понедельник, 17 сентября 2012 г.


Byline: Greta Zenner

Buying toothpaste or even a small appliance is a decision that most of us feel comfortable making, and we understand that we have different options when doing so. However, finding a primary care provider can be a difficult and confusing task, especially when you're unfamiliar with the medical system. But choosing the right person to see when you have an earache, need a physical or want to manage high cholesterol is an important step in maintaining or improving your health.

The first line of defense in health care -- a primary care provider -- doesn't require a referral. They are the first people you see when you a have a medical concern of any kind. Before your first visit, though, even before calling to make an appointment, it is important to consider four main issues.

First, decide which kind of specialist is most appropriate for you. Primary care providers specialize in one of four areas: family practice, internal medicine, pediatrics or obstetrics/gynecology. Each field has something to offer different groups of patients.

Pediatric providers generally attend to children under 18, whereas specialists in internal medicine, or internists, see only adults. Obstetrics and gynecology (ob/gyn) is also primarily an adult-care field, but only for women. Family practice providers see everyone, from patients just beginning their lives to those in the golden years.

When choosing a provider, consider in which of these environments you would feel most comfortable. For example, some elderly patients might prefer to spend time in a child-free waiting room and see someone who specializes in adult-only care. Others might enjoy the diversity of a family practice environment and the continuity of seeing one provider throughout their lives.

Having decided on a specialty, a second issue to consider is the provider's certification. Within any clinic, you will likely have several options from which you can choose, including medical doctors (M.D.s), doctors of osteopathy (D.O.s), nurse practitioners (N.P.s) and physician assistants (P.A.s). Although these certifications differ from each other, the providers offer comparable quality of care.

M.D.s and D.O.s are both fully licensed doctors, but D.O.s differ in that they attended an osteopathic medical school rather than a traditional one. Osteopathic schools train physicians to manipulate the muscular, skeletal and nervous systems to improve health, rather than immediately relying on drugs or surgery. Beyond this, however, D.O.s and M.D.s function very similarly in the clinic setting, especially as traditional medicine begins to integrate more ideas from alternative medicine.

N.P.s and P.A.s, also known as midlevel providers, are another equally good option. The primary differences between these two certifications and those of physicians are length of training and independence.

In comparison to a doctor's seven to eight years of graduate training, P.A.s earn their title with an undergraduate degree, and N.P.s earn theirs with a two-year master's degree after completing a registered nursing program. Midlevel providers are also supervised by physicians, meaning that they consult with a doctor when they have questions and that a doctor co-signs all notes and records.

N.P.s and P.A.s can be a good choice when cost efficiency is an issue or when the care you require is of a more routine, chronic or preventative nature. Cary Liebl, an ob/gyn P.A. with Dean Health Care West Side Clinic, describes the role of midlevel providers. 'I identify and manage diseases like doctors, but an N.P.'s focus, like a P.A.'s, is health promotion and disease prevention,' she says.

A third step in choosing a primary care provider involves gathering information from other sources. Some communities, like Sun Prairie, publish a yearly 'best provider' list in the newspaper. Asking people you know for recommendations is also useful. In addition, HMO Web sites, like Dean's, often include a 'provider finder' function, which allows you to search for a specific person, or for providers of a specific gender or specialty.

The fourth consideration, and perhaps the most important, says Liebl, is making sure that you feel comfortable talking with your provider and that she or he is listening to you. Different people feel comfortable with different kinds of people and personalities. 'Many people don't realize they have a choice in choosing a provider,' says Liebl, 'but choice is important.' Toothpaste isn't the only thing you have a say in.