How to pick a doctor — and fix the US health care system

WASHINGTON — Ezekiel Emanuel is a well-known and accomplished doctor, but even he was at a loss when his daughter asked him to recommend a physician in Boston, where he previously practiced medicine.

“So what did I do? I did what every American does. I called someone up and said, ‘Who should my daughter see?’ And that is a terrible way of going about it,” said Emanuel, an author, policy expert and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

In his new book, “Prescription for the Future: The Twelve Transformational Practices of Highly Effective Medical Organizations,” Emanuel not only outlines solutions to improve the country’s health care system, but he tackles the common conundrum of how to select a good doctor.

Here’s his advice:

For the younger, healthier patient

If you’re under 45 with no serious health conditions and are on the hunt for a primary care doctor, Emanuel recommends asking two questions. The first is: Do you have open-access scheduling?

“That is, do they start the day with about half of the slots unfilled so that if you have a problem, or someone has a problem, they can come right in. They don’t have to wait weeks or be double-booked or go to the emergency room,” Emanuel explained.

While conducting research for his book, Emanuel saw both small physician groups and larger health systems adapting this model.

“I think it’s a very important patient-centric way of caring for people,” he said.

The second question to ask is: Are the doctors participating in some kind of performance monitoring system and performance improvement system?

This type of model requires doctors to measure how effectively they’re treating patients and to have improvement standards in place. The result is a group of physicians and medical professionals who are constantly thinking about delivering the highest quality care possible, which is great for the patients. 

For those with a chronic illness

If you’re managing a chronic illness, or are caring for someone who is, Emanuel said to look for a doctor’s office that works with chronic care coordinators.

Practices that have chronic care coordinators don’t wait for the patients to come to them. Coordinators reach out to the patients often, and check to make sure they’re doing things like adhering to their medications or sticking to their diets.

Emanuel even references a diabetes clinic he visited where caregivers cut the patient’s toenails.

“Because diabetics often can’t feel their toes, if they cut their toenails and happen to cut their skin, it could get infected,” Emanuel said.

“Plus, when you cut someone’s toenails you can actually talk to them and find out what’s going on in their life, and it could be very helpful in figuring out if they need additional services or not.”

Emanuel recommends that patients with cancer inquire about palliative care service options; and those with a life-threatening illness ask about home visits.

If you have anxiety or depression, ask the physician’s office if they coordinate their care with a behavioral care provider, rather than leaving it up to the patient to find a professional.

If these types of physician-integrated services sound like the kind of perks only reserved for those who can shell out money for them, they’re not. Emanuel said these practices are being implemented in health care settings across the country and are moving the needle in terms of improving quality and lowering costs.

Currently, the U.S. spends more than any other country on health care — “about $10,000 per American, per year on health care. It’s an outrageous amount of money,” Emanuel said — and ranks 35th in terms of quality performance.

In his book, he argues that adjusting the way we pay doctors and hospitals, to even changing the way we see patients, can have a positive impact on the bottom line. But, it might take a while before we see noticeable change.

“It takes a lot longer to transform how people are cared for and to actually get all of the numbers right,” Emanuel said.

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