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The M.D.: Many factors in finding the right doctor

August 15, 2011|By Valerie Ulene, Special to the Los Angeles Times
  • Studies show female doctors spend more time with their patients during visits.
Studies show female doctors spend more time with their patients during… (Thomas Barwick, Getty Images )

A few weeks ago, I scheduled a consultation with a new physician I knew very little about. My decision to see her was based on nothing more than friends' recommendations, and, when the day of my appointment rolled around, I arrived at her office having no idea what to expect.

Before she'd even walked into the office where I sat waiting to meet her, the diplomas mounted prominently on her walls had me convinced I'd made a good choice. There were loads of them, from some of the best schools in the country: Undergraduate degree at Brown, medical school at Cornell, a residency at UCLA.

With training like that, she had to be a good physician, right?

Not necessarily. A doctor's academic credentials are certainly not the only things to consider when choosing a doctor. A variety of factors play into the kind of care a doctor delivers and influence a patient's level of satisfaction with the care he or she receives.

In fact, a doctor's training — including where they did it and how exhaustive it was — may not be a particularly good indicator of quality. In a study published last year in the Archives of Internal Medicine, researchers compared doctors who had graduated from foreign medical schools (which are typically viewed as less desirable than domestic schools) to physicians trained in the United States. They also looked at doctors who were board-certified versus those who were not. They did find some differences in quality, but these were generally quite small: Graduates from U.S. medical schools performed only 1 percentage point higher than those trained abroad, and board-certified physicians scored just 3 percentage points above their uncertified colleagues.

Sometimes a doctor's more personal characteristics wind up mattering most to patients. Age, for example, may affect the way they practice. Medical science is constantly evolving, and two doctors qualifying just a decade apart may learn very different things during their training.

In a study published in May in the International Journal of Clinical Practice, Italian researchers examined the attitudes and prescribing habits of more than 1,000 family physicians, cardiologists and diabetes specialists. They found that, when it came to treating cardiovascular disease, a doctor's age made a difference.

Younger physicians relied more heavily on medications than their older colleagues to help control risk factors for heart disease such as high blood pressure, high cholesterol and diabetes in their patients. Older doctors were more inclined to recommend lifestyle modifications such as diet, exercise and smoking cessation in lieu of drugs.

Male and female physicians are somewhat different in their approach to patient care, particularly when it comes to how they communicate with patients. Generally speaking, the communication style of women tends to be warmer than men's: They reveal more about themselves in conversation and encourage others to talk more freely and more intimately about themselves. Apparently, these differences carry over into the doctor's office.

A 2002 article published in the Journal of the American Medical Assn. examined more than 25 studies on the relationship between physician gender and patient communication. Collectively, these studies showed that female doctors engage in more patient-centered dialogue than their male counterparts and spend about 10% more time with patients during their visits.

Personal lifestyle choices can influence a doctor's practice style as well. Though all physicians should counsel their patients about healthy behaviors such as exercising and giving up smoking, it's only logical that those who are personally committed to living healthfully themselves will do a better job at it. They'll invest more time and energy in this type of counseling. And their advice will be viewed as more credible, and taken more seriously, by patients.

A study presented at the annual meeting of the American College of Sports Medicine in June found this to be the case among doctors-in-training. Medical students who were physically active were most likely to encourage their patients to exercise and more likely to say that such counseling was important.

Silly as it may sound, even a doctor's sense of style can influence the physician-patient relationship. Most patients have clear ideas about what their doctor should and shouldn't wear to the office. Doctors whose wardrobe choices match these preferences instill a sense of confidence in patients, while those whose appearance doesn't can inadvertently erode their patients' trust.

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