By Patricia Fennell, MSW, CWS-R

How to Find Qualified Physicians

Your doctors, psychologists, social worker, physical therapist, or occupational therapist all should be qualified professionals. These people should be licensed and required to have certain levels of training. The American Medical Association, for example, has a directory of all doctors in the country that lists where the doctors trained, when they graduated, where they did their residencies and in what specialty.

Most medical specialties have their own associations and certification programs as well.

State Licensing Agencies

If you want details of what competencies you should expect of doctors, psychologists, therapists, social workers, massage therapists, acupuncturists, etc., you can contact the department in your state that licenses these professionals. They will tell you what qualifications people in that field are required to demonstrate before they receive a license. They can also give you information on how the state monitors the standards of those already licensed.

Medical Social Workers

If you want objective information, you might find it helpful to contact a medical social worker to discuss your disease and how to go about obtaining the best medical help for it in your location. Although social workers are individuals with personal preferences like the rest of us, they will approach the evaluation of local practitioners more objectively than your friends will. At the same time, they’re usually aware of which practitioners are interested in your problem, which ones are attentive and believing, and which ones patients have found most helpful.

Social workers also see the big picture of your illness. They may recommend that you contact certain professionals in areas that you hadn’t even considered to help with problems related to your illness. If you’re new to a location, it can be particularly helpful to consult with a medical social worker about finding appropriate health-care professionals.

Dealing with Health Maintenance Organizations (HMOs)

Primary Care Physician

If you belong to an HMO, you may have a very limited range of doctor choice. Ordinarily you must go through your gatekeeper primary physician to reach other specialists. This makes choosing your primary physician crucially important. Most HMOs have several primaries available, so you should try to locate the one whose manner and attitude best fits with you. It’s less important that your primary be an expert on your condition than that he or she is willing to learn and refer you to specialists as necessary. Remember to pay attention to the office staff as well. They will be important because they mediate your contact with the doctor.

Available Services

You’ll want to learn from your primary physician and from reading your health-care policy what services are available to you and under what conditions. It is really important for you to read your health care contract and to understand what services your HMO will provide, for how long, and under what circumstances. For example:

• What is the HMO’s medications prescription policy?
• Will the HMO allow you to see a specialist outside the organization?
• Will it allow you to see a specialist in another city or state? If so, what conditions have to be met and what permissions do you need?
• What’s the HMO’s policy on physical and occupational therapy?
• What’s their policy on counseling?
• Can you see a medical/clinical social worker or a psychologist?
• What kinds of medical equipment do they help pay for?

When to Change HMOs

If you find that your present health insurance won’t permit you access to many of the services you need, you should try to change to an HMO that does. Different HMOs provide different service selections, and you may be able to find one that fits your particular needs better.

Services You Pay For

Certain services that will help you significantly may be ones that you’ll have to pay for on your own. However, many aspects of living with chronic illness can be so greatly improved when you receive these services that it’s worth the expense. If the cost is totally beyond your budget, a social worker may be able to help you locate publicly funded services.

What To Expect from Your Health-Care Providers

• Your health care provider should treat you competently, respectfully, and with caring attention.
• Your health care provider should take the time to listen to you carefully.
• Your health care provider should demonstrate that they believe what you report to them.
• Your health care provider should inform you of their findings and diagnoses in language that you understand, and they should make sure that you understand what they have been telling you by asking you questions. Your answers show whether you understand or not.
• Your health care provider should answer all your questions.
• Your health care provider should explain what they are going to do and how most people experience the treatment they’re prescribing. They should tell you about regularly anticipated side effects and inform you about what to do if you have unanticipated reactions.
• If your health care provider isn’t able to figure of what’s going on with you, they should say so and refer you to others who may be better able to diagnose and treat you.
• Your health care provider should perform tests on you prudently to determine your condition or when the results will aid in selecting better treatment for you. They should not carry out tests simply because that’s the automatic next step.
• Your health care provider’s offices should schedule appointments in such a way that you’re not kept waiting an unreasonable amount of time if you arrive on time, and you’re not rushed when you’re with the doctor.
• The personnel in your health care provider’s offices should be respectfully and attentive, and they should answer questions clearly and politely.