As the health-reform law takes effect over the next several years, some 32 million newly insured Americans will gain access to a regular doctor. They will soon learn what others already know: Getting the best care from your doctor requires navigating a complex relationship within the 20 or so minutes allotted for the typical office visit. Despite those constraints, three-quarters of the 49,007 Consumer Reports subscribers we surveyed said they were highly satisfied with their doctors. But they still had complaints ranging from the irritating, such as having to sit too long in the waiting room, to the substantive, such as ineffective treatments.
We also surveyed 660 primary-care physicians who had a lot to say about their professional challenges—and about what patients could do to get the most out of their relationship with their own doctors. Some highlights of the surveys:
The Consumer Reports National Research Center conducted the subscriber survey in 2009 (our readers may not be representative of the U.S. population as a whole). The online poll of a national sample of primary-care physicians was conducted in September 2010.
Doctors said that forming a long-term relationship with a primary-care physician is the most important thing a patient can do to obtain better medical care, with 76 percent saying it would help "very much."
Research suggests that patients who frequently switch doctors have more health problems and spend more on care than patients who have a consistent relationship with a single physician.
Being respectful and courteous toward your physician was the No. 2 thing doctors said patients could do to get better care; 61 percent said it would help "very much." But 70 percent said that since they had started practicing medicine, respect and appreciation from patients had gotten "a little" or "much" worse.
But being courteous doesn't mean you have to be passive (though you can if you wish; 37 percent of patients we surveyed preferred to trust their doctor's judgment on treatment decisions). Most doctors said that it was "somewhat" or "very" helpful for patients to ask them questions and occasionally question their recommendations; a mere 4 percent thought those strategies were downright unhelpful.
Noncompliance with advice or treatment recommendations was the top complaint doctors had about their patients. Most of the doctors we surveyed said it affected their ability to provide optimal care: 37 percent said it did so "a lot."
Feel free to discuss, even debate, your doctor's treatment plan while you're still in the office. Then do your best to comply. If you're having side effects, are unsure whether you're following instructions properly, or experience new or recurrent symptoms, tell your doctor immediately.
Doctors were harder on themselves than patients were when it came to judging their ability to minimize the pain, discomfort, or disability caused by a condition. Only 37 percent of physicians thought they were "very" effective, though 60 percent more thought they were "somewhat" effective. But 79 percent of patients said their doctor helped to minimize their pain or discomfort.
Perhaps that's because patients were thinking only of their own conditions, whereas doctors were thinking of their overall effectiveness with all of their patients, including those with chronic conditions that are difficult to diagnose and treat, such as fibromyalgia, immune disorders, headaches, neck and back pain, and depression and anxiety. Our survey found that patients with those conditions were significantly more likely to complain about ineffective treatments. Just 53 percent said their doctor helped to minimize their pain or discomfort, and only 31 percent were highly satisfied with their doctor overall.
Slowly but surely, primary-care doctors are switching over to electronic medical records. Thirty-seven percent told us they keep their records electronically only, compared with just 24 percent who did so in 2007, during our last survey.
But they want you to know that it still pays to keep track of your medical history yourself. Eighty-nine percent said that keeping an informal log of treatments, drugs, changes in condition, notes from previous doctor visits, and tests and procedures could be helpful. But only 33 percent of patients routinely did so. Likewise, 80 percent of doctors thought taking a friend or relative to your office visit could be beneficial, but only 28 percent of patients reported doing so.
The patients we surveyed were enthusiastic online researchers; 61 percent reported that they had read about their condition on the Internet. Doctors are not convinced that online research is helpful, to put it mildly. Almost half of physicians we surveyed said online research helps very little or not at all, and just 8 percent thought it was very helpful.
Instead of starting by entering the name of your condition in a search-engine box, try going directly to a few reliable sites. Our health site, ConsumerReportsHealth.org, reviews impartial evidence and takes no advertising (but some of its content is available only to paying subscribers). Government sites are also a good place to start. Try these:
If you find information online that you want to discuss with your doctor, print out only the relevant parts.
Physicians said the sheer volume of insurance paperwork was No. 1 on the list of things that interfere with their ability to provide optimal care. Next was financial pressures that may force the majority of primary-care providers in our survey to work more than 50 hours a week seeing more than 100 patients.
To get the most out of your time, plan ahead. Jot down a list of questions or concerns you'd like to address during your appointment, and prioritize them so you get to the most important ones first. If you don't have time to discuss everything, ask whether you can follow up by e-mail (that is, if you can; only 9 percent of patients said they e-mailed their doctor directly in the previous year).
The doctors we surveyed are clearly chafing against health-plan rules and restrictions. Most said such red tape interfered with the care they provided, and 42 percent said it did so "a lot."
You can't do much as an individual about burdensome health-plan rules, but you can avoid unwelcome surprises by reading through and understanding your health coverage. (Ask your human-resources department for help if you need it.)
For instance, inquire about your plan's formulary, a preferred list of drugs for which it charges a lower co-pay. Understand what services your deductible applies to, and find out what rules, if any, apply if you need to see a specialist.
The medical profession has not always been the most transparent. The American Medical Association, for example, has fought to keep the Medicare payment records of individual doctors confidential. Here are a couple of things that primary-care doctors might not want to tell you:
If you are concerned about your doctor's relationship with pharmaceutical companies, don't hesitate to bring up the subject at your next visit.
It's true that a malpractice suit can befall any doctor and that disciplinary actions from medical boards don't necessarily represent the doctor's overall skill. Still, disciplinary actions levied by medical boards can be for serious offenses, such as substance abuse or criminal behavior, that could affect your care. You might be able to look up your doctor's record online, though the information that's available differs by state. Find your state's medical board at the Federation of State Medical Boards website, at www.fsmb.org, or try your state health department.
This is an excerpt from “What doctors wish their patients knew” on ConsumerReportsHealth.org.
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