Monday, August 1, 2011

HOW SHOULD YOU CHOOSE YOUR DOCTOR?

STEPS TO BE FOLLOWED WHILE CHOOSING A DOCTOR

Today, we have choices in every field of life. Whether it is eating out in a restaurant, choosing an airline, or buying a home appliance, there are multiple options available. We follow certain steps such as a comparison of the quality, convenience, cost, etc to arrive at the best choice. Various websites offer comparison between different brands of home appliances, and travel portals give us the flight timings, services and costs, helping us to choose an airline. However, there is not much help available to enable us to choose the best doctors. This article looks at all the important questions that crop up in our minds when we think of consulting a doctor.

Should you consult a doctor or try home remedies?

Many minor ailments are self-limiting in nature (they get better on their own); so one can try home remedies for them. These include viral fever, loose motions, cough & cold, minor occasional headaches, occasional sleep disturbance, minor bruises after a fall, etc. However, one should consult a doctor if symptoms are severe or persist beyond usual duration. For ex- if fever persists beyond 3 days, loose stools continue leading to dehydration, headaches are severe, one should seek a doctor's advice. Generally, one should consult a doctor if the symptoms are severe leading to impairment or interference with activitites of daily living or if the symptoms are recurrent in nature.

Should you consult a general practitioner (GP) or a specialist?

It is one of the most important issues to delibrate before choosing a doctor. GP is one who has the basic medical degree (MBBS in India). MBBS training requires four and a half years plus one year of internship (total duration of five and a half years). Certain specialised courses are available for GPs such as Family Medicine, but very few doctors are trained in that speciality in India. A specialist is one who has a postgraduate degree- MD (Doctor of Medicine). MD is offered in medical specialities and the equivalent surgical degree is MS (Master of Surgery). MD or MS can be done only after MBBS and it is of three year duration. For super-specialisation, one can then do DM (Doctorate in Medicine), which is of further three years duration. MCh is the equivalent degree in surgical specialities. Therefore, the highest medical degrees in India are DM (in medical field) and MCh (in surgical field), and it would take a minimum of about 12 years after +2 to get these degrees. Remember that there are entrance exams before MD and DM, and then one has to pass both theory and practical exams to be awarded these degrees. A thesis (research) is also mandatory during MD and DM. A point to note is that certain foreign countries award MD as the basic medical degree. So, an MD of USA, Russia or China is equivalent to MBBS of India.

Medical science is rapidly advancing and several new diagnostic tests & treatment modalities have become available in the past two decades. These include widespread use of MRI in 90s and PET scans (which show the functional activity of an organ) now. Infections and tumors can now be more accurately diagnosed. Similarly, several new treatment options are available- such as thrombolytic therapy in stroke, deep brain stimulation (DBS) surgery in Parkinson's disease, new medications for high BP & sugar, etc. It is not very difficult to believe that a GP would not be aware of these latest diagnostic & treatment modalitues.

On the other hand, when you consult a specialist, there could be some drawbacks. A specialist is likley to order more tests (such as coronary angiogram for a suspected cardiac problem), MRI scans in cases of headaches to exclude brain pathology, etc. In addition, the consultation fees could be more; it may be more difficult to get their appointments; you may not be able to discuss your problem in detail because of their busy schedules. For example, there are only 1500 neurologists (DM in neurology) out of a total of 1.5 million registered doctors in India (0.001%). This also translates to one neurologist for one million population. In addition, you may have to see several doctors if you happen to have multiple problems. For example, if you suffer from high BP, diabetes, thyroid problem and knee pain; you would have to consult a cardiologist, endocrinologist, and orthopedic surgeon. Sometimes, problems in other systems may remain undiagnosed, if you consulted a specialist of one system.

Therefore, it may be better to consult an MBBS or MD doctor in the beginning, if you have minor ailments or if you have multiple problems. However, please consult a specialist if your problem is serious or not getting better with treatment under a GP; having frequent reccurrences or if you wish so. In several countries such as UK or USA, one may not be able to consult a specialist unless referred by their GP; however, in India, you are free to consult any doctor of your choice including a specialist.

Identify the doctor of the correct speciality (as per your problem)

You need to choose the appropriate doctor, specialising in the disease you are suffering from. For ex- for ear discharge/ear pain/decreased hearing, you need to see ENT; for chest pain-cardiology; for knee pain-orthopedics, etc. Sometimes, you may not be aware of what speciality to consult. In this case, the receptionist or the secretary of the doctor can help you. If you happen to consult or know any doctor for any previous ailment, you could ask him to guide you in choosing the correct specialist for the current illness.

Should you go to a doctor in a clinic set-up or a multi-speciality hospital

Both clinics and hospitals have their advantages and disadvantages. Hospitals have multiple doctors in the same speciality, so, if one doctor is on leave, you can always consult another doctor. Also, if any cross-referrals are given (if you are asked to see another specialist), you could see them in the same hospital. Most investigations and medications are also available in the same hospital. Drawbacks of a hospital may include longer distance from home/office; higher costs; and uncomfortable surroundings. In a clinic, you tend to feel more familiar with a particular doctor, and you may find the surroundings more comfortable. Cost of treatment could be lower in a clinic. However, a serious illness usually can not be treated in a clinic. For ex- if you have suffered a heart attack or brain stroke, thrombolytic therapy may not be available in a clinic, and valuable time may be lost whie shifting from clinic to a bigger hospital.

Therefore, for a serious illness, you should prefer to consult a doctor in a hospital; and for a minor illness, you could consult a doctor in a clinic. Also, if your illness is undiagnosed, the chances of making an accurate diagnosis is more in a hospital because of availability of all investigations. So, your initial visit (prior to diagnosis) could be to a hospital, and subsequent follow up can be done in a small clinic.

How do you ascertain that a certain doctor is better than others in the same speciality?

Though it is not always easy to identify a better doctor, certain points can help you in this decision.

1. Look where the doctor got trained: If a doctor got trained at AIIMS, PGI Chandigarh, CMC Vellore or some other good colleges, their knowledge & expertise would be better than if they studied in a lesser known college or colleges that give seats after taking money (management quota). Certain magazines like India Today routinely come out with the rankings of top medical colleges and that could be one source for finding the best medical colleges in India.

2. Look at the degrees and qualifications: A doctor with MD (or MS) is better trained than those with MBBS alone, and those with DM (or MCh) are better trained than those with MD (or MS). Certain doctors may also obtain special fellowships in a more specific disease.

3. Number of years of experience: Senior doctors are generally better than the fresh pass-outs, and as the doctor becomes more experienced, he becomes better. This is true for both surgical and medical specialities. For ex- a surgeon who has performed 500 cases of spine surgeries is definitely better than the one who has performed only 20. Similarly, a neuroloigist who has treated 1000 cases of stroke is better than the one who has treated only 50. Every patient has a right to ask his doctor about the number of similar cases treated/operated by his doctor.

4. Any research in the specific field: A doctor with research experience in the field should be preferred over someone without any research experience. Similarly, if a doctor is on the editorial board of a journal or is routinely invited to give talks on a specific disease, he is considered to be an expert and should be preferred. These details can be obtained from different personal and public websites (such as Google scholar and PUBMED).

5. Look for reviews about a doctor or hospital on websites.

6. Knowledge of a specific language: Good communication is the key to a correct diagnosis and better treatment. So, if the doctor knows your language it is an advantage. Many doctors have translators for the benefit of their patients.

I have tried to discuss various issues in this vast topic, and I may have sounded vague at some places. I would welcome any suggestions from your side.


DR SUDHIR KUMAR MD (MEDICINE), DM (NEUROLOGY)
SENIOR CONSULTANT NEUROLOGIST
APOLLO HOSPITALS, JUBILEE HILLS
HYDERABAD, INDIA- 500033
Phone: 0091-40-23607777/60601066


5 comments:

Chris said...

The best blog I have ever come across on choosing a right Doctor and the options a patient has very informative, That's what good education in good college/Institute gives us Dr Sudhir,The quality!!!
I don't know when it will become mandatory for the doctors display on the Board, where he studied , whether he got seat on merit or on payment or on some reservation, Don't you think Patients have right to know before even he/she speaks to the doctor, Because after entering the consulting cabin, you cant come out.What is the way out.It should also be included on the certificate and prominently displayed Am i Wrong?

Dr. Sudhir Kumar said...

I fully agree with you, Chris.

satyaky95 said...

Hallo sir mere father ko dementia ho gaya hai aur unko kuch bhi yaad nahin rahta main kya karoon?

Clare, Calfirnia US said...

I second Chris's comment. I have a reasonable IQ and found two types of articles, elementary and advanced, none of which were helpful in the least! Thank you for providing a thorough and understandable article for choosing a doctor.

andrew fields said...

It contains information related to that. I would like to thank you for your efforts to prepare this article.






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