How to be a general contractor for your health

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Our bodies and our houses have a lot in common. Both need regular maintenance and the occasional major remodeling or repair project. That’s why I like to think of myself as my own general contractor for my body and health — the person in charge of managing all the subcontractors who do the hands-on work.

So when my internist or general practitioner tells me I have high blood pressure or my knee starts to signal that it is nearing the end of the line, I start doing what any good contractor does.

First, I think about just how comfortable I am with my existing subcontractors — the health care providers I see routinely.

Then I outline the scope of the work needed, whether it be for a new medication regimen or a new hip joint. Next I start looking to find good subcontractors to handle the project.

You can use this approach too. Here are some steps to consider as you scope out your medical options:

Insurance options

Making sure you know what your insurance plan covers is the first step, according to and most other healthcare organizations.

Does your policy require that you get a formal referral from your GP, or can you see specialists without a referral? What is your responsibility for costs with out-of-network specialists? Are second opinions covered? Do you need pre-approval?

Do your research

Contact your current health care providers, friends, family and acquaintances who have similar health conditions or have worked with group practices or hospital centers that deal with your type of health issues. What has been their experience? Which ones would they recommend for their family members?

As you narrow the list consider: Do any providers show up twice with positive recommendations? Or are there certain practices, hospitals or individual doctors that received particularly glowing recommendations from those you know and trust? At this point you should check whether the physicians take your insurance (in-network) if you are not willing to go out-of-network.

Don’t limit yourself to one doctor. If you were shopping for an electrician or landscaper, you’d interview several. The same is true of healthcare professionals.

I use the internet to initially screen practitioners. I confirm the information at several sites including the profile usually offered at their practice website. For MDs, I make sure that they went to an accredited medical school and post-graduate training program. Does the practice profile confirm that they are board certified in their area of specialty? Board certification is an important indicator that they have passed rigorous testing by their peers.

How long have they been in practice? Where do they practice and with whom? Where are their offices located? You want a location that is convenient. Where do they have hospital privileges? Is this a hospital that works for you in terms of location and is it covered by your insurance?

Make appointments

Pay attention to the how long it takes to get an appointment: next week, next month, two months. How important this is depends on how urgent your medical needs are. Earlier might be better or waiting some weeks might be just fine.

Would you be willing to go out-of-network to see a highly recommended practitioner or one with an earlier appointment time? Check with your insurance to see if you are covered for consultation visits; then check with the practitioner’s office to see if they offer a limited consultation visit, both in time and cost. This is a possibility, especially if you are looking for a surgeon, and getting the input of several.

Collect your records

Often in-network providers will already have access to your medical records. Chances are you have already given permission. Remember all those papers you signed about privacy and record-keeping, and using patient portals to see your test results?

Even if you are staying in-network, it is valuable to collect all the relevant tests and procedure results to take with you when you see a new practitioner. Most radiology sites will provide you with discs showing your x-rays, CT scans, echocardiograms, and such. If you bring them along, these results can be uploaded and reviewed by doctors at the time of your visit.

Also be sure to make a list of your medications and any blood work results that you can print from your patient portal or obtain from your primary doctor.

The initial visit

You’re almost ready to begin visiting the most likely prospects. Before you do, prepare a list of your questions. Write them down. Your questions may range from the number of surgical procedures similar to yours that the doctor does each week to their general approach to your chronic medical condition.

This list might also include specific questions about new treatments or complication rates. Also inquire about the doctor’s willingness to stay in contact with other specialists that care for you.

When it’s time for your first visit, bring your insurance information, medication list, and any diagnostics (labs, x-rays, results of other studies). Bring your list of questions.  Also consider bringing along a friend or family member if you need extra support or as a note taker!

Consider asking the clinician who they would recommend for themselves or their family members who might need to be treated for the same condition – basically who would they recommend for a second opinion. Be aware of how comfortable you are with communication and the candor with which the clinician answers your questions.

Assessing the visit

Now that you’ve seen a doctor or two, it’s time to assess how you feel about each of them.

Did you feel that you could comfortably ask questions and get clear answers? Was the clinician forthcoming about their practice and experience? Were they willing to answer questions about success rates and adverse events? Did they provide good guidelines for what to expect from new treatments or medications? Are they willing to communicate with your other health care providers by sharing results and course of treatment? Were you comfortable with the location, facilities and other medical personnel you would be working with closely?

Remember: You want a doctor who is proficient but also one that cares for you, and part of caring is good communication.

Second opinions

Interviewing potential doctors is one thing. Making a final decision about your course of action is another. I am a strong proponent of getting a second opinion, even when I have confidence in the first, especially for surgical procedures or a completely new course of treatment. I really value another set of experienced eyes looking at the same clinical data.

Sometimes there is a new perspective, or a confirming one. Either way it helps me feel more confident in my choice. I’m reminded of a friend who was facing eye surgery and was feeling a little queasy about it. He made an appointment with a second surgeon. At their meeting, my friend described the first surgeon’s diagnosis and the planned treatment.

“That is exactly what I would do in this instance and the surgeon you have picked is the most highly regarded eye surgeon in this area,” the second surgeon said. “In fact, I studied under him in medical school and there is no one I would trust more to operate on me or my family.”

You may not get a reaction quite that strong but a second opinion is always worthwhile.

Who should you see for a second opinion? Ideally, it will be someone you already identified in your initial search — someone who practices in your area, who has gone to an accredited medical school, has done their residency in an accredited program and is board-certified.

When should you ask for a second opinion? “The sooner the better,” says the Columbia University School of Surgery. “In fact, you could ask the doctor who says you need surgery for a recommendation for a second opinion before you even leave the office. You certainly don’t want to wait until the operation is about to be done.”

Final thoughts

Trust is such an important element of any working relationship. To achieve a level of trust you need to do your due diligence in finding experts and then vetting their diagnosis and proposed course of action through a second opinion.

Being a general contractor for your health means that although you depend on the expertise of your subcontractors, you realize that they are specialists and ultimately you are the final decision-maker. This means you may need to facilitate communications between them to ensure that they are clear about the various aspects of your project — your health.

About the Author

Rebecca Lieser, M.D.
Rebecca L. Lieser, M.D. Dr. Lieser’s background includes clinical medicine, corporate medical consulting, teaching, research, medical writing and academic coaching.