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How I've Found, and Why I've Kept My Doctors
A Personal Essay
By Bridget Avila

While we were visiting my parents in Louisiana for Christmas the year before last, my one-year-old daughter's fever and nasty cough brought me to the dreaded conclusion that I'd have to find a doctor to see her on Christmas Eve-one who had never seen her before and likely would never see her again. First, I called my former pediatrician, whose answering service informed me that the office was closed for the week. I tried a second office, found on my insurance company's web site. They refused to see her on a one-time basis, suggesting instead that we bring her to the emergency room at the local children's hospital. Huh? I used to work in an emergency room, and didn't like my odds of having her seen and treated in less than 3 hours.

Bracing myself for another rejection, I called my old family doctor-not even sure if he treated young children at all. A female voice with a mildly lilting Cajun accent said, "We can see her at 10:30."

So I took my darling girl to see the burly man with a bushy beard and calming persona who had treated three generations of my family already. His examination of my daughter made it four. He scrawled a prescription for her, saying "This will help clear the gradu out of your nose and chest, cher."

Besides sparing me keeping a sick toddler cooped up in an emergency room for hours, the visit to my former physician had been comforting to me. It reminded me of what I valued in a health care provider, and what I thought I'd probably been lucky to find in Annapolis-doctors who were right for me and my family.

I've never been one to follow directions, so I've never exactly followed the advice of how-to-choose-a-doctor articles that pop up in consumer magazines and health insurance paraphernalia. But somewhere between my teens and my 30s I've learned what I want in a doctor.

Everyone expects competence from their physicians, but I'm not sure of any hard and fast way to measure competence beyond learning where a doctor earned a medical degree and where they interned and went through residency. The how-to articles always recommend finding a doc with board certification in their chosen specialty, but a quick glance through the phone book will show you that there are few physicians without board certification who will hang out a shingle. The truly determined patient will likely go a step further to find out if a doctor has been under any kind of formal disciplinary action or investigation, and possibly even interview doctors themselves before choosing one in particular.

But I'm willing to wager that most of us open up the latest physician directory from our current insurance provider and look for the comfort of a familiar name and the convenience of a nearby office. Beyond this initial "research," I've come to rely on my own intuition to cull through the nominees, looking for what I really want-a competent physician who knows more about me than what's in my chart and who cares about what happens to me when I walk out the door.

Before college, and before the term "managed care" meant anything to me, I could probably have counted the number of different physicians who'd treated me on one hand. The only reasons my family would have had to change doctors would have been if they were unhappy with a doctor or if the doctor retired. I'm sure it was a great comfort to my parents to know our health care providers so well, and that the doctors, in turn, knew all of us.

Once I was on my own and living in a new town, I had to choose my own health care providers, which was an entirely foreign concept to me. Ironically, even though my first "real" job was in a hospital, I felt completely inept at choosing a doctor. And since I didn't plan to stay in the area for more than a year, I was able to put off any decision, and get the occasional unofficial exam from the doctors I worked with. Not exactly what you would call being an advocate for my own health. But I was young and healthy and had other things to worry about, like paying my rent and following my fiancé's naval career around the country.

For the young and transient, continuity of care seems a romantic, unattainable notion. Continuity of care-not just for an individual patient, but for an entire family-can also be rare to nonexistent for anyone whose health care plans may change frequently. This can result from job changes or even an employer's shifting insurance options-in other words, can happen to anyone for any reason.

Before I could even consider keeping a doctor for more than 2 or 3 years, my husband would have to become a civilian. After that hurdle came buying a home in which we intended to stay for an indefinite period. In the meantime, I went through countless physicians, most of whose names I don't remember, for various minor illnesses and regular checkups.

The first doc I made a conscious decision to steer clear of was a dentist who, in one visit, told me I had four cavities that needed filling and that I had temporomandibular joint syndrome (TMJ). That I'd only had one filling in my life up to that point and that I'd never had any symptoms of TMJ led me to believe that this guy was just looking for ways to rack up charges. The next three dentists I saw agreed with that assessment.

It's a fuzzy way to take a measure, but I've found that my gut feelings have never steered me wrong. If there's something that makes me uncomfortable about a health care provider or the provider's office, then I heed that warning, unquantifiable as it might be.

Of course, gut instinct won't tell us everything. My mother's gastroenterologist made national headlines when he was convicted of attempting to murder his former lover and employee by injecting her with an HIV-contaminated blood sample. My mother always stood by this doctor's treatment of her, and still has a hard time believing he could be capable of murderous intentions. And my father apparently didn't question his urologist's treatment of his longterm prostatitis until another doctor's biopsy led to the discovery that he had prostate cancer so far advanced that it had already entered his lymph nodes.

These examples may seem extreme, but my guess is that similar scenarios play out all the time. Perhaps the most important part of being an advocate for your own care is to really pay attention to your own observations, to the local paper, and even to the rumor mill-and to do some basic research. Ask questions. Find out where your doctor received his or her training. Are they are board certified? Have they ever been investigated for malpractice?

After living in Annapolis for 4 years (an eternity for a former military family), I can finally think of my cadre of doctors as people who will be with me for the long haul. This occurred to me after the last time I saw my primary care doctor. He's an even-keeled, friendly man who seems genuinely interested in people. He remembers that he once did a summer of volunteer work in the small Louisiana town where my father grew up. He knows that I quit working after my daughter was born to stay home with her. He knows me.

Even when we see my daughter's bilingual pediatrician around town, he remembers to speak Spanish to my daughter because we want her to learn it, but not to speak too much because while my husband is fluent, I'm not.

I'm happy with all of our doctors. I find them competent and attentive to more than just the results of any physical examination. I'm happy to think of these physicians as lifelong partners in my family's health care. And knowing I've chosen good doctors makes this community feel a little more like home.

How I've Found, and Why I've Kept My Doctors
A Personal Essay
By Bridget Avila

While we were visiting my parents in Louisiana for Christmas the year before last, my one-year-old daughter's fever and nasty cough brought me to the dreaded conclusion that I'd have to find a doctor to see her on Christmas Eve-one who had never seen her before and likely would never see her again. First, I called my former pediatrician, whose answering service informed me that the office was closed for the week. I tried a second office, found on my insurance company's web site. They refused to see her on a one-time basis, suggesting instead that we bring her to the emergency room at the local children's hospital. Huh? I used to work in an emergency room, and didn't like my odds of having her seen and treated in less than 3 hours.

Bracing myself for another rejection, I called my old family doctor-not even sure if he treated young children at all. A female voice with a mildly lilting Cajun accent said, "We can see her at 10:30."

So I took my darling girl to see the burly man with a bushy beard and calming persona who had treated three generations of my family already. His examination of my daughter made it four. He scrawled a prescription for her, saying "This will help clear the gradu out of your nose and chest, cher."

Besides sparing me keeping a sick toddler cooped up in an emergency room for hours, the visit to my former physician had been comforting to me. It reminded me of what I valued in a health care provider, and what I thought I'd probably been lucky to find in Annapolis-doctors who were right for me and my family.

I've never been one to follow directions, so I've never exactly followed the advice of how-to-choose-a-doctor articles that pop up in consumer magazines and health insurance paraphernalia. But somewhere between my teens and my 30s I've learned what I want in a doctor.

Everyone expects competence from their physicians, but I'm not sure of any hard and fast way to measure competence beyond learning where a doctor earned a medical degree and where they interned and went through residency. The how-to articles always recommend finding a doc with board certification in their chosen specialty, but a quick glance through the phone book will show you that there are few physicians without board certification who will hang out a shingle. The truly determined patient will likely go a step further to find out if a doctor has been under any kind of formal disciplinary action or investigation, and possibly even interview doctors themselves before choosing one in particular.

But I'm willing to wager that most of us open up the latest physician directory from our current insurance provider and look for the comfort of a familiar name and the convenience of a nearby office. Beyond this initial "research," I've come to rely on my own intuition to cull through the nominees, looking for what I really want-a competent physician who knows more about me than what's in my chart and who cares about what happens to me when I walk out the door.

Before college, and before the term "managed care" meant anything to me, I could probably have counted the number of different physicians who'd treated me on one hand. The only reasons my family would have had to change doctors would have been if they were unhappy with a doctor or if the doctor retired. I'm sure it was a great comfort to my parents to know our health care providers so well, and that the doctors, in turn, knew all of us.

Once I was on my own and living in a new town, I had to choose my own health care providers, which was an entirely foreign concept to me. Ironically, even though my first "real" job was in a hospital, I felt completely inept at choosing a doctor. And since I didn't plan to stay in the area for more than a year, I was able to put off any decision, and get the occasional unofficial exam from the doctors I worked with. Not exactly what you would call being an advocate for my own health. But I was young and healthy and had other things to worry about, like paying my rent and following my fiancé's naval career around the country.

For the young and transient, continuity of care seems a romantic, unattainable notion. Continuity of care-not just for an individual patient, but for an entire family-can also be rare to nonexistent for anyone whose health care plans may change frequently. This can result from job changes or even an employer's shifting insurance options-in other words, can happen to anyone for any reason.

Before I could even consider keeping a doctor for more than 2 or 3 years, my husband would have to become a civilian. After that hurdle came buying a home in which we intended to stay for an indefinite period. In the meantime, I went through countless physicians, most of whose names I don't remember, for various minor illnesses and regular checkups.

The first doc I made a conscious decision to steer clear of was a dentist who, in one visit, told me I had four cavities that needed filling and that I had temporomandibular joint syndrome (TMJ). That I'd only had one filling in my life up to that point and that I'd never had any symptoms of TMJ led me to believe that this guy was just looking for ways to rack up charges. The next three dentists I saw agreed with that assessment.

It's a fuzzy way to take a measure, but I've found that my gut feelings have never steered me wrong. If there's something that makes me uncomfortable about a health care provider or the provider's office, then I heed that warning, unquantifiable as it might be.

Of course, gut instinct won't tell us everything. My mother's gastroenterologist made national headlines when he was convicted of attempting to murder his former lover and employee by injecting her with an HIV-contaminated blood sample. My mother always stood by this doctor's treatment of her, and still has a hard time believing he could be capable of murderous intentions. And my father apparently didn't question his urologist's treatment of his longterm prostatitis until another doctor's biopsy led to the discovery that he had prostate cancer so far advanced that it had already entered his lymph nodes.

These examples may seem extreme, but my guess is that similar scenarios play out all the time. Perhaps the most important part of being an advocate for your own care is to really pay attention to your own observations, to the local paper, and even to the rumor mill-and to do some basic research. Ask questions. Find out where your doctor received his or her training. Are they are board certified? Have they ever been investigated for malpractice?

After living in Annapolis for 4 years (an eternity for a former military family), I can finally think of my cadre of doctors as people who will be with me for the long haul. This occurred to me after the last time I saw my primary care doctor. He's an even-keeled, friendly man who seems genuinely interested in people. He remembers that he once did a summer of volunteer work in the small Louisiana town where my father grew up. He knows that I quit working after my daughter was born to stay home with her. He knows me.

Even when we see my daughter's bilingual pediatrician around town, he remembers to speak Spanish to my daughter because we want her to learn it, but not to speak too much because while my husband is fluent, I'm not.

I'm happy with all of our doctors. I find them competent and attentive to more than just the results of any physical examination. I'm happy to think of these physicians as lifelong partners in my family's health care. And knowing I've chosen good doctors makes this community feel a little more like home.