to Choose a Primary Care Doctor—If You Must
Sick people visit doctors, take medications,
and undergo surgeries—healthy people don’t. Your goal is to
get as far away as possible from the medical and
pharmaceutical businesses. The only way to safely accomplish
these goals is to become and remain healthy. Genuine health
comes from proper nutrition (a near vegetarian, low-fat
diet), clean air and water, moderate activity, adequate
sunshine, and a comfortable psychosocial environment.
Unfortunately, even with the best intentions, and after the
most sincere efforts to obey life’s basic rules, medical
services may be required.
Establishing a Relationship with a Doctor Can
An undeniable fact is that the more you see
doctors, the more likely you are to be tested and
treated—for better or worse. Therefore, establishing a
relationship with a doctor opens the door for you to become
an active patient. You don’t want to be a patient. Most
major health organizations agree there is the risk for
serious harm in establishing a regular doctor-patient
relationship and all have agreed that routine annual
checkups for healthy adults should be abandoned. (See the
July 2005 McDougall Newsletter article: The Annual Physical
Exam – A Ritual to Be Avoided.)
However, most people are taught the
opposite—they believe they need a trusted personal physician
who knows them intimately in case of an emergency or other
unexpected illness. This sounds like a good plan.
Unfortunately, in the real world when the day comes that you
need care, your chosen doctor is likely to be
unavailable—you will have to see the “doctor-on-call” or
visit the local emergency room or an outpatient facility.
Furthermore, long-standing familiarity with a patient is
rarely necessary in order to provide excellent care in times
of need—a brief past history of allergies, medications and
illnesses is usually sufficient.
Don’t Choose an “Alternative Medicine Doctor”
Readers of this newsletter have often lost
faith in standard medicine and are therefore inclined to
look for alternative approaches, and that means doctors with
a reputation for providing “unconventional” or “holistic”
care. My experience has been that most of these
“alternative” physicians are still focused on “pills for
ills.” The difference is they are prescribing vitamins,
minerals, natural hormones, and other supplements—with
enthusiasm. The results of their remedies are similar to
the ones sold to you by pharmaceutical companies, providing
few benefits with significant costs and side effects. Other
alternative doctors use methods that have not been
established to be beneficial, such as those using chelation
and ozone therapy—so be careful.
You shouldn’t even look for a
vegetarian-oriented doctor, because you do not need someone
to tell you AGAIN to eat a low-fat, near plant-food based
diet (The McDougall Diet), to exercise, to not smoke,
etc.—you know all of these fundamental rules. You don’t
really care what your doctor personally eats, as long as his
bad habits don’t turn into unhealthy recommendations.
However, you do want a doctor who will respect your diet and
lifestyle choices and not try to undermine them—or worse
yet, challenge you with nonsense like the Atkins Diet or the
South Beach Diet.
Ideally, you are looking for a
traditionally-trained doctor, not completely brain-washed by
the pharmaceutical and medical device industries, who is
interested in you becoming healthy through better self-care,
and by your being actively involved in your own
The Character of the Right Doctor
Your relationship with your doctor should be
a “partnership” focused on improving the quality and
quantity of your life. This requires comfortable
communications and trust. The right doctor will be
passionate about the study of medicine and as a result will
be very knowledgeable about the care of a human being. This
doctor will be willing and able to clearly explain your
present condition and the possible courses of action for you
to take—including several different ways to test and treat
your problems. There are almost always options for your
care; for example, your colon can be examined with an
optical colonoscopy, virtual (computer based) colonoscopy,
or a barium enema and sigmoid examination. Another example:
for blocked heart arteries with chest pain you can have
bypass surgery, angioplasty, medications, and/or dietary
change. You should hear about all of the available options
along with their costs, risks, and advantages. If you are
hearing “My way is the only way,” then you are likely with
the wrong doctor. Remember, as the health care consumer—the
customer—you always have the right to say “No.” Your doctor
must face the fact that you have the most to lose or gain in
this relationship and therefore, must be comfortable with
you having the final say in all decisions. Unfortunately,
this is rarely the case. I have heard doctors respond to a
patient’s request with angry retorts such as: “When did you
go to medical school?” and “Find another doctor if you are
unwilling to follow my advice.”
Secondary concerns for you may be your
doctor’s manners, personal appearance, politics, and
Find a Generalist for All of Your Basic Needs
Generalists, general practitioners, family
practitioners, and primary care doctors are descriptive
terms for the role of the doctor whom you should be seeing
first and foremost for your medical care. Your generalist
will act as your advocate if the time comes when you do need
to see a specialist (more on this in a future newsletter).
Internists and family physicians are the two largest groups
of generalists for adults. Pediatricians and family
practitioners act as primary care doctors for children.
Many women see obstetricians/gynecologists for these basic
needs, but this can be a little risky. You do not want to
have a specialist acting as your generalist. Consider that
women who have a gynecologist as their primary care doctor
are twice as likely to have a hysterectomy as women cared
for by a general practitioner.
Whom to Ask to Find a Doctor?
Finding the right doctor when you need one is
well worth the hours required in the search.
The best persons to ask about desirable
doctors are hospital nurses—they see doctors at their best
and worst. This advice does not work for nurses working in
private offices, because of their loyalties to their
employers. If you don’t know a nurse then ask anyone who
works in a hospital—here the “grapevine” of gossip is
well-established and you can expect reliable information on
the “best” doctors from almost any hospital employee.
If you do not know anyone working for a
hospital, you might try establishing a new relationship.
Call your local hospital and ask for the “Medicine Ward,”
“Surgical-care Rooms,” “Geriatrics Unit,” or “Obstetrics
Floor.” When the receptionist or nurse comes on the line
tell her, “I’m new to the area and looking for a general
doctor, could you give me several names?” You will be
surprised how friendly and willing to help most people can
You should ask friends and relatives about
their experiences too. However, their opinions are usually
based on personal relationships rather than the quality of
professional care, and their experiences may be so
individualized that they do not really apply to you.
Don’t fall for the “Ask a Nurse” telephone
referral services. These are companies hired by doctors to
help them build their practice. Local medical societies
usually have a physician referral service and will give you
names based on your geographical area and the type of
physician you need. However, the value of this information
is no more helpful than what you can find under the
“Physician” heading in the Yellow Pages.
Before Meeting the Doctor
If you have an insurance plan which has a
select group of doctors with whom they contract, then you
may want to limit your search to these doctors. If you
choose a physician who is not participating in your
insurance program, then you need to know how much this will
cost you extra out-of-pocket. Next you will be contacting
the doctor’s office and gathering information. Here are
some valuable questions.
for the Office Staff:
the doctor have training and background to meet my
the doctor certified by a medical specialty board?
In what specialty area?
the practice location convenient? Is it accessible
by public transportation? Does it have ample
are the office hours?
the office process insurance claims, or must I pay
up-front for services and file the claims myself?
they accept my insurance?
the doctor practice alone, or as part of a group?
provides care for the patients in the doctor’s
Which hospital(s) does the doctor use?
Where are laboratory and x-ray tests performed?
physician assistants and nurse practitioners provide
the care, rather than the doctor?
the doctor answer or return phone calls from me?
the doctor answer e-mail questions from me?
long must I usually expect to wait for an
appointment after I call?
often can I expect to sit in the waiting room for
more than 15 minutes before being seen?
I be seen on the same day if I have an urgent need?
the doctor make house calls?
Inform the doctor's staff, when you make your
first appointment, about how much time you will need with
the doctor to ask all your questions and have your concerns
addressed. Expect to pay for this time.
The Job Acceptance Interview
Before you decide on a personal physician,
you may want to have an “interview appointment”—a chance to
meet with the doctor when there is nothing urgent. This
meeting will give you an opportunity to determine whether
you are comfortable with the physician, the office staff,
and the facilities. You can sit quietly and gather
information during this meeting or you can ask some
“ice-breaker” questions, such as the following:
Blunt Questions for Your Doctor:
you comfortable assuming my care with my kinds of
health care problems and my personal needs?
you have a special interest in my kind of health
problems (heart disease, diabetes, overweight,
is your view on the doctor-patient relationship; is
it a "partnership" or do you expect me to just
do you feel about me researching at the National
Library of Medicine and bringing in articles for us
to discuss? (on-line at
do you feel about me getting my own second opinions?
you help me work with any specialists I must see and
will you act as my advocate—rather than turning me
over to their care?
you believe people are capable of changing their
diet and other habits (smoking, exercise, etc.) to
regain health? Do you actively offer encouragement
in this kind of behavior?
decide to become healthier through diet and
exercise, will you help me reduce and stop my
you make a conscious effort to avoid the use of
medications and surgery in my care? Will you use
these only as a very last resort?
you comfortable with me possibly refusing to accept
you get angry at patients who refuse to follow your
we do not complete any discussions during the office
visit, will you call me after hours on the phone,
e-mail my answers, and/or be willing to set up a
longer appointment in the near future?
Presenting these bold questions will firmly
set the tone for your future care—the doctor will not soon
forget you. Offending a doctor should be your last
concern—the issue on the table is your health and your life
or the future health of a family member. No sense in
investing all your time and money in a doctor who ultimately
ends up contributing to your early demise. Future
newsletter articles on the doctor business will help you be
in control of your destiny.