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The good doctor

Finding one is getting easier as physicians provide more info and stress consumer service. A key question to ask: How is the practice run?

July 09, 2007|Jan Greene | Special to The Times

CONSUMERS have largely been in the dark when trying to choose a new doctor. They might want someone who is skilled, pays attention to their concerns and makes it easy to get an appointment. Instead, with little information to go on, they pick someone out of a directory whose office is conveniently located.

But a new emphasis in family medicine on providing quality care and pleasing patients is giving consumers more to go on. They can find out basic quality information about doctors -- such as how well they provide preventive care -- from some insurers, state health officials and private companies such as HealthGrades. And a few well-placed questions about the way a doctor runs his or her practice can give consumers a sense of the type of doctor-patient relationship they'll have -- and, to some degree, the quality of care they'll get.

"Times are changing, and people's expectations of what they want from their medical care has changed, and we as practitioners are changing," says Dr. Donald Klitgaard, a family physician in Iowa who, like doctors across the nation, has computerized his record-keeping, made it easier for patients to get appointments and helped his office staff become more efficient.

Odd as it may seem, simply calling prospective doctors and asking whether their office is computerized may turn out to be the best advice for finding a physician committed to patient care over the long term.

"The average consumer takes it as a given that doctors have these systems in place," says Peter Lee, chief executive of the Pacific Business Group on Health, an employer coalition based in San Francisco. "They don't know how much medical care today is not 20th century, let alone 21st century, in terms of how much doctors rely on paper instead of computers."

Nationally, only about 20% of physician offices are computerized; the rest still rely on notoriously inefficient paper charts. But computers are an easy benchmark for quality. They can help a doctor not just keep track of files, but also send out prescriptions accurately and quickly, get lab results inserted into the record automatically and be reminded what the scientific evidence suggests is the next best step with a patient.

At the same time, for doctors to get the most value out of computers, experts say they need to use them as more than word processors; physicians should use features such as electronic reminders to prescribe a test or a medication, and change the way they practice as a result. "I believe it really does translate to better care," says Robert Eidus, a New Jersey physician with a background in business and medical quality improvement. "But it's not just that I have an electronic medical record, it's how do you use it and how does it impact caring for patients."

Oso Family Medical Group in Mission Viejo converted to an electronic medical record system in 2004, going through the expensive and painful process of converting thousands of paper files. But it was worth it, says Dr. Lee Burnett, an osteopath and partner in the five-doctor practice.

The change improved patient care and stopped the constant and inefficient search for file folders. "We had two people on staff whose jobs were just to find paper charts," he recalls.

But simply asking whether a doctor's office is computerized shouldn't be the sole determinant in choosing a physician. Ultimately, in the new doctor-patient dynamic, patients should have easier access to their doctors when they need them -- in person, by phone or online.

Other aspects of this "new model" of family practice are largely invisible to patients but just as important: The staff acts as a team to improve patients' health by making sure they follow up on medical advice and make it to appointments; the doctors base care on scientific evidence rather than instinct or habit; patients with chronic illnesses receive follow-up care; the practice follows up on test results and visits to specialists rather than waiting for the patient to track down that information.

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'Patient experience is key'

This patient-centered approach is considered a new measure of quality because it means patients will be more motivated to not only see the doctor but also accept the medical and lifestyle-change advice dispensed.

Patients who work with their doctors in a collaborative way, for example, are more likely to take care of themselves, according to a study of 24,609 adult patients with chronic or serious conditions.

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