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.)

Dear Doctor: Coconut oil has gotten to be really popular, but now there's a study that says it's just as bad for you as beef fat and butter. How is that possible? It has no animal fat whatsoever.

Dear Reader: Coconut oil is definitely having a moment. It has gone from being a specialty item in the health food store to sitting side-by-side with the rest of the cooking oils in major grocery stores. And you're correct -- coconut oil is definitely not an animal product. However, that doesn't prevent it from being a saturated fat.

Coconut oil turns out to have a significantly higher percentage of saturated fat than does butter, beef fat or lard. Coconut oil is between 80 and 90 percent saturated fat. Butter is about 65 percent saturated fat, while lard and beef fat each come in at 40 percent saturated fat. The reason this is an issue is because saturated fat in the diet is associated with a rise in blood levels of low-density lipoprotein, or LDL cholesterol, the so-called "bad" cholesterol. Blood levels of LDL are tied to heart attack risk and cardiovascular disease.

But coconut oil has a few surprises as well. At the same time that it acts like a traditional saturated fat by raising LDL levels, it also has a beneficial effect on blood levels of high-density lipoprotein, or HDL, the so-called "good" cholesterol. While LDL is associated with the buildup of fatty deposits, known as plaque, in the arteries, HDL is believed to help clear that plaque away. It may be this beneficial effect on HDL that helped coconut oil earn a reputation as a healthful fat.

That brings us to the new study you referenced, which is actually an advisory from the American Heart Association. With cardiovascular disease causing more than 17 million deaths per year, the AHA used the advisory to reiterate the health benefits of choosing unsaturated fats over those that are saturated. In the report, the AHA cites coconut and palm oils as saturated fats to avoid, along with the usual suspects -- butter, lard and beef fat. That's why the news stories had those "coconut oil will kill you" headlines.

We believe the subject deserves a bit more nuance. First, it's important to remember that although fats are notorious for high calorie counts and an association with weight gain and heart disease, they're also essential nutrients. They're needed for metabolic functions like helping with the absorption of fat-soluble vitamins and micronutrients, and are required for the synthesis of the steroid hormones testosterone, estrogen and progesterone. The message is not that fats should be cut from the diet, but that they should be chosen wisely. We're also very interested in the continuing research that suggests inflammation plays as much of a role in cardiovascular disease as do cholesterol counts.

But back to coconut oil. In our opinion, it's not a miracle food and it's not a poison. It's a saturated fat with nice flavor and some very interesting nutritional properties. Just like butter or lard, coconut oil can be safely used in moderation.

(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.)

Dear Doctor: I was recently diagnosed with an aortic thoracic aneurysm and scheduled for surgery. What are the risks, and can I expect to live a normal life afterward?

Dear Reader: As difficult as it is to hear the diagnosis of an aortic aneurysm, you're fortunate that your surgery could be scheduled. (More on that later.) Now an explainer for other readers: An aortic aneurysm is a bulging area within the aorta -- the body's main artery -- through which the heart pumps blood to the rest of the body. The aorta starts in the chest, called the thoracic region, and then runs down into the abdomen.

The problem with these bulges is that they can lead to rupture of the aorta, causing major blood loss and possible death. The majority of ruptures -- accounting for two-thirds of aneurysm-related hospital visits -- occur in the abdominal aorta; thoracic aneurysms account for the other third, and the rate is increasing.

People with thoracic aneurysms are usually unaware of the aneurysm until it is about to rupture; most are found through imaging studies looking for something else. The decision on whether to have surgery is based on the size of the aneurysm, whether the aneurysm is growing rapidly and whether it's causing symptoms. Survival rates are much higher for aneurysms that don't cause symptoms; the five-year survival rate in those needing urgent surgery is 37 percent, and 85 percent among people choosing to have the surgery. So you can see why the ability to schedule surgery is a positive.

The type of surgery depends on the location of the aneurysm. Those closer to the heart are more likely to require an open surgical procedure -- specifically, a median sternotomy. In this surgery, the sternum (breast bone) is cut up the middle to open up the chest, and blood must be bypassed away from the heart and into a machine that pushes it through the body. The diseased section of the aorta is then removed and replaced with an artificial graft.

For aneurysms farther from the heart, an endovascular repair can suffice. With this operation, there is no need to open up the chest. A doctor inserts a graft through an artery in the upper thigh and places it inside the vessel. The graft works like a stent, allowing blood to flow through it without putting pressure on the aneurysm.

The risks of an open procedure, because of the amount of surgery involved, are greater than those of endovascular repair. Complications include pneumonia, stroke and heart attacks during the procedure, although newer surgical techniques have dramatically lowered the complication rate.

One problem with the endovascular repair, however, is that over time -- in about 7 percent of cases -- the graft/stent within the blood vessel can move away from the area of the aneurysm, exposing the aneurysm again to rupture. Also, in 25 percent of cases, blood can leak around the stent (an endoleak), leading to increased risk of rupture.

Although the open procedure has a greater risk of complications, the overall survival rate is similar for both procedures. But surgical techniques for both procedures are improving all the time, increasing the likelihood of a return to normal life. I don't have the specifics of your case, but it's safe to say you should follow your doctor's advice to get back on your feet as quickly as possible.

(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.)