example, described a “robust relationship” between board certification and quality of care. It isn’t hard to understand why. A board-certified specialist has gone through a rigorous residency followed by more training in the specialty and finally testing and peer evaluation (plus periodic recertification). A doctor’s board status can be checked at CertificationMatters.org. The American Board of Medical Specialties recognizes more than 150 specialties and subspecialties, including family practice, internal medicine, surgery, cardiology, and orthopedics.
Sometimes you’ll need to move fast. Need further testing to determine whether a spot on your skin is cancerous? A second opinion before beginning an experimental treatment? Been told surgery is a must? In all cases, it’s most important to find out about the doctor’s experience with patients like you.
[How to See a Doctor—Stat]
The more often a doctor performs a procedure, the better he gets and the lower the chance of calamity. It follows that the more cases he sees like yours, the likelier the results will be good. Finding out is surprisingly simple, and good doctors wish more patients would make the effort. You only need to ask directly how many patients like you the doctor has seen over a recent period and how they fared. If you’re discussing heart bypass surgery, for example, what you want to know is the number of these procedures the specialist has performed in the past 12 or 24 months on patients in your age group in similar physical and medical condition and the death and complication rates for those patients. To put the answers in perspective, ask if there are national benchmarks to use as comparison.
Deaths are almost unknown in some procedures, such as hip and knee replacements, so an impressively low figure may be misleading. For those, what counts is the percentage of patients who returned to a good quality of life, and—again, for patients like you—how long that typically took.
