Years ago I enjoyed doing an occasional home visit. It seems so complicated now, with insurance mazes, limited lists of prescription drugs approved by insurance companies, electronic medical records, and a host of ever-changing documentation guidelines and procedures that have changed healthcare dramatically, even in the 19 years I’ve been working as a nurse practitioner.
There are still a few providers who still make house calls. The reality, though, is that health care is a competitive market. Local health care organizations want your business. As a patient, you have the right to highly competent, compassionate, and professional care.
As primary care providers, we do our best to meet your needs within the limitations of the health care system and available medical knowledge. And we need to do this in 15 minutes, or if we’re lucky, maybe 30 to 60 minutes.
A primary care provider is a physician, nurse practitioner or physician assistant who coordinates your care. They are usually internal medicine or family practice physicians. Your primary care provider’s role is to provide you with basic care, and provide annual physical exams. He or she is the first person you call when you need to discuss any health issue.
Primary care providers can diagnose and treat many conditions, referring you for diagnostic tests or to a specialist if necessary. Many health insurance plans require their members to consult a primary care provider before seeing a specialist. Some also offer preventive care and teach healthy lifestyle choices.
When you meet a new provider, there are specific questions you should ask. Otherwise, how do you know if he or she is a good match? Medicine is not an exact science. Beyond the essential medical standards and protocols we all must follow, each provider has an individual way of caring for patients and will have his or her own approaches and ideas about treatment options.
That elusive quality of “bedside manner” is completely subjective. As the patient, you get to score that one.
Here are some questions to ask in advance about a new provider, or to ask at your first visit:
— What days and hours do you see your patients?
— Who is available to see your patients when you are either booked, or not in the office?
— When I call the office, will I be able to speak with a person, or will I get a menu of voice mail?
— How long before someone calls me back?
— Do you work with one particular medical assistant, whom I can contact when I need something, or does that person change from day to day?
— Can I contact you by email?
— How long are your routine follow-up appointment and annual exam slots?
— Do you leave time in your schedule for same-day, acute visits?
— Is there someone on-call by phone when the office is closed, or will I need to use walk-in or emergency services?
— If I go into the hospital, who will take care of me there?
— Will you call or send me copies of my lab and test results, even if they are normal?
— How often will you want to see me for routine visits? Will I get to see you, or will I see one of your colleagues?
— Do you have any areas of subspecialty or particular expertise?
— Do you incorporate any alternative medicine into your practice, and are you open to patients’ use of these therapies?
Some practices offer a “meet and greet” option, in which you can have an appointment at no or little cost, to sit down with a provider and talk before you sign on as a patient. Others have intake people or surveys that do their best to match you up with a provider who can best meet your needs. Word of mouth referrals from people you know and trust are also popular.
From the provider’s perspective, we also have many questions and concerns when we meet a new patient. At that first office visit, most patients are asked so many questions that they may not have an opportunity to ask their own questions. I’ll address that in a future column, and hopefully I can shed some light on what we’re thinking when it may seem like we’re interrogating you. We’re really not just nosy.
I’ve practiced in Maine since 1996, and in almost every new setting, I’ve started out with hopes that I’d grow old with my patients. The truth is, as health care changes, there are changes in the needs of providers, communities and practices.
Just as in other professions, jobs and people in health care can come and go. The most common first question I hear from new patients in my practice is, “Are you staying?” Here’s what I tell them: “I’m planning to, so let’s make this relationship work. Now, tell me what you’re looking for in a provider.”
Cindy Leiffer is an adult nurse practitioner at St. Joseph Internal Medicine.