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FirstHealth of the Carolinas
Choosing the right primary care provider By Dick Broom
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By Dick Broom


“First, my providers have to be clinically competent and know what they’re talking about,” she says. “Second, they need to have both the ability and the desire to communicate with the patient on the patient’s level. And, third, they have to be accessible when you need them.”

That’s not only what Williams wants, it’s what she says every patient deserves.

Williams isn’t your typical health care consumer. She has more than 20 years of experience in health care, first in nursing and now in administration. As administrative director of practice management for FirstHealth of the Carolinas, she oversees the operation of several of the FirstHealth Family Care Centers.

“I want my primary care providers to have the knowledge, experience and expertise to take care of just about all my needs and, at the same time, to know when to refer me to a specialist,” Williams says. “They need to be on the cutting edge, and they need to have confidence in their abilities.”

That all sounds good, but how do you know if a particular doctor practices top-notch medicine?

Williams suggests doing an Internet search to find out, at the very least, what degrees and certifications the physician has. If a doctor is board certified in his or her specialty, that indicates a high level of knowledge. The Web site of the North Carolina Medical Board (www.ncmedboard.org), which licenses physicians to practice in the state, has information about their qualifications and whether they are in good standing with the Medical Board.

Asking relatives, friends and neighbors which primary care providers they recommend is perhaps the best way to find one who is a good match for you and your needs.


Robert Townsend, D.O.

“Word of mouth is a great resource,” says Robert Townsend, D.O., a family practice physician with the FirstHealth Family Care Center in Raeford. “Talking with friends who have had success with someone is a good way of finding out how competent that doctor is.”

But you won’t really know whether a doctor is right for you until you take the medical equivalent of a test drive.

“Schedule an appointment and talk with the doctor about your health status and medical concerns,” Dr. Townsend says. “You will be able to tell a lot from the way they address your complaints. You can usually tell if they know what they’re talking about.”

If you have any doubt, don’t hesitate to ask about the physician’s experience in dealing with whatever your particular health problem might be. While physicians have different styles, nearly all of them are well educated, well trained and competent, so most people recommend their physician to friends and neighbors based on other considerations.


Touber Vang, M.D.

“For most people, it’s more of a personality issue than a medical issue,” says Touber Vang, M.D., the family practice physician at Mid Carolina Family Medicine in Troy. “People gravitate toward people they like. My residency director used to say that you can teach somebody medicine, but you can’t teach good personality or bedside manner. It’s something you either have or you don’t.”

It is essential that you choose a primary care physician with whom you feel comfortable, says Bill Edwards, CEO of Pinehurst Medical Clinic, which includes a number of internal medicine physicians who provide primary care.

“Someone might be the smartest physician in the world, but if you don’t feel comfortable with him or her from a personality standpoint, then it’s probably a good idea to choose another primary care physician,” he says.

Having a good rapport with the physician’s nurse and other staff members is also important, he says.

Doctor-patient communication
Patients tend to be happiest with primary care physicians who take the time to listen to them, answer their questions and explain things to them in language they can understand.

“I always encourage patients to let me know if I haven’t explained something clearly enough for them to go out and explain it to somebody else,” Dr. Vang says.

J.K. Daniel, M.D., of FirstHealth Family Care Center-Richmond Family Medicine encourages patients to prepare and periodically update their personal health profile because, he says, “Your health changes as you age.”

J.K. Daniel, M.D., a family practice physician with FirstHealth Family Care Center- Richmond Family Medicine in Rockingham, agrees that communication is essential for a good doctor-patient relationship. But, he says, the communication has to be two-way.

“I tell my patients it’s a ‘we’ process, and they need to do their part,” he says.

That means being open with the doctor about all of your problems and concerns, learning as much as you can about your medical conditions, asking questions and giving the doctor feedback.

“If you don’t feel I’m giving you the time or attention you need, please tell me,” Dr. Daniel says. “If you have a problem with check-in, or you have to wait a long time to see me, or if anything else impedes your experience in my office, I want to know about it.”

Williams says it is unacceptable for a patient to leave a doctor’s office feeling uncertain or confused.

“The last words out of the doctor’s mouth before the patient leaves should be, ‘Have I answered all your questions?’” she says. “That’s a really big push for us in our clinics.”

According to Dr. Townsend, communication between doctors and patients builds trust, which is necessary for a good relationship and, ultimately, for good medical care. The more he knows about a patient, he says, the better he is able to meet their needs.

“Everything that a patient comes to me for has an emotional and spiritual as well as a physical component,” Dr. Townsend says. “If I’m not addressing all of those aspects of the disease, then I’m not doing a good job of taking care of the whole problem.”

Available and accessible
In overseeing the Family Care Centers, Williams tries to make sure that FirstHealth’s primary care providers are available to see patients whenever they are needed. She insists that they be accessible.

“That means a doctor will break up his day to see a patient who really needs to be seen,” she says. “It means that if you go to the office in a panic, you don’t get that look that says, ‘We don’t take walk-ins.’ It means that when you call the office, you can talk to a nurse who works directly with the physician and can get your question or concern addressed. You’re not diverted to someone who can’t help you.”

That doesn’t mean patients never have to wait when they come for an appointment. In fact, good doctors often have so many patients that waiting is inevitable.

“Doctors who are really thorough and spend a lot of time with their patients may cause other patients to have to wait longer,” Dr. Vang says. “If you’re a person who doesn’t like to wait, then you might want to go to someone who can get you in and out faster.”

Williams says she doesn’t mind waiting, as long as the office staff lets her know the reason for the wait and how long it will be.

“I recognize that there are emergencies and other circumstances that are beyond the physician’s control, and physicians sometimes run late because they spend as much time as needed with patients,” she says. “That’s all right, because I know that when I get in there, I’m going to be given the same courtesy and my needs are going to be met.”

Some physicians practice on their own, while others are part of a group practice. Edwards says patients should find out who will see them if their primary care physician isn’t available, who will take care of them if they have to go to the hospital, and what procedures are in place for getting in touch with their physician in case of an emergency.

Often, if patients can’t get in to see their doctor when they have an urgent problem or if they can’t get their questions answered over the phone, they blame the doctor’s staff. But the responsibility ultimately lies with the doctor, Williams says.

“Accessibility has to come from the provider,” she says. “If any of our providers tries to build a wall around himself, I readily pick up on that and immediately take steps to break it down.”

Your personal health profile
One way patients can help their doctors help them is by creating a personal health profile. Physicians say it should include your past medical and surgical history, family history, current medical conditions and any medications you are taking.

“When somebody comes in with a complete history, it helps me evaluate whatever is going on with them at the time,” says Robert Townsend, D.O., of the FirstHealth Family Care Center in Raeford.

Dr. Townsend recommends keeping your health profile with you because you never know when it might be needed.

“If you go to an Emergency Department for acute care, having a record like that with you, especially a list of the medications you are taking, can be invaluable to someone deciding on a treatment plan for you,” he says.

According to J.K. Daniel, M.D., of FirstHealth Family Care Center-Richmond Family Medicine, a health profile should include the patient’s “social history” including whether he or she smokes or drinks and, if so, how much. Dr. Daniel says it also should include the patient’s occupational history: “Do you work where there are certain hazards, such as in the military or in a mill where you inhale a lot of dust?”

A health profile can include healthrelated goals, such as giving up smoking or losing weight, and it should be periodically updated, he says.

“Your health changes as you age,” he says, “and you can have different problems and concerns at 45 or 65 than you did at 25.”
 
Health care and the Internet
Gone are the days when nearly everyone thought of their doctor as all wise and all knowing in matters of health. Gone, too, are patients who are passive, unquestioning recipients of care.

Nowadays, most doctors want their patients to be well-informed partners in their care.

The Internet has made it much easier for people to learn about their medical conditions and treatment options. Hospitals, medical schools and government agencies provide a wealth of health information online. The Web sites of non-profit organizations such as the American Heart Association and American Cancer Society have factual, easy-to-understand information about specific diseases.

Many people are now using these online resources before going to their doctor, according to Robert Townsend, D.O., with the FirstHealth Family Care Center in Raeford.

“Oh, yeah,” Dr. Townsend says with a chuckle. “While it’s good for patients to educate themselves, you’ve got to be careful. I mean, there’s a reason why it takes a minimum of seven years for somebody to get through medical school and residency training. Patients often get a little bit of information but don’t understand how to put it into the overall picture of their health care.”

According to Dr. Townsend, both WebMD and Familypractice.org, the Web site of the American Academy of Family Physicians, are good sources of reliable consumer information. J.K. Daniel, M.D., of FirstHealth Family Care Center-Richmond Family Medicine in Rockingham, also recommends WebMD.

“I encourage my patients to look up information on a Web site, print it out and bring it in,” Dr. Daniel says. “I’m happy to go over it with them. Doctors have a thousand things going on, so if something new came out just yesterday, I might not be aware of it. So bring it to my attention, and I’ll research it myself and tell you whether it applies to your situation.”

Saul Salvador, M.D., a hospitalist physician at FirstHealth Moore Regional Hospital, recommends the Mayo Clinic’s Web site for “good explanations and illustrations of how various procedures are done.” FirstHealth’s Web site, www.firsthealth.org, also offers a userfriendly “e-Health Library” link.

The more informed patients are, the better off they are, Dr. Salvador says. “For one thing, they can give a more confident ‘yes’ or ‘no’ to a certain procedure or other treatment option,” he says.

Prescription drug advertising on television and in magazines—a relatively recent phenomenon— has raised people’s awareness of certain medical problems, educated them about potential treatments and made them more assertive in their relationship with their doctor. All of that is mostly good, physicians say, but ads can give people false hope.

“I sometimes have to explain to patients why a particular medication they have seen advertised isn’t the best choice for them,” says Touber Vang, M.D., of Mid Carolina Family Medicine in Troy. “It might not be appropriate for them medically, or it might cost a lot more than another drug that would work just as well, or their insurance might not cover it.

“But as long as a drug meets the criteria for what the patient needs and there aren’t any contra-indications for it, and if cost isn’t an issue for them, then I have no problem prescribing it.”