Learn About Your Heart...
Made Simple


By Nicolas Shammas, MD


A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics



1.
Statistics about Heart and Blood Vessel Diseases in the United States
2.
Structure and Function of the Heart and Blood Vessels
3.
Diseases of the Blood Vessels of the Heart
4.
Surgical Therapies for the Cardiovascular Patient
5.
Peripheral Vascular Disease
6.
Diseases of the Blood Vessels of the Head and Neck
7.
Strokes: How to Survive Them and How to Prevent Them
8.
Valvular Heart Disease
9.
Heart Rhythms: How to Recognize Them and Treat Them
10.
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test



CHOOSE YOUR DOCTOR AND HOSPITAL

Anne D. Pauly, MS, RN, BC

How do I find a doctor if I move to a new town or if I want to change the doctor I currently have?

Choosing the right cardiologist (a doctor that specializes in the treatment of heart disease) can be a challenging step. Cardiologists are specialists, and the majority of them accept patients by referral from a primary care doctor. Finding the right primary care doctor is among the best things you can do for yourself. Primary care physicians are the "gatekeepers," referring you to the appropriate specialist, including a cardiologist, when necessary. Most of this chapter will focus on how to find the right primary care doctor for you since this step most often leads you to the specialist you need to see.

First, check with your health insurer or employer's benefits office. Insurance plans are continually changing. You may be limited to a list of doctors who agree to certain requirements, and a requirement may be that you must select a primary care physician from this list. This physician is then responsible for your care.

What if my insurance does not limit my choice of a physician?

If you are not limited to a list of doctors, you might want to look in the phone book. Physicians probably will be listed by specialty. You will want a physician who will provide overall management of your healthcare:

  • For adults, a family practice physician or internal medicine specialist (internist)

  • For women, an obstetrician/gynecologist

  • For children, a pediatrician

  • For elderly, a specialist in geriatrics.

A family practice physician can usually manage all of the above groups of patients and will refer as necessary. You might also inquire of friends or coworkers about physicians they like. Additionally, many county medical societies will provide you with a list of family physicians or those with specialties you want. Hospitals in your area might offer referral services, so check with them as well.

What kind of doctor should I be looking for?

You will be looking for a medical doctor (MD) and/or a doctor of osteopathy (DO).

What is the difference between these doctors?

Both of these types of doctors are basically taught the same way and have their advanced training (residency) together. The DOs have a little more osteopathic training (therapy based on the assumption that health can be restored best by manipulating the skeleton and muscles). MDs and DOs may be specialized in any of a large number of specialties, such as cardiology, gastroenterology, neurology, or orthopedics, to name a few.

You will be looking for a MD or DO as your primary care provider who will then refer you to a specialist when necessary.

What if I need a referral?

If you need a referral to other health specialists, the primary care physician must make the necessary referral.

When I have the appointment, will I always see the physician?

Many doctors have other health practitioners working with them. They may have nurse practitioners (NPs) or physician assistants (PAs) working with them.

  • A nurse practitioner (NP) or advance registered nurse practitioner (ARNP) is a registered nurse with an advanced nursing degree, usually a Master's degree; the NP is also specially trained to diagnose and prescribe certain medications

  • A physician assistant (PA) is a professional trained in the medical model to assess and examine the patient, perform certain procedures, and give instructions to patients.

The NPs and the PAs practice under the direction of physicians. They may see the patient initially, obtain a history, and perform a physical exam. If the physician sees the patient, the NPs and PAs may reinforce instructions from the doctor and/or spend time with the patient answering questions and teaching the patient how he or she can improve and/or maintain his or her health.

The NPs and PAs perform an invaluable service to the physician and patient in that they can usually spend more time getting to know the patients, their health problems, and their concerns than the physician has time to do.

When I decide which doctors I might want, what's my next step?

When you have your list of physicians, from whatever your source--insurance list, friends/coworkers, county medical society--call the doctors' offices to ask if they are accepting new patients and if they will accept your insurance plan.

Keep track of how you are treated on the phone, how promptly you were waited on, and if the staff is willing to respond to a few questions that you have about the care of patients in that practice. If they do not have the time, would they be willing to call back at their convenience? If they don't call back in a reasonable length of time, call back 1 more time, then consider other offices if they won't respond to you. If they call back, ask them questions. If you like what you hear, consider making an appointment. If not, don't call back. Remember, you are looking for a knowledgeable, competent person who you can trust and who can diagnose and help you sort out your problems and assist in finding a solution.

Before you actually make the appointment, call your county or state medical board to verify that the doctor has a current license in your state. Also, find out if there have been any disciplinary actions or if any charges are pending.

When should I make an appointment?

The best for both you and your physician is to meet and talk about your health concerns while you are well. The more you are informed about your health and can adequately discuss with your doctor, the better he or she is going to be able to help you get in shape and stay that way.

When you have decided on your new doctor, make an appointment and have your records transferred from your previous doctor.

What do I need to take with me to the doctor?

There are things your doctor will want to know about your health history, so prepare and take a list with you:

  • Current conditions for which you are being treated

  • Any allergies you have to medications, latex, etc.

  • Surgeries you have had and when they occurred

  • Things that have changed since the last time you saw a doctor

  • Prescription drugs you take and dosages--take the original medication containers to show the correct dose information

  • Any over-the-counter (OTC) medications you are taking, such as vitamins, herbal medications, pain medication, nutrition supplements, etc.

  • Name and address of your previous doctor(s)

  • Person(s) to contact in an emergency

  • Your employer's address and phone number, if currently employed

  • Your Medicare and/or insurance company and policy numbers--bring insurance identification (ID) cards if you have them

  • Family medical history

  • Any types of alternative therapies you are using (such as chiropractic, naturopathic, Reiki, etc.).

  • If you are of a different culture, and there is something specific you need, let your doctor know. Doctors deal with many different people and need to understand multicultural health information.

What else should I think about before going to the doctor?

You may want to take a list of questions you want answered. This may be a very important step for you.

If you are not sure of the doctor's specialty or special area of practice, ask:

  • Who covers the doctor's patients when the doctor is not available?

  • Does the doctor use other physicians, NPs, or PAs to participate in your care, and is it optional?

  • Does the doctor have special training in managing any medical conditions you have, such as diabetes, high blood pressure, heart disease, etc.?

  • Will the doctor be willing to care for other members of your family who might need a doctor?

  • To which hospitals can the doctor admit patients?

  • Are there any restrictions on the doctor's hospital privileges?

How do I choose a hospital?

The number of hospitals in your area, your health insurance plan, or the places where your doctor has privileges may limit your choices for hospitals. Ask your doctor which hospitals have the most experience with your situation. Call the public relations or marketing department to find out how often the hospital performs the procedure in question or treats a certain type of illness.You may also wish to contact your insurer, health maintenance organization, or the hospital itself about published reports of treatment results--federal, state, and local governments also collect and publish information about hospital performance. However, for routine procedures, it might not matter which hospital you use.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a nonprofit organization that evaluates and assists hospitals to improve their performance. JCAHO provides information to the public about accreditation status and selecting quality care. Performance reports of accredited organizations and guidelines for choosing a healthcare facility are available to the public and can be obtained by calling JCAHO at 630-792-5000 or by visiting its website at http://www.jcaho.org.

Hospitals who are committed to their patients want to know about the quality of care they provide. They use this information to improve their service. Call the hospital marketing or public relations department for information about patient satisfaction surveys, or talk with someone who works in the hospital. This information is usually the fastest and best way to estimate the quality of the care you will receive.

"Choosing a Hospital" is a website that describes types of hospitals and more questions to ask when choosing a hospital. This site can be accessed at http://www.ahcpr.gov/consumer/qnt/qnthosp.htm.


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