Ask the Doctors

Dear Doctor: Our doctor is retiring, and my wife and I have been told we need to select a new physician within two months. But we read the bios of available doctors in our area who are accepted by our insurance, and their degrees are not from first-class facilities. How can we make a good selection and be assured of quality care?

Dear Reader: Finding a primary doctor is not an easy task. You and your wife probably had a very long and good relationship with your physician. Such a relationship is not simply about treating a disease, taking care of vaccinations or providing preventive care. It's a human relationship -- one with ups and downs, but also mutual trust and a sense of comfort. So trying to replace that relationship is understandably daunting.

But let's ask: What makes a good primary doctor? It's not simply the source of the medical degree or the institution with which a doctor is associated. Those might be factors, but they might not speak to a doctor's overall quality.

If the doctor is affiliated with an institution, consider standard markers of quality about the institution itself, such as the percentage of patients getting vaccinations, colon cancer screenings, Pap smears and mammograms. Some states make this publicly available; California's Office of the Patient Advocate website is one example. Other, non-governmental websites provide patients' ratings of a doctor's care. Although multiple poor reviews could reflect poor quality of care, positive reviews don't necessarily reflect uniformly good care. Some offices encourage patients to provide good reviews, and some offices actively manage sites -- both of which can skew the results.

Then there's word of mouth. Try asking your friends, family or the people you work with for a recommendation. They may be able to give you an idea not only of a doctor's ability to diagnose and treat illnesses but also the doctor's personality. For many people, that's an important aspect of the doctor-patient relationship. Primary care doctors can be great diagnosticians, but can have personality traits that create barriers to good communication. If someone you trust attests to a doctor's ability to both communicate and to treat, this can be a powerful endorsement of his or her quality.

Another difficulty, of course, is the relative shortage of primary care physicians. After the cost of schooling and the physical and mental toils of residency, many physicians choose more lucrative specialties instead of primary care, which generally nets less income. In addition, some primary care physicians have concierge practices, meaning they accept a limited number of patients but at a higher cost to the patient.

Sometimes simply making an appointment with a new primary care doctor -- and assessing how his or her office is run -- is the only way to know whether a particular doctor will be a good fit. This may require some patience on your part. There may be some aspects of the office that you like and others that you don't, so expect an adjustment period.

But over time, you can again develop a good rapport with a doctor and have another trusted relationship for many years.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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