Plus, red flags to look out for and what you should know about hospitalists.
No one is coming to save us. I mean this in every way possible and I mean for it to motivate, not discourage, you. You must take full charge of your health, and your healthcare. While the underlying disparities in healthcare remain stubbornly entrenched, the practice of medicine has changed dramatically in the past 20 years. So, you have to shift too. That’s just common sense.
Chances are, no one informed you of these changes or how they would impact your life. For the record, no one really informed us doctors either. But we all must adapt — and that begins with understanding the emerging landscape, and then embracing it at least enough to learn how to effectively negotiate its inefficiencies.
We have overlapping trends converging and most are centered not on the individual patient, but on innovative and costly technologies and economies of scale that have all led to the systemic corporatization of medicine. Doesn’t exactly give you the warm fuzzies, does it?
Regardless of your race or the deepness of your pockets, for most people, the days of Marcus Welby, MD, are gone forever (and if you don’t know who Marcus Welby is, google him — my God, I’m older than I thought). But, of course, you already knew that. What you may not have realized is how drastically different the average doctor-patient interaction has become — and will continue to be.
The expectation that you will have a relationship with a doctor who is competent, caring, kind, and will be there for you in any medical situation is no longer a reality for most people. The decades-long doctor-patient relationship is history. Sole practitioners or small physician-owned group practices, where the doctors themselves are in control of their time, patients, and office staff, are becoming relics. If you’re enjoying one, start looking for a replacement now, because the trends are not on your side.
What is a hospitalist?
In fact, you will have increased difficulty getting your doctor to return a phone call, even when you are hospitalized and at your sickest. Oh, you will see a doctor there, perhaps several. But you may never see your doctor there. Most people don’t realize that, generally speaking, primary care doctors and internists no longer take care of their patients when they are hospitalized. Rather, your care will be led by a hospitalist (yes, that’s a real word), and if you don’t know what a hospitalist is, you are not alone. A hospitalist is a doctor, typically employed by a hospital, who only cares for inpatients. They are usually internists or family physicians who manage your care only while you are hospitalized.
Most likely, they won’t know you. They may or may not have access to your medical records. They may or may not inform your primary care doctor that you are in the hospital. If that sounds less than ideal, that’s because it is.
How did this happen? First, there is the graying of the doctor population that was oriented toward traditional, personalized patient care. (Have you seen my picture? I’m in that number.) Juggling the demands of seeing patients in the office along with the administrative tasks of running an office while caring for sick patients in the hospital was admittedly a challenge, but no one actually asked doctors before moving to this new system. Hospitalists just kinda showed up in the mid-90s, and just like that, doctors stopped caring for their patients who were admitted to the hospital. (To be clear, if you have a surgical procedure, you should expect to see that surgeon, or at least one of their colleagues, while hospitalized. But for nonsurgical admissions, chances are you will see a hospitalist.) Hospitalists certainly relieve the stress on busy physicians, and arguably improve patient care, but at a price. From the patient’s perspective, there is a decided lack of continuity of care and loss of the comfort that accompanies sheer familiarity. And, in some cases, there is a lack of context for the medical and social issues that preceded the patient’s admission. Adding to that, the entire medical community is still in a state of post-pandemic restructuring that, like COVID itself, is stressing and burning out healthcare workers at every level. One recent survey reported that up to 70 percent of doctors are experiencing burnout. A combination of venture capital groups and large hospital conglomerates have bought up private practices across the country, leaving less than 30 percent of doctors in a traditional private practice setting today. And that number is declining.
What this means for you
As the nature of medicine is changing, the people providing regular care is changing. Physician assistants, nurse practitioners, and traveling — or temporary — nurses are on the rise. Corporate hospital systems are creating large, standardized group practices where the pressure to fuel profits is at least as high as it is to satisfy patients’ needs. Younger doctors face the added burden of an unconscionable amount of education debt, which, as employees, may make them less loyal to their jobs.
This corporate takeover was made possible by the mounting inability of solo practitioners and small groups to manage the escalating costs of rent, utilities, malpractice insurance, and personnel costs against rising patient needs and declining insurance reimbursements. Concierge medicine has stepped into the void left by the disappearing small group practices and comes at a high premium, which the average patient cannot afford.
Suppose you need a pair of basic black pants. You can buy a pair at Walmart, or you can buy them at Neiman Marcus. Are the pants you get at Walmart functional? Yes, they are. Are they the same size and cut as the pants from Neiman’s? Yes, and yes (roughly). Are the Walmart pants as good a buy as the pants you get from Neiman’s? It depends. The Walmart pants cost less and are machine washable, but they may not last as long. The Neiman pants could last longer, but they’ll need expensive dry cleaning. You get my drift. The overarching questions are: What is most important to you, and What pants can you afford? There is no right choice, just the one that’s right for you.
The same is true for your medical care. Affordable is not synonymous with low-quality, and expensive doesn’t always translate to utility. That is why you need to know what’s important — to you. Only then can you effectively evaluate your primary care options.
How to find a good primary care doctor
In most doctors’ offices today, nobody’s talking, everybody’s typing. No one recognizes your face, knows your name, or asks about your kids. Of course, you’ll be seen by a physician, physician’s assistant, or nurse practitioner, as well as a nurse or medical assistant. (And let’s not even discuss artificial intelligence — but don’t be surprised if, in the not-too-distant future, you’re interacting with Dr. Chatbox.) And how often, once you leave, will you really feel like you’ve been more than just Patient X in Exam Room D on Day 3 of another doctor’s dispassionate week on their J-O-B?
The answer to this question depends on how carefully you choose your medical home. Start with your insurance provider and choose a primary care doctor (internist or family practitioner) within that network. If you don’t, you’ll leave money on the table, and you won’t necessarily get any better care.
Run your provider’s list by friends and family to see if there’s any overlap with doctors they know or can recommend. Also pay attention to:
- Location: Annual appointments an hour away might work, but what if you require frequent visits? Or if you are in pain and travel is uncomfortable? Suppose you have mobility issues and walk with a cane or walker — is there ample parking nearby? Is the office easily accessible by public transportation? Convenience matters. A lot.
- Hospital Affiliation: Make sure you’re comfortable with the ratings and rankings for the hospital your doctor is affiliated with (readily available through several sources online), as well as its proximity to you. You will ultimately want to keep your doctors aligned with the same hospital, if possible.
Once you’ve identified an option or two, do some sleuthing. Google is not where you should seek a diagnosis (ever!), but it’s great for getting intel on some of the following details:
- Board Certification: You might be surprised by how many practicing doctors are not board-certified, and ideally you want doctors who are. Although board certification is not a guarantee of good care, it is a helpful data point. This information is available online (I recommend certificationmatters.org).
- Licensing and Disciplinary Action: Local and state medical boards maintain databases related to the licensing and disciplining of doctors. These feed into the Federation of State Medical Boards Physician Data Center, a comprehensive repository of the nation’s more than 2 million licensed doctors, which includes disciplinary actions and malpractice cases dating back to the early 1960s.
- Training: You shouldn’t base your decision solely on where a doctor went to school or where they did their residency, but it’s still good to know.
- Online Ratings: Occasionally worthwhile, but be warned: They’re always going to skew negative because happy patients rarely bother to post reviews. The worst online evaluation I ever got was from a man I never met who was mad because I prescribed his 16-year-old sexually active daughter birth control pills. He gave me a “1,” but I’m sure his daughter would have given me a “5.” And if your doctor has 100 percent 5-star ratings, they may actually be great, but know that there are quite a few ways to juke the stats. Think about it: Was your last Uber ride really a 5-star?
- Top Doctors Lists: Media-generated lists of “top” or “best” doctors can help (full disclosure: I’ve been on a few) but this comes with a giant caveat. They tend to be popularity contests, and often don’t surface the most diverse candidates. Also, once you’re on them, they’re loath to take you off. So, use them to source names, but then do your own sleuthing to learn more.
After you’ve identified a primary care prospect, call the office and talk to the administrator — an actual human being. They will not be trying to have a long conversation with you, so come prepared and be persistent. Tell them you’d like to become a new patient and want to make an appointment, but you have a few questions first. They should be willing and able to help. If they’re not, that’s a red flag worth jotting down in a place you reserve for keeping track of your healthcare journey. Now is no time to rely on your memory. So, keep scribbling, as you ask:
- What’s the average wait time to make an appointment?
- What’s the average wait time once I arrive for an appointment?
- How will test results be communicated? (Patient portal? Text?)
- Will I be seeing a doctor most often or a nurse practitioner or physician’s assistant?
- Is it okay for me to bring a friend or relative to my appointments?
- Does the office have evening or weekend hours?
- How do you handle emergencies and acute care?
This last one is important because, as a rule, the emergency room should not be your Plan B for nonemergency care.
How to assess a new doctor on the first visit
You’ve finally chosen a doctor and made an appointment — preferably a wellness appointment, or routine checkup. (If you’ve been someone who only goes to the doctor when you’re sick, you’re done with that!) Show up on high alert because the most important part of your assessment phase begins now.
First impressions matter big time. Trust your gut. If the office were a restaurant, would you eat there? Order and cleanliness matter. Courteousness and efficiency matter. Plush seating and big-screen TVs in the waiting room? Not so much.
Trust how people make you feel. And heed the wisdom of Maya Angelou, who said: “When someone shows you who they are, believe them the first time.” Does your doctor communicate well? How about the support staff? Is everyone on the team receptive to your questions and concerns, or noticeably irked by them? Do they show you and other patients respect? Do they complain or share inappropriate information with you? Are they generally thoughtful and present or do they seem harried, disgruntled, or distracted? If the people who work there seem like they’d rather be anywhere else, you probably should be too.
Need a second set of eyes and ears to help you gauge the quality of your initial visit? Bring a trusted family member or friend to be a fly on the wall, particularly if you will be discussing complicated issues or upcoming surgery. Get their impressions afterward, but remember, this is your life, your health, your doctor, and your decision to make.
Keep in mind that nobody’s perfect. I know brilliant doctors who I’d never want to party with, and charming doctors who I’d never want to treat me. Bottom line, your doctor should make you feel:
- Confident in their intellect and abilities
- Safe in their presence
- Respected
- Seen and heard
Don’t settle. With a shout-out to one of my favorite showrunners, Shonda Rhimes, and all you Grey’s Anatomy fans: Forget Dr. McDreamy and Dr. McSteamy, you need Dr. McSeeMe — literally and figuratively. Like the United Negro College Fund says about a mind, a doctor’s visit is a terrible thing to waste. Especially when they can be so hard to get! So, find a practice that values you and your time — and theirs. Make a list of your questions and concerns and get them addressed before making a final decision. Then once you’ve established that relationship, let your primary care doctor refer you to specialists that you might need. You will get better referrals and better responsiveness if you work with doctors who routinely work with one another.
Excerpted from Grown Woman Talk by Sharon Malone, MD. Crown Publishing Group, 2024.
