One of the most common questions I encounter, in one form or another, is “How can I find a good primary care physician?” There’s no quick answer, really. I’ve discussed this topic in various podcasts, including our very first AMA, but I’d like to do so again.
Start by considering two related questions:
- What constitutes a “good” primary care doctor?
- How can you figure out if the person you’re talking to fits the bill?
Let’s start with the first question. Speaking very generally, I think there are four characteristics by which you can evaluate a physician: advocacy, affability, availability, and ability. While it’s difficult to find all of these qualities in the same person, you should at least consider all four when making your decision.
A physician who is an advocate is a physician who’s connected, who knows how to help you navigate through a storm, and knows how to get you what you need.
For example, let’s say you need to get a colonoscopy. An advocate should be able to connect you to the best endoscopist possible. Whatever test you need, they are your point person to get to the best specialist or facility (e.g., mammogram or colonoscopy). If, God forbid, said test comes back with a worrisome finding, an advocate will know the right follow up, too, if needed. And a truly good physician won’t just have a good Rolodex—they’ll also be your advocate in the system, doing everything they can to make sure you get the care and treatment you need. They can coordinate care across multiple teams of providers (this is not uncommon in cases where people have complex medical issues), and serve the effective quarterback for care, even when it means being a go-between across multiple specialists who rarely communicate.
An affable doctor is one who talks with you, not to you. It’s a person who still remembers the human side of the art of medicine. It’s the person who probably went into medicine because of how much they love the intimate nature of patient care. There was a time when this trait was not viewed as necessary, especially in some fields of medicine, but I suspect the days of going to a doctor who constantly talks down to you is over. Your doctor might be the expert, but if they can’t bring you along in their decision-making process, then they probably won’t be a good fit.
How much access do you have to your doctor? Are you looking for someone that you can call 24/7? If that’s the case, you might be looking for a concierge doc, whom you’ll pay an annual fee or retainer to protect a certain amount of time and availability in their schedule for you. Are you looking for same-day appointments for urgent care? Do you want same-day care, as long as you can see one of their partners? Prescription refills on weekends? House calls? You get the idea. Know what you want before you go shopping.
So much of what we learn in medical school is irrelevant by the time we’re practicing, let alone 10 years in. The lag between when something becomes a finding and when it becomes mainstream or obvious enough that everyone is doing it tends to be about 12-20 years, so it’s crucial that physicians keep up with the latest literature.
I think it’s good to get a sense of how curious your doctor is and whether they have a passion for learning. Because if you’re not learning as a doctor—not trying to get smarter on diagnostics or advancements in the field—you’re probably not practicing great medicine.
Not surprisingly, finding “10/10” advocacy, affability, availability, and ability in one doctor is about as likely as finding a doctor capable of breaking Joey Chestnut’s hot-dog-eating record. It’s not impossible per se, just low probability. No physician is perfect, and you’ll probably have to make some trade-offs. But you should consider all four criteria when speaking to a prospective physician.
Once you know what you want (or, more specifically, how you want to optimize around the four traits), the next question is how to operationalize your search. To help make that process easier, we put together a quick list of ten questions below that you can take as a foundation to build on as you speak with potential doctors. (Here is a link for a printable version.)
Asking a physician these questions should give you a pretty good idea of whether they’ll make a good advocate, whether they’ll be affable, available, and most importantly, whether they’ll be able to help you. (And a doctor’s reaction to these questions is a good litmus test. If a doctor is put off by a patient that wants to be active in bettering their health, it’s probably not the right doctor.)
- How long have you been practicing?
- How do you think about balancing the line between prevention and treatment of disease? How much of your time with patients is spent focusing on the former versus the latter?
- How long is the average visit with your patient?
- How much time, on average, do you spend with each patient per year (i.e., in-person visits, video meetings, reviewing labs and records, phone calls, emails)?
- Which lab tests and biomarkers do you consider essential for patient management?
- What areas of medicine interest you the most, either beyond or within primary care?
- Which conferences do you try to attend each year?
- How much time, on average, do you spend per month staying informed of the latest research in medicine overall, such as reading broadly from journals like JAMA or NEJM?
- How much time, on average, do you spend per month staying informed of the latest research in your areas of focus, such as specialty journals (e.g., lipidology, nutrition, exercise physiology)?
- Are there any other things you would like prospective patients to know about you or your practice?
People shouldn’t be afraid that this process can take a while.
Hopefully, this helps you as you try to navigate the medical system, in search of a doctor who fits your needs.
For me personally I believe I can be an advocate for myself and if I can’t there are other services you can use for advocacy, Affable is a nice to have as I won’t be bullied by a doctor who talks down to me. At the moment I don’t need a lot of care so availability isn’t a huge concern but obviously that is subject to change if issues arise. Ability is the biggest thing for me. Finding physicians who keep up with the times outside of what drug to prescribe is the biggest challenge. Just finding a doctor that can have an intelligent conversation about diet and nutrition is difficult
Matthew Walker would also have you ask how much sleep they get in order to determine potential error rates. (From Why we sleep)
Wow! That’s quite a wish list. I am fortunate to have such a doctor, in my hematologist/oncologist at Mayo Clinic, but finding a primary care doctor like that would probably cost way more than people like me on Medicare could afford.
I have found such a doc, but it’s concierge medicine and comes at a price. Well worth it. I do realize few will be able to afford it. My HSA is reserved for catastrophic events.
Thanks for this helpful list. 4 of the 10 questions are about time spent on various activities. What would you consider to be good/acceptable answers for each of those?
This recommendation of how to interview a primary care doctor is geared to the wealthy. Most patients who rely on health insurance would not be able to find a PCP willing to give up valuable time to answer these interview questions without compensation.
It seems you are very much out of touch with the circumstances of the vast majority of health care consumers in the USA. For many patients, finding any PCP who is available to see them is a major challenge. Primary care physicians are becoming more scarce with each passing year. May of those that retire are not being replaced. NPs are becoming the norm for much of the population.
If you are wealthy and are hiring a concierge doctor, then this list could be helpful. Unfortunately, only a small percentage of patients have the means to access concierge medicine.
You made a good point that it’s important to know a doctor’s specific interest in the medical fields when choosing a primary care physician. I’m currently at the age when I am quite susceptible to having diabetes since my family history does have a good number of instances of it. If I ever do get it someday, I hope that my primary care physician is someone who is quite an expert on it.
As a Veterinarian, I am amazed that physicians routinely fIl to do thzt which a Vet does on every office visit….A PHYSICAL EXAM. People are not all that accurate in terms of memory, nor do they necessarily note slow changes in both their environment and themselves.
A physical exam usually takes 5 or 10 minutes. The examiner will frequently find a pain, swelling, discoloration, or other major or minor finding that may never have been addressed. And somatic cues can jar a patient’s memory about a concern or sensation that may have never been discussed. Ausculting the thoracic cavity is NOT a physical exam.
To me, an excellent physician engages reen of their senses to evaluate your well-being. He engages in conversation with you to pointedly check your general health status, and asks what your concerns are. Good medicine should begin with a physical and verbal exam. It is not about a computer screen and routine bloodwork
I like the idea of getting a doctor that has a passion for learning. You would have the confidence that your doctor is actively practicing medicine. That could be a great way for people to find the best doctor possible.
My 10-year-old sister is a competitive swimmer, and she has been complaining about having difficulty hearing for the past few months. At first, we figured that her ears were just clogged with pool water but now it seems like it might be a real problem. We are thinking about taking her to an ENT doctor, and you make a great point that we should ask potential doctors about their experience and how long they have been practicing medicine.
So, I just actually asked these questions to my new potential PCP.
I looked up the questions this morning and took them with me to my first ever appointment with my new doctor.
They were very professional and kind. When I first asked a few questions they said, “this sounds like an interview?” When
I asked them about which conferences they attend, they looked at me as though I was crazy and replied, “I don’t see what this has to do with your health.” They said their average time is 20 minutes with a patient and that their hospital demands a patient quota.
I tried to be really nice about the questions, but they were really weirded out by them and seemed to explain that the boards are very difficult and they’re required to know tons of stuff, etc.
I wonder if it would have helped to ask them how they would choose their PCP.
I make very little money but there are hundreds of PCPs in my city (Philadelphia), and I was trying to ask these questions meekly, but I wonder if there are many PCPs who would be ok with these questions. Anyway. I got some bloodwork and flu shot, etc.. I didn’t ask for Lp(a) though perhaps that will be for my next doctor (unless I really like the notes that come back with the bloodwork. I’m 39 now so it seems like a pivotal health decade and I’d like to deeply trust my PCP that I see once or twice a year. I suppose I’m likely to keep digging until I find someone interested in geeking out with me about things like Ketogenic diet, saturated fats from suet, and Lp(a).
Anyone else have experience, or a better way to ask these questions?
I never thought to look for a doctor who is an advocate, it seems like that would come in handy though. My sister is looking for a general practice doctor for her family, to make sure they are taken care of in case anything were to happen. I will have to let her know that looking for these attributes will help her find the right one.
I once asked a doctor if he was “any good”? – response was “not bad”. I never went back.
I liked how you said that a good doctor will find you good referrals if you need a specialist. My sister is experiencing a lot of dizziness, but she isn’t sure if it’s something she should talk to her cardiologist about or if she needs to talk to someone else. It seems like her primary physician should have the tools to let her know which one to talk to and offer her a referral if necessary.