The information available today is staggering. Even the most skilled and specialized provider can’t know it all. Because it isn’t possible for any one doctor to know everything, you need providers in the plural, with different training and specialties to suit your particular needs.

Many people choose a medical doctor based on what they read in magazines or see on TV. Local city magazines, for example, often take unscientific surveys to determine the “best” city doctors and publish the results along with the “best” local restaurants, ice cream shops, and yoga studios. These are subjective lists only. They don’t reveal the qualifications and possible conflicts of interest of the individuals voting and the criteria they used in making their selections. These are usually nothing more than name recognition lists, often used for self-promotion of a hospital, magazine, or who knows what.

Or maybe we rely on anecdotal stories from others when making health care choices. We ask our family and friends how they like their doctor, pharmacy, rehabilitation center, or dentist. These folks are trying to help, especially in communities with lots of physicians. Whether we get a referral from our insurance company or from a friend or family member, many health care providers are good at what they do. Can every physician be “the best?” Probably not. But the overwhelming majority is probably best for certain people in certain circumstances. It depends on you and your needs.

There are exceptions, however. Sometimes we’re not going to the right place because our particular problems aren’t that provider’s specialty. Ask questions. Make sure this provider has experience treating your specific condition. The first thing you want to know when you see a new physician is something often taken for granted: Will this physician be good for what you need? How do you know? How do you define “good”?

So how do you decide who’s a good physician? Start by defining the traits you’d like in a doctor. In medical school, residency, and fellowship studies, all physicians are taught that being well trained, having good bedside manner, and keeping long hours are the most important qualities of a good doctor. We call these qualities the three As: ability, affability, and availability. Because it’s difficult for us to assess the ability or affability of a doctor we’ve never met, most of us choose our physicians by availability.

Certainly, the availability of your physicians is important. None of us wants to travel three hours to the nearest city, wait weeks or months for an appointment, or sit in the doctor’s waiting room for hours. But availability takes a back seat to ability in certain circumstances. If you need complicated brain surgery to treat a brain aneurysm, you should be asking the newly introduced neurosurgeon, “Do you think you can help me?” not “Do you have an East End office?” When your life is on the line, you want a doctor with top-notch skills and experience who will provide the best possible care. Availability, while still important, should become a secondary consideration.

When you’re picking a new health care provider, don’t just pick the first name in your health care insurance book. Instead, ask around and get referrals. Also if you’re seeing more than one physician for a particular condition, consider whether they know each other and have a good working relationship. Ask Doctor No if he works with Doctor Yes. If you don’t get an answer, check with the doctor’s staff. In a time of crisis, you need your providers to be able to communicate with each other. And although we’d like to think they could rise above personal differences, would you be able to?

Another important factor is whether your different physicians have admitting or consulting privileges at the same hospital. Unknowingly, patients often rely on two or more groups of physicians at different facilities. If you see one doctor as an outpatient and are then admitted to a hospital that he or she doesn’t visit, you’ll be stuck with someone new. During initial consultations with new physicians, ask what facilities they use. Check with your current doctors about the hospitals they’re affiliated with, and tell them which one you prefer. Too much time and money is wasted when selected providers are affiliated with different medical systems.

If you’re like most of us, the first thing you do when you’re referred to a new physician is check your health insurance directory to make sure the referred doctor is part of your insurance plan. Before you scream and yell that he or she isn’t there, check the online directory for your insurance company or give them a call. Better yet, call the business office of the physician you want to see and ask. The directories come out annually and aren’t always updated regularly.

After availability, affability is the next trait that most of us consider when picking a new provider. During your initial visit, you’ll get a sense of the doctor’s personality. Ask yourself if it will be easy to get along and talk to this person. You should feel comfortable asking questions, and you should feel as though he or she listens and explains things clearly. If a physician makes you feel uneasy, brushes off your concerns, or seems to speak in another language, then he or she probably isn’t the one for you.

Two factors impact your doctor’s bedside manner: personality and interests. As part of your bedside manner evaluation, think about your own personality type. The Jung-Briggs-Myers typology is a commonly used tool to assess personality. It classifies people using four criteria. The first criterion, extroversion versus introversion, focuses on the source and direction of energy expression. Because the extrovert’s source and direction of energy expression is mainly in the external world, he or she is usually very friendly, talkative, and outgoing. The introvert focuses his or her energy mainly in the internal world and is usually quiet, contemplative, and shy. You can find both extroverted and introverted physicians.

Sensing versus intuition is the second criterion. It focuses on how a person perceives information. If you’re a sensing person, you generally believe the information you receive is from the world around you. If you’re intuitive, you believe information you receive is from the internal or imaginative world. Most physicians are more sensing than intuitive.

The third criterion is thinking versus feeling, which looks at how new information is processed. A thinking person makes a decision using logic. A feeling person makes a decision based on emotion. Because most physicians fall within the “thinking” category, this can be a common area of conflict when patients are feeling people.

The last personality criterion looks at what a person does with the information he or she has. A judging person organizes the information, formulates plans, and acts on the plans. A perceiving person is more inclined to improvise and seek alternatives. Once again, physicians usually fall into the judging category.

It’s the different combinations of these above four criteria that determine personality type. When you’re considering the affability of a potential new doctor, you need to think about the type of personalities you like to be around given your own personality.

With that said, personality types shouldn’t be the most important thing because most of us can get along with others, even if they’re different. Your physicians’ special abilities and particular interests, therefore, may be more pertinent than affability when choosing the “best” physician for you.

Generally, it’s uncommon to meet an experimental physician in the course of any disease management program. If the disease is rare enough, however, or if the research center is large enough, there’s a chance you could interact with such a doctor. If you’re interested in getting to the root of the disease you’re facing, you might seek out an experimental physician, but don’t expect to depend on him or her for nonspecialized problems or to manage your case.

A clinical research physician is usually associated with a large hospital or practice, university clinic, pharmaceutical company, or government research agency. He or she would likely work closely with other clinical research physicians or Ph.D. scientists but may still see patients who have conditions that he or she is researching. The advantage to finding a clinical research physician for your disease is that he or she will likely be one of the most knowledgeable physicians for your disease type. With that said, however, if your subset of the disease isn’t what he or she is truly interested in, you probably won’t receive as much attention. You’ll likely still need a practicing physician to manage your care.

A numerical physician addresses medical issues in business management, often in the private or public health insurance or pharmaceutical industry or in a financial research firm. Most numerical physicians no longer see patients and instead crunch numbers for a living.

A pure regulatory physician is another physician you’re not likely to see. Generally, regulatory physicians work with medical societies, government agencies, and pharmaceutical companies, for example, to ascertain the current thinking in the area of his or her expertise. If the subject is, let’s say, cardiovascular disease, a regulatory physician may know almost everything there is to know about the current treatments of this disease. Whether a regulatory physician can still take care of you depends on whether he or she is still associated with a group of practicing physicians.

An institutional physician is usually the administrative physician for the practice that you go to. It can be the group’s senior physician or the physician with the most business savvy. Because it’s a time-consuming job, there may be more than one institutional physician. You can expect that this doctor will be the best resource in understanding the local medical community and the personnel within his or her practice. This doctor can make things happen with the clinical staff and office personnel. Many, but not all, institutional physicians see patients as practicing physicians.

The doctor with the most availability is the practicing physician. If you have complex, multiple conditions that are unrelated to one another, you want a practicing physician who can help you with each of these issues. Check to make sure the practicing physician you see has some involvement with his or her state specialty association because you’ll benefit from your doctor’s interaction with other experts in the community.

Remember, it’s possible, and often the case, for your physician to wear more than one hat. Choose the hat or hats that best fit your circumstances. Don’t think badly of your physician just because he or she doesn’t wear the right hat for you. Just like the fashion world, certain hats go with certain outfits.

The ability of a medical doctor is determined by his or her background. Ask where he or she was trained. What residency was completed? Was time spent doing a fellowship in a particular specialty? Don’t be afraid to make inquiries because you need the answers. Although you can trust that your physician will send you to the right specialist for your illness, you should still ask questions to understand his or her perspective. Remind the doctor who’s making the referral about the issues that are important to you before asking for a recommendation. Ask if the specialist is available and affable as you define it. Check to see that he or she is a trained specialist for your condition or conditions. Inquire as to board certifications. Find out if the specialist has had any licensing problems with your state medical licensure board.

Medicine is complex. And because no one medical doctor can know everything, there are specialists and subspecialists for different parts of the body, different illnesses and injuries, and different treatment methods. When you receive a diagnosis, ask the diagnosing physician who you should see and why. Ask for an explanation of the recommended specialty (or specialties) and what that specialty does. Check to see if there is a subspecialist who might be better for your condition. If the diagnosing physician can’t suggest a particular specialist, inquire as to how you can find the right specialist for you.

Even the most dedicated doctors need a vacation. When meeting a new physician, ask about his or her associates because they’ll be covering for your vacationing or sick doctor. For example, when a mother-to-be is selecting an obstetrician to deliver her baby, she should interview or inquire about all the doctors in the group because she won’t be able to control who will be on call when it’s her time to give birth.

If you live in an urban area, chances are you have access to a wide range of medical facilities. We’ll start with the one we all know the best—the hospital. But there isn’t just one type of hospital—there are academic teaching hospitals, community teaching hospitals, general community hospitals, and specialty hospitals.

Academic teaching hospitals are usually affiliated with a university program and emphasize research and teaching more than just serving patients. At these institutions, you may see experimental and clinical research physicians, as well as a lot of medical students and physicians who are in training.

Community teaching hospitals, often larger in size, are usually affiliated with a medical school teaching program. Their focus is patient care, followed by research and teaching.

General community hospitals, found in almost every local area, have no (or a limited) role in training physicians. Their sizes run from small to large. Patient care is their primary focus.

Specialty hospitals concentrate on particular conditions, such as pediatrics, mental health, mobility, rehabilitation, or cardiac care.

Government hospitals (such as Veteran’s Administration hospitals) can be found at the federal, state, or local level and can be academic, community teaching, or general community, depending on their government charter and opportunities within the community. A government facility may offer you services at greatly reduced rates if you’re eligible, although timeliness and staff availability may be impacted.

Ambulatory care facilities are not hospitals, although they can resemble them. These facilities include outpatient surgery centers, emergency care centers, and medical centers. At an ambulatory care facility, you can’t be admitted as an in-patient or for more than 23 hours. The advantage to these facilities is that they’re easier to use and often have a more focused purpose. The downside is that a full range of medical services isn’t available.

Doctor’s offices or clinics may offer medical services in addition to office examinations with your doctor. For example, you may receive chemotherapy treatments, stress and radiology tests, dialysis, or other outpatient services at your physician’s office. The benefit is efficiency, ease of use, and generally a friendly, less intimidating environment. Like the ambulatory care centers, a full range of medical services won’t be available. Physicians’ offices are just that—the place you go to meet your doctor. Some offices provide minor medical services, such as biopsies; others refer you to other facilities if additional medical care is required.

Public health clinics are commonly arranged by each state, through the county system, to deliver health care to the under- or uninsured. Often, public health clinics treat communicable diseases, such as HIV and sexually transmitted diseases. In certain regions of the country, all types of health care are provided, including dental services, eye exams, and care for kids and pregnant women.

Immediate care centers are acute care doctors’ offices that don’t require appointments. The physicians staffing these centers are often nonspecialists or emergency specialists who make themselves available for minor injuries (a cut finger requiring stitches), acute, non-life-threatening illnesses (the flu), or other ailments that require a doctor’s attention but don’t warrant a trip to the emergency room.

Convalescent and rehabilitation centers are places where patients are taken to recuperate after a serious injury, illness, or surgery. You often hear of stroke or paralysis victims transitioning from a hospital to a rehab center. Patients who’ve had knee or hip replacements often spend time in a rehab center before heading home.

Nursing homes are long-term care centers for people needing continuous nursing care, whether it’s due to old age, illness, dementia, or injury. Sadly, patients in need of nursing home care are not expected to get better.

So how do you determine what type of facility is best for you? First, talk to your doctor. If you need a minor surgical procedure, an ambulatory care center may be best. Perhaps you need a biopsy; if it’s highly focused, your doctor may send you to a specialty hospital. There are different facilities for every need, many with overlapping services. Discuss your options with your caregiver every time. Once you determine what type of facility you need, you may have different ones to choose from. Your doctor may have a recommendation, of course. If cost is an issue, you should check with your insurance provider to find out what facilities are covered by your insurance. The Joint Commission on Accreditation of Healthcare Organizations has a Web site (www.jointcommission.org) with information on accredited facilities. HealthGrades (www.healthgrades.com) uses Medicare mortality and complication data to rate hospitals. Medicare (www.medicare.gov) can help you search for hospitals in your geographic area.

Sometimes you may be governed by your geography, but whenever possible, try not to let this limit you. It may be inconvenient to drive hours to get to a better hospital or testing facility. But if that facility will provide optimal care, it may be beneficial in the long run. Sometimes a little inconvenience is worth it. However, we’ve also heard reports of people traveling overseas for elective surgery at reduced rates. All we’ll say is that you often get what you pay for—and sometimes you don’t even get that.

Today, there are at least three types of pharmacies (besides the inpatient pharmacies you find in medical facilities). For starters, there are the ones many of us know and love: the locally owned, Mom-and-Pop drugstores. These small businesses, which are quickly disappearing, often have a pharmacist who knows you and all the medications you’re taking. Your neighborhood pharmacist has the ability to personalize your service and often provides home delivery. There’s a level of comfort that may make it easier for you to ask questions.

In addition to these Mom-and-Pop drugstores, we also have national retail pharmacy chains, such as Walgreens, CVS, and Rite Aid (the top three chains in North America). Others are emerging and growing fast. The national retail pharmacy chain has consolidated much of the drug delivery industry, which has helped to reduce costs. It has also impacted prescriptions written by physicians by making a state medical license for all practical purposes a national license; you can travel to another state and still have your prescription filled. The new trend among national retail pharmacy chains is to offer nurse practitioners on a regular basis to answer questions and provide minor medical care, such as writing a prescription for a stomach virus or an infected cut, along with annual flu shots and blood pressure monitoring. We believe this is a likely future direction of the practice of general medicine. Just don’t forget to tell your doctor that you received medical attention on the run.

Nowadays, you can also get prescriptions filled by mail-order pharmacies. In most cases, you must provide a doctor’s prescription via fax or mail or have your doctor call it in. The benefit to you? You can get your Rx without ever having to leave the house or wait in long lines. However, with mail-order pharmacies, you do sacrifice immediate and personalized service. The Federal Drug Administration (FDA) warns people to steer clear of mail-order pharmacies that don’t require a valid prescription. Mail-order drug delivery works well for chronic conditions but clearly won’t work if you need a certain drug right away. The cost savings is a big plus, but you’ll sacrifice personalized service.

When you go to different pharmacies, there’s no record of all the drugs, either prescribed or over-the-counter, that you’re taking. As we’ve said before, any drug you take, no matter how insignificant it may seem to you, is still medical care. Until your health care records are completely interoperable, it’s up to you to make them interoperable by telling your doctor everything.

You may be thinking, “What’s palliation?” Palliation creates comfort for the uncomfortable. It’s the treatment of your symptoms, such as pain, to alleviate discomfort. Palliative care isn’t the treatment of the disease that’s causing the problem. The sole focus of palliative care is to make you comfortable, often because further medical intervention has been deemed fruitless by you and your physicians. Hospice is the best example of palliative care for the terminally ill and, contrary to popular belief, it isn’t just for cancer patients. You often see palliative care and pain management for those suffering from Parkinson’s Disease, ALS, MS, AIDS, and cardiac disease, to name a few.

Palliative care is available at many medical facilities and is often closely associated with hospice programs. Hospice isn’t a place; it’s a treatment program provided at a hospice facility, in your home, or within another medical facility. The goal of hospice is to provide comfort and care to people suffering from a terminal illness or injury. Hospice is able to administer previously prescribed pain medication as well as drugs for symptoms that haven’t occurred yet. Pain is treated to provide the patient with some quality of life even though life’s end is near. However, pain treatment isn’t the only service that hospice provides. It also addresses a patient’s social, spiritual, and emotional needs.

It’s this multifaceted approach that makes hospice unique. Patients interact with physicians, social workers, nurses, and even members of the clergy. Although the underlying disease isn’t treated, other manageable conditions, such as labored breathing, are addressed. Drugs to alleviate pain are provided, but so is physical therapy if it helps the patient. Hospice is about finding ways to make the end of life better for the patient as well as those around him or her. Counseling and support are offered to care-giving family members. Hospice volunteers often fill in for primary caregivers so they can take a much-deserved break. Martha, age 33, cautions, “You need to be prepared for the harsh reality of the message they deliver—that they are there to prepare the patient and family for death.”

More than 3,000 hospice programs are available in the United States today, with most insurance plans including hospice as an insured benefit. These programs are both for-profit and not-for-profit. Hospice, as noted earlier, is available for terminally ill patients only, which means an anticipated life expectancy of less than six months. To participate in a hospice program, you must also agree to a Do Not Resuscitate, or DNR, Order (discussed at length in Chapter 8, “Medical-Legal Wishes: Defining Capacity, Consciousness, and Contingencies”). Do you need a prescription to call hospice? Yes. Ask your doctor. There’s also a chance that your physician will suggest hospice first.

The benefits of hospice are incredible. Kathy, age 32, “had an amazing experience with hospice” when her father was in the final stages of brain cancer. “At first, I was angry and very resistant to the concept and thought it was simply giving up. But I quickly learned how incredible the people who work in hospice care are—they are truly angels here among us. Helping someone you love go out in a peaceful way is the last thing you can really do for that person.” Everyone we surveyed that had any experience at all with hospice had similar sentiments.

Hospice, though, isn’t for everyone. It’s not for you if you don’t have a terminal illness. Chronic pain can be treated by a pain specialist (usually an anesthesiologist in private practice). If you have a terminal condition without systematic discomfort and you have good social, financial, and family support, you won’t necessarily require hospice. Alternatively, if you’re still receiving treatment of your disease in an aggressive manner, even if you’ve been diagnosed as terminal, hospice isn’t for you because hospice doesn’t treat your underlying disease. If you’ve made the decision to battle your condition, it doesn’t mean you won’t receive pain medication. The alleviation of pain is part of all good disease treatment. Don’t be afraid to tell your provider that you’re in agony. It’s the provider’s job to help you deal with your pain. It’s also not worth it to take the stiff-upper-lip approach to pain. Suffering needlessly saps your energy, exhausts you, and, at the very least, makes you irritable. Fighting illness is hard work; make sure you save your strength for what’s important. Don’t waste it on enduring pain.

The decision to call hospice is a delicate balancing act. You either want to continue to explore treatments, or you want to receive comfort measures only. You don’t want to call hospice too soon, but you also don’t want to forget to call them. It’s critical to have serious discussions with your doctor about what you want and what you can do. Before you go on hospice, confirm with a medical specialist to be sure you really need it. If he or she tells you there’s nothing else you can do for recovery, it may be time to make the call.

Just picking a doctor or medical facility out of the phone book or from your insurance provider book is easy, but it’s not the greatest way to find the best provider, facility, and program for you. Decide what you need, and then ask questions and research your options.