|Luise Light, M.S., Ed.D., former USDA Director of Dietary Guidance and Nutrition Education Research, was responsible for the original food guide pyramid. She developed the National Cancer Institute's first diet and cancer prevention guidelines, and national health promotion programs with supermarkets, the American Cancer Society, the Red Cross and others. She has been health editor of Vegetarian Times and executive editor of New Age Journal, and now teaches, counsels and writes in Vermont. Her newest book is What to Eat; The Ten Things You Really Need to Know to Eat Well and Be Healthy. You may contact Luise at firstname.lastname@example.org.|
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SELECTING AND DEALING EFFECTIVELY WITH A HEALTHCARE PROFESSIONAL
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HOW TO FIND THE RIGHT HEALTHCARE PROFESSIONAL FOR YOU
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Our guide to selecting a primary-care physician who will work with you to get the alternative treatments you want and need.
There are many reasons why you might want to find a new family doctor: Your longtime physician may be retiring, or you may be moving, changing jobs or health-insurance carrier. Perhaps the level or type of care you've received has not been satisfactory. Whatever your motivation, the decision of which doctor to choose to oversee your care may be one of the most important you ever make, and in these days of managed care, the choice is more crucial than ever before.
As alternative treatments become increasingly available and more insurance plans cover them, it is your choice of primary-care physician that will impact most dramatically on your ability to integrate conventional with alternative care and shape your own medical future.
WHAT IS A PRIMARY-CARE PHYSICIAN?
The primary-care physician is the critical gatekeeper of your managed care and insurance plan. As an informed generalist, he determines whether or not to refer you to medical specialists and what tests and treatments should be administered. The case of Lois Lai, a 39-year-old singer and songwriter from Oxford, Conn., afflicted with a severe kidney disorder, bears testimony to the importance of seeking out a physician who can help you navigate through today's complex health-care maze. This person is responsible for deciphering any symptoms you might have, determining the most beneficial diagnostic tests, preventive services and healing treatments - both conventional and alternative - that your insurance will cover, and coordinating the multiple decisions your care requires.
LAUNCHING THE SEARCH
Lai went looking for a new doctor when her team of kidney specialists (at a local Ivy League teaching hospital) told her that total kidney failure and a transplant would be imminent. She viewed the prognosis and prescribed course of treatment as a judgment call based on her medical team's extensive experience, but one that ignored the role that hope, spiritually and less popular medical therapies can play in healing the body and mind.
"The medical profession is a business now," says Lai. "They go by the book. My doctors at the medical center didn't talk to me; they monitored me. The head of the kidney department told me pointblank that sometimes people get better with a condition like mine (glomerulonephritis), but they don't know why." Lai believed that her doctors did not regard her as a partner in the management of her own health and that they dismissed the validity of combining tried-and-tested alternative treatments with the conventional ones for her particular condition.
Lai wanted a doctor who could oversee her program of prescribed medications but also consider authorizing or administering alternative treatments rooted in a more holistic concept of the body; a doctor who would view the body as a integrated system rather than as a set of discreet parts and consider illness as a disruption in the system rather than as individual symptoms.
After an arduous search process that included Internet and library research, interviews of friends and family and finally of doctor candidates themselves, Lai found her ideal primary-care physician. He is Polish-born Tadeusz Adam Skowron, M.D., a board-certified internist who, having experienced great frustration with symptom-management emphasis of conventional medicine, became proficient in two alternative-therapeutic approaches - nutrition and bioresonance, a healing technology developed in Germany that works on rebalancing energy. "I had been trained to treat symptoms and not to heal people," Skowron recalls. "I got to the point where I was either going to have to give up medicine or find more effective ways to practice it. Fortunately, I found several alternative treatment approaches that make people well."
Offered in conjunction with Lai's conventional treatments, these therapies ended up improving her kidney function (as confirmed by classic medical tests) enough to reduce the frequency of her dialysis sessions from three times to twice per week and imbued her with the conviction that she may continue to improve and, one day, no longer need dialysis.
Although Lai was critically ill and therefore, had more at stake in finding an alternative medicine-friendly doctor than someone who is well, her determination to broaden her options and the new methods she employed to find a new primary-care physician are instructive to anyone who would like more holistic, patient-centered care.
The search for a doctor who combines conventional medical expertise with hard-core knowledge of alternative practices or, at the very least, who is open-minded and willing to refer a patient to alternative practitioners, can be a difficult, time-consuming process. In fact, there are more people interested in holistic health care than there are doctors to provide it. Why? Joel Evans, M.D., an obstetrician-gynecologist practicing in Stamford, Conn., suggests that the problem is a matter of economics. Effective alternative therapies, such as acupuncture and nutrition, take more time than most conventional treatments. Because their insurance reimbursements have decreased under the managed-care system, physicians are pushed to see more patients a day. "It's faster to prescribe a pill than to talk to patients about other options or administer them," says Evans.
The enhanced well-being Lai experienced shows just how worthwhile the search can be. It is, of course, best to take on the task before illness gives you a compelling reason to do so. You are in the best position to choose wisely when you are feeling well and clear-minded.
Jane Heimlich, a Cincinnati-based writer, started hunting for a primary-care physician receptive to alternative healing when she began to doubt the wisdom of managing her health via a scattershop approach comprised of visits to many specialists. "An old saying popped into my head," she says. "'He who treats himself has a fool for a doctor.' When you don't have a primary-care doctor to coordinate your care or have one who is operating along strictly traditional lines, no one has a complete vision of your health but you; and there is no one to mastermind a multilayered approach in a coherent way."
The approach Heimlich took to find such an M.D. involved five major steps. Use these steps to guide your own search for a primary-care doctor and any alternative practitioners you consult.
- LEARN YOUR OPTIONS
Knowledge is power, so gather all the information you can about any medical condition you have, and familiarize yourself with the range of alternative therapies that exist. Visit web sites, conduct library research and read books and articles. Seek information about treatments from experts, such as alternative therapists, nurses, dentists, representatives of holistic organizations and information services including the American Holistic Medical Association and the American Preventive Medical Association (see Medical and Health Information Sources). Remember, the more you know, the better you can direct the quality and type of care you get.
Personal research - a serious look within - should occur in tandem with your external information-gathering. "Learn what support you need to heal your emotions," says Jeremy Geffen, M.D., director of the Geffen Cancer Center and Research Institute in Vero Beach, Fla. "Explore your beliefs about the conscious and unconscious meaning of your illness or state of health, your life's purpose and your values and priorities. Until you are clear about these issues, you can't really make intelligent choices."
- GET GOOD REFERRALS
We spend more time shopping for a car than for a health-care provider who may mean the difference between life and death. Get high-quality referrals for primary-care physicians from people you know or whose opinions you trust - family and friends, professional associations (see Medical and Health Information Sources) and experts in the field. Sandra McLanahan, M.D., medical director of the Integral Health Center, Retreat and Spa in Buckingham, Va., says: "Sixty-four medical schools have departments or courses in alternative medicine now. Ask those who are teaching the courses for names of M.D.s who embrace alternative routes of care."
Following this process, you'll create a list of names. Whittle these down by looking into the personal history, qualifications and competence of the candidates. Find out what their overall academic credentials are and ask where they were trained in alternative medicine, how many hours they underwent training, and how many years they have practiced the techniques and therapies they use. "It takes years of study to become proficient in fields such as biochemical nutrition and energy medicine," says Serafina Corsello, M.D., a lecturer on alternative medicine at the Corsello Center for Medical Nutrition in New York City. "By checking what professional organizations a doctor belongs to and what licenses he holds, you can learn how knowledgeable and committed he is."
What licensing, accreditation and regulatory laws governing alternative treatments and therapies are not yet as heavily regulated as the conventional ones, it still is useful to contact state or local regulatory agencies and professional certifying organizations with authority over the therapy or treatment you candidates offer. (See Medical and Health Information Sources) Continue to ask questions until you are satisfied that the prospective primary-care physicians are solid professionals who have helped many others with medical histories similar to your own.
- SCREEN THE CANDIDATES
Before you set up an actual patient visit, question the staff, especially the office manager, about the doctor's background, knowledge and philosophy of practice. Ask how much experience she has with any particular health condition you have and with alternative therapies for it. Says Lai: "I wanted to know that my doctor had true expertise in my type of problem and has been successful in treating it." Find out how the doctor prefers to deal with specific problems you might have. What is the doctor's general approach to combining conventional with alternative therapy and her referral policy for alternative practitioners?
Talk to patients in the waiting room. Are they satisfied with the care they're getting? What do they like best and what least? How long, on average, does the doctor spend with a new patient? Although seven-minute visits are standard in the managed-care arena, anything under 20 minutes is wholly inadequate. Ask yourself if the office environment is warm, supportive and courteous - all of these qualities are vital to healing.
- INTERVIEW THE DOCTOR
Your relationship with your primary-care physician is one of the most important relationships in your life. Assess the doctor's personality and ask yourself if it is what you are looking for in a health-care specialist. Pace the interview but be frank. The doctor has limited time so get to the most important questions and forget the details. Find out how open the practitioner is to communicating with patients about technical aspects of treatments, possible side effects and potential problems (see Questions to Ask Your Doctor). "The most important thing is good communication," says Kathy Doner, M.D., an internist and founder of the Alliance for Holistic Health in Sebastian, Fla., "Make sure the doctor explains things to you in language you can understand and that you get a sense of encouragement about you situation. You are going to be doing more than just popping pills, and you will need your doctor's support every step of the way." Look for someone who is accessible, easy to talk to, and who encourages you to ask questions.
Tell the doctor about your medical history and what you are looking for. Tell him what you already know and the approaches to healing or preventive care you would like to try. Ask what his recommendations are and reply to these honestly since you are pursuing an open dialogue. Get information on costs and follow-up or ancillary treatments. When you've got a clear picture of the individual, how he operates, and what he has to offer you professionally, you're prepared to make a choice.
- FORMING A PARTNERSHIP
Getting well and staying well requires a relationship of mutual respect between patient and doctor. The most productive doctor-patient interactions can be described as caring, honest and committed to common goals and strategies. "Tell the doctor clearly that you have come because you want a partnership and that you are willing to take the initiative if he will guide you," advises Barry Sultanoff, a Kensington, Md.-based M.D. and writer on doctor-patient relationships. "Let him know you are looking for an adviser, not a dictator."
Determine whether the prospective provider is willing to support you emotionally, mentally and spiritually by believing in your recovery and wellness and by learning about and then authorizing or offering treatments, which, though controversial, might help you.
By following the five-step search procedure, you will be able to seize control of your health-care destiny and make sure that ever-widening range of medical treatment options is available to you. You'll hardly be along: The nation survey (Archives of Family Practice, March/April, 1997) reports that as many as half of all adults use holistic health therapies, up from one-third in 1992.
It became clear to Lai that her new doctor, Skowron, was not running a medical mill during her first visit - he spent two hours taking a careful history and diagnostic tests. To Lai's mind, her recovery is attributable to her persistence in finding a solution to her condition and having complete confidence that her health-care provider is competent and well-trained. Heimlich's choice of doctor has made her feel that she has a true ally.
Knowing that we are partners in our own care and that care is not limited to what is strictly conventional can tip the scales in our favor. Don't we owe it to ourselves to find a primary-care physician who will let us be a partner? (See Medical and Health Information Services.)
Questions to Ask Yourself|
- How do you react to the doctor's office and staff?
- Do you feel like a valued person when talking to the doctor?
- Is you personal dignity being respected?
- Are your anxieties and fears being adequately addressed?
- Do you feel the doctor would treat you like a partner in a patient-doctor relationship?
- Do you feel unconditionally accepted by this doctor?
- Would you send you spouse or best friend to this doctor?
- Does the doctor appear healthy?
- Does your gut say, "Yes, this is the one," or "No, not this one"?
Questions to Ask Your Doctor
- What professional training and affiliations do you have?
- How do you feel about the alternative treatment that I think might work for me? If you are not familiar with the technique, are you open to learning about it?
- Which tests, treatments and therapies have worked for other patients with similar health issues and conditions?
- How much experience do you have with health issues similar to mine?
- What types of patients do you most like to treat?
- What kind of diagnostic tests do you administer routinely?
- If a specific treatment is needed, how long before I can see results? Are there any side effects? What are they?
- May I talk to another patient who recently went through something similar?
- Will I need any follow-up care?
- Do you consult with other experts in cases like mine or do you refer to other alternative practitioners? To whom?
- Who is on call when you're not available?
- May I talk to you if an emergency arises? How and when can I reach you?
- How much will your treatment, tests and follow-up program cost me?
- How does your office handle payment and insurance arrangements?
- How do you feel about my use of alternative therapies you don't offer, endorse or know much about while I am under your care?
- What do you expect of me as a patient?
- How much time do you spend with a patient who is well? Unwell?
This article was originally published in the October, 1997 issue of Vegetarian Times Magazine. Resource references were updated as of 2005.