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6. "I hate technology."
It's almost impossible to imagine anyone doing his job these days without a computer -- except your doctor. Although billing and other systems may be computerized, when it comes to medical records, many GPs still prefer pen and paper. New electronic medical-record systems can print out clear prescriptions that are cross-referenced with medical databases to avoid incorrect dosages or dangerous drug combinations; hospitals can access patient histories in case of emergency; and care can be better tracked over time. But as a group, primary-care physicians have been slow to adopt the technology: A recent study found that only 28% use these systems. Why? They can cost up to $70,000, and cash-strapped GPs see little payoff.
For most patients the benefits of the technology are huge. It eliminates prescription errors due to illegible handwriting. It ensures that patients get the right dosage. Records won't get lost. It reminds doctors when they need to monitor their patients. And specialists and others can easily forward electronic records to your GP. "I'd seriously consider changing doctors if he didn't have an electronic records system," King says.
7. "Your insurance company is calling the shots."
These days doctors have more freedom to send you to a specialist or order expensive tests than they once did under managed care. But that doesn't mean the system is fixed. For starters, your insurance provider's pool of doctors may lack, say, a great cardiologist, King says. And with increased deductibles, it's often the patient who foots the bill for a referral or an expensive test.
Insurers also still wield the power when it comes to hospital stays, says Jerome Epplin, a geriatrician and clinical professor at the Southern Illinois University School of Medicine; he has recommended that a patient spend four days only to have the insurance company overrule him, refusing to pay for the last day and sticking the patient with the bill. "We are powerless over it," Epplin says. "It's incredibly frustrating." Mohit M. Ghose, spokesperson for America's Health Insurance Plans, an industry trade group, says, "When I hear physicians speaking like this, it tells me that physicians need to be working more closely with plans to understand what the guidelines are."
8. "My legal history is none of your business."
Today's insurance plans give patients a wider range of doctors to choose from, but patients don't have any more information to help them decide. "If insurance companies really wanted to bolster patient choice, they would give patients the ability to make informed choices," says Peter Lurie, deputy director of the health research group at Public Citizen. The best information about doctors is off-limits to patients. It's the National Practitioner Data Bank, which state medical boards and hospitals use to do background checks, and it includes information on disciplinary actions and malpractice payments.
To find out if your doctor has been sued, you'll have to go down to the local courthouse, but if your doctor has moved around, you'll get only part of the picture. The best publicly available information is tracked by state medical boards, many of which publish this information on their Web pages. If yours doesn't, you can pay $9.95 for a report from DocInfo.org, a site run by the Federation of State Medical Boards.
9. "If you're over 65, don't bother me ..."
As troubling as things are in primary care, the situation is worse when it comes to treating elderly patients, especially those on Medicare. Doctors who specialize in geriatrics are certified by the American Board of either Family or Internal Medicine, and they're increasingly rare. Right now there is just one geriatrician in the U.S. for every 5,000 seniors, about half of what we should have, according to the American Geriatrics Society.
The problem is that fewer medical students are choosing this subspecialty: Last year only two-thirds of geriatric fellowship programs were filled. That's because treating older patients who have multiple, often complex problems is about the worst way a doctor can make a living. Medicare doesn't compensate much more for a 45-minute appointment with a patient with dementia, hearing loss and a half-dozen other maladies than it does for seeing someone for a simple checkup. "It is fiscal suicide to go out there and say, 'I am a geriatrician,'" Robinson says. "You get the patients that require the most time that pay the worst."
10. "... unless, of course, you're willing to pay extra."
Unfortunately, the shortage of geriatricians is worsening. As med students shy away from geriatrics, the number of people over 65 is set to grow faster than ever as boomers retire. The American Geriatrics Society estimates that by 2030, there will be a shortage of about 36,000 geriatricians in the U.S., up from 7,000 today.
Though the situation seems dire, there are ways to guarantee qualified care. One approach is to see a good primary-care doctor who is also a geriatrician long before you need one. Epplin says that in southern Illinois, not many doctors accept new Medicare patients, but when their existing patients go on Medicare, they keep them. Other approaches can be costly. In Sarasota, Fla., where Robinson practices, many doctors provide "concierge" service: Patients pay an annual retainer of about $4,000 in exchange for their doctor's cell number and upgraded access. Other physicians in Florida have begun asking patients to pay an annual administrative fee of about $200 or $300 to help them continue to provide individualized care. These pricey options aren't what most people have in mind when they think of health care reform, but they may be the only way to maintain ready access to a good doctor.
