WPS Health Insurance

How to Choose a Doctor

Decide What You Want in a Doctor

What is most important to you in a doctor? Below are some ideas to consider. Feel free to add to this list to help you choose a doctor that is right for you.

  • Must be highly rated by a consumer or other group. You will want to find out who did the ratings. Is the information reliable? Who collected it? Does the group have something to gain from the ratings?
  • Determine the type of doctor you want. Internists and family physicians are the two largest groups of primary care doctors for adults. Many women see obstetricians/gynecologists for some or all of their primary care needs. Pediatricians and family practitioners are primary care doctors for many children. If you are elderly, and have conditions associated with aging, you may want to seek a specialist in gerontology.
  • Experience with my condition(s). Research shows that doctors who have a lot of experience with a condition tend to have better success with it.
  • Permitted to practice at the hospital of my choice in my network.
  • Style of communication. Do you want someone that is clinical and business-like? Do you want someone with an excellent bedside manner?
  • Preference for a male or female doctor and their age.

Check Your Health Plan

  • Primary care physicians required? Some WPS plans require you to select a primary care physician and others do not.
  • Is the doctor part of your plan network? Check to make sure the doctor you are considering is part of your plan, unless you can you afford to pay extra. You can do this by checking Find a Doctor to see if the doctor is part of your network. If you are unsure what provider network you are part of, check your member card which lists this information.
  • Doctor and your hospital. See if the doctor has privileges at the hospital of your choice. Use Find a Doctor to help out.

List Preferred Doctors

  • Ask doctors or other health professionals who work with doctors, such as hospital nurses.
  • Call a doctor referral service at a hospital. But keep in mind that these services usually refer you to any of the doctors on the staff of that hospital. The services do not have information on the quality of care these doctors provide.
  • Ask family, friends, neighbors, and co-workers why they like the physician they use. Their insight and personal experience with the doctor can be useful information for you during your decision-making process.

Check Quality

Below are some factors to consider as you look at quality. Look for a doctor who:

  • Is rated to give quality care.
  • Has the training and background that meet your needs.
  • Takes steps to prevent illness-for example, talks to you about quitting smoking.
  • Encourages you to ask questions.
  • Listens to you.
  • Explains things clearly.
  • Treats you with respect.

Below are websites that can provide information as you are considering a doctor:

  • American Medical Association website can give you lists of doctors, by specialty, who practice near you. Here you can find the physician's name, specialty, contact information, training, and AMA certification. Select 'Search for a Physician' under Patients and Consumers (you will be asked to enter a random string of characters to continue to the search tools).
  • Healthgrades offers information on physician background and performance. For a fee they can provide you a report with information that includes the doctor's specialties, board certification, education and training, governmental disciplinary actions from the last 5 years (this does not include malpractice or lawsuit information), and quality information.

Prepare for Your First Appointment

Before your first appointment with a new doctor, make a list of things you want to tell the physician about your previous health history. Your past health history gives the physician valuable clues on potential outcomes for any course of treatment for any future health problems.

Questions to Ask

A very important step is to make a list of questions you want answered. Inform the doctor's staff, when you make your first appointment, that you will need time for the doctor to address your concerns. Be up front that you are "interviewing" the doctor as you are making a very important decision for you and your family. The questions you may want to include are:

  • The doctor's specialty or special areas of practice
  • Who covers his patients when he or she is not available
  • Whether other physicians or non-physicians such as a nurse practitioner or physician's assistant will participate in your care, and whether this is optional
  • What special training the physician may have in managing any medical conditions you have (such as diabetes, heart disease, high blood pressure, HIV or other major, life-threatening chronic disease, etc.)
  • How does your doctor view the doctor-patient relationship; is it a "partnership"; or does the doctor expect you to follow his/her orders without question; the answer to this question can give you valuable insight into how the doctor will act and react to your concerns
  • Whether he or she will provide care for others in your family
  • What hospitals the physician can admit patients to; and if there are any restrictions on the doctor's hospital privileges, prescription writing privileges or on his/her medical license in general. It is important that your doctor is able to admit you to a hospital if you need in-patient care. If the doctor does not have admitting privileges, make sure you have a very clear understanding of how hospitalizations will be handled

Your Final Decision

After your first visit with the doctor, you should feel that you were treated courteously, that all your questions were answered, and that you did not feel rushed or dismissed.

Your relationship with your doctor should be considered a "partnership." The ultimate decision regarding your personal health and that of your family's is up to you. Your doctor simply advises you on what he believes to be the best treatment options. As a health care consumer, you always have the right to a second opinion on your diagnosis, prognosis, and treatment alternatives.

After the first visit, hopefully you are satisfied with the rapport you had with the doctor and staff. If you were not comfortable and satisfied with your first visit, remember the choice is yours and you may try another doctor. It is your health and the health of your family that is at stake.