I’ve been in the Seattle area for a year and a half now. I’ve been seeing a doctor at the local Virginia Mason (who I found through the “close to work and able to see me today” method), but I’ve been becoming increasingly dissatisfied with him. (Among other things, he misdiagnosed an eye inflammation that is now costing me months of impaired vision because of delay in treatment. While I think it may have been an “anyone could have missed” thing the first time I came in to see him, it had progressed to a classic presentation of iritis by the second time, and he completely blew it off.)
In general, my friends here either live so far away that any doctor they see is going to be pretty much inaccessible without traveling for unreasonable times, or they’re also new in the area and don’t have doctors that they’re happy with, either. (I’m willing to go into downtown Seattle for someone good, but I’d much prefer someone in Bellevue, Issaquah, Renton, or Kirkland.)
So I need a new GP, and I’m hoping to need an OB in the not-too-distant future, too. How do you go about finding a good doctor in a place where you don’t know a lot of people? Are there good online review sites? Some secret person to ask, like a pharmacist or someone?
Have you tried asking co-workers for recommendations? Or if you’re willing to take anonymous message board recommendations, when I was living on the Eastside I went to Bellevue Family Medicine and never had any bad care.
Yes, I’m at a startup, and most of my co-workers are also relatively new to the area (or they live a ways in the opposite direction from my workplace). Thanks for the tip on Bellevue Family Medicine, though. I’ve never been to a “family doctor” - can you say anything on how you think it’s different from seeing an internist or GP?
Ask your local pharmacist for recommendations. Pharmacists almost always know who the good doctors are, since they talk with local docs all the time about the prescriptions they write for various patients. Pharmacists are especially good at spotting doctors who are: 1. Up-to-date in their knowledge of the medications available; 2. Careful in deciding on which medications to prescribe ; and 3. Honest about the limitations of their knowledge and honest about when they may have made a mistake.
If a doctor is careful about deciding on what medications to prescribe, he or she is probably also careful about other aspects of treating patients. Doctors who make sure to update their knowledge of medications are usually on top of other medical advances, too. And, of course, someone who’s willing to admit to a lack of knowledge in one area will probably be honest when they don’t know something in other subjects, too.
This is better referred to Qadgop the Mercotan, who is not only a family doctor but a Fellow of that prestigious academy.
Here’s the basic dope. When we docs get out of the four years of medical school, we get an MD, but no hospital in the world will allow us privileges with our basic training, and we aren’t even allowed to get a license to prescribe drugs until we do one more year of post-graduate training. Many years ago this year was called an “internship”. Docs in their first year after medical school are still colloquially called “interns” though no program formally uses the name.
When people leave medical school, they go directly into a three-, four-, or five-year post-graduate training program. The post-graduate training programs are called residencies, and a doctor training in one is called a resident. If a medical student is like a recruit going through four years of basic training, a resident is like a lieutenant, third class: newly minted officer, not yet trusted with serious responsibility. I am now a program director (equivalent of officer over a small training school) and I have to swear to the education authority that my resident is never out of supervision. This doesn’t mean always under my eyeball; general supervision means I am responsible for that resident’s decisions, even if not watching her (him). As you can guess this makes me rather nervous at times.
But that’s a side tangent. Sorry. If a person chooses the three-year family practice residency, when they graduate it, they become eligible (permitted) to take a grueling exam called the Boards in Family Practice. If they prefer to take the three-year internal medicine residency, then they will not be eligible for the Family Practice test, but they will be eligible for the Internal Medicine test. The main difference is Family covers children and adults, while Internal covers only adults, but may go deeper into some adult diseases. In the same way, Pediatrics covers only children, and may go deeper into some childhood diseases. FPs do it all.
The surgery residencies are mostly five years long because they have to spend a long time training the hands as well as the head. (The family practice docs do a good bit with their hands, but less specialized maneuvers, more like general human dexterity.) My field, pathology, because it’s the odd man out and never does anything like anyone else, goes for four years.
Once a person has their residency done and over with, they can either go into practice with privileges at any hospital, or they can go on for another year or even two more years of subspecialty training. The program I direct takes four-year residents from pathology and trains them in the subspecialty of forensic pathology. There are also subspecialty residencies in surgical pathology, cytopathology, neuropathology… you get the idea. A person who has his Boards in family practice can go on for a year of training in some special subset of diseases like allergy and immunology, kidney, heart, etc. Then they are eligible to sit for an even more grueling Boards. I remember when I told a non-doctor friend that I had passed my first set of Boards, but had another set to pass, she looked at me funny and said, “That must have hurt. Did it take a lot of laxatives?”
A person who has subspecialty training is likely to be more expert in their area, but not necessarily a better doctor. You wouldn’t expect someone with special training in eye diseases to miss iriditis, but they still could if they weren’t paying attention that day, or if they already made up their mind what your disease is and weren’t noticing subtle indications that they were wrng. Sounds to me like your doc is a loser. I would abandon him/her. Good luck.
Arrgh. After all that scribble I forgot to say what a GP is. Fifty years ago, when you could do four years of med school and a year of internship, then hang out a shingle and set up your practice, you would be called a GP, or general practitioner. Nowadays there is no such person and the basic doctor who handles all your needs is a family practitioner, who has at least three years of post-medical school training. Some people casually use GP to refer to docs generically as intern is casually used to refer to first year post medical school docs. No functional definition in modern use.
When I moved here I asked my doctor how to find a new one. He said ask pharmascists, since they deal with doctors every day and know who is good and who is bad. He also suggested I ask nurses, but since he didn’t suggest how I find nurses to ask, I think the first idea is easier.
When looking for a good primary care physician, I’d suggest you opt for one who is boarded in Family Medicine or Internal Medicine.
The FM (and I believe the IM) Board requires re-certification testing periodically. So the doc must work to stay current and abreast of new developments in order to get recertified. Board certification is no guarantee of the doc being competent and all that, but it does tend to raise the odds that a Board certified doc will be, on average, more up to date than one who is not.
It’s perfectly legitimate, when contacting a doctor’s office, to ask if they are board certified.
Thanks, everyone! Despite working with several (nonpracticing) MDs for years, I had only the most rudimentary understanding of the process. My grandfather called himself a GP - I didn’t know that the term wasn’t used any more. The doctor I have been seeing here is board-certified in Internal Medicine.
I actually don’t have a problem with his not correctly diagnosing it, as much as I have a problem with him not referring me to someone who could recognize it when it didn’t follow the course he was expecting. The first time I saw him, he told me that most eye infections are viral and I should tough it out. I called him back after a week of no improvement, and he just gave me antibacterial eye drops. I called an opthamologist on my own the next day when I was in too much pain to get out of bed. After she saw me, she actually asked me to call my PCP back and tell him what my diagnosis was, and that photosensitivity was not a normal symptom of conjunctivitis. I had had it for long enough that I have a bunch of pigment stuck to the lens, which is gradually clearing now, and I have several hundred floaters in that eye (which the opthamologist says will take six months or more to clear).
amarinth sent me some names, whom I will check out, and I also at least have a few ideas about how else to search. I realized last night that I should ask my daughter’s pediatrician about OBs (especially since the pediatrician just had a baby herself) - I really like her, and I suspect she wouldn’t put up with any BS from her doctor.
They came from very different streams of thought about medicine once, but now they have almost merged.
Because the doctor of osteopathy came out of a paradigm which was related to chiropractic, homeopathy, and massage, they tend to be: 1) more hands-on 2) more family-practice-oriented and less subspecialty oriented 3) more open to alternative medicine (YMMV) 4) more tolerant of chiropractic. MD’s tend to be less hands-on (try to get your MD to rub your neck), more oriented towards special training rather than general practice, less tolerant of alternative medicine particularly chiropractic, and more interested in combining research with practice.
However, the classes in DO schools and MD schools are virtually the same, and the only differences are these slight cultural ones.
I know a retired DO who practices as a local medical examiner, and he’s a great reference to go to with musculoskeletal problems - better than any MD I know. However, he would probably have missed iriditis. His training 40 years ago was too general and not specific enough. Either that, or he’s forgotten a lot.
Ah, but would he have figured out that an eye problem wasn’t progressing “normally” and referred it to an eye doctor? (By the time I saw him the second time, the whites of my eyes were bright red, and I had the very characteristic thick, dark line around the iris.) Personally, that’s all I think I can reasonably ask.
Boy, that was an unclear post. “All I can reasonably ask” is that a doctor recognize his own ignorance and refer to a specialist when things don’t seem to look right. And my own PCP didn’t do that, hence my new search.