By Catharine L. Shaner, MD, FAAP
Define your specific requirements.
Each of you has unique needs and circumstances that are important factors in your decision-making process. Ask yourself these questions:
1| Do I need a specialist?
Generalists, such as family doctors, are trained to know about a very broad range of topics. Your family doctor treats all of your problems, not just fibromyalgia (FM). If you need more in-depth treatment for your FM, she can be helpful in coordinating care with a specialty doctor. Specialists have extra training in their field of expertise and may be needed to diagnose a condition or provide advanced treatment. Traditionally, the rheumatologist is the specialist who most often diagnoses and treats fibromyalgia.
2| How far can I travel?
Most patients with chronic or complex conditions would travel any distance to see a good doctor if they could. Realistically, driving is very hard on some and impossible for others. Think about what you can consistently manage.
3| Does my insurance restrict who I can see or where?
It is easier to work within your insurance guidelines than outside of the network, but consider all possible doctors at this point, regardless of insurance.
Make a list of potential doctors.
Compile an interview list with the names and phone numbers of doctors who interest you. Leave several spaces between each name to jot notes and record appointment dates and times. The phone book is one way to start your list. Most yellow pages list physicians by specialty and location, two of the criteria from step one. Additional sources for locating doctors include:
State and county medical societies
Hospital referral services
Other doctors or nurses
Word of mouth (relatives, neighbors, co-workers)
Local chapter of the Arthritis Foundation
Web sites (See Finding a Doctor on the Web)
Support groups If there is a support group for fibromyalgia in your area, you have the inside scoop! There sits a group of people with your condition, people who are satisfied or dissatisfied with doctors of all kinds. Dont be shy about asking for names. Keep in mind, however, that everyones needs are different regarding physicians. Hear complaints? Ask specifically what others dislike. For example, an excellent doctor might be worth a long waiting-room time.
Make phone calls.
Interview list in hand, your first phone call should be to the office manager for each doctor or medical group. Leave a message that you are a potential patient and you would like to speak with her about the doctors and the office. The office manager knows the doctors training and experience. She can answer many of your routine questions, leaving you valuable time when you interview the doctor. Questions to ask the office manager:
1| Is the office accepting new patients?
2| What are the office hours and locations?
3| What is the accessibility of the office and facilities?
4| How long is the wait for a new patient appointment? A routine appointment? A sick visit?
5| In case of emergency or hospitalization, who will see me?
6| Does your office participate with my insurance? Is the office planning to drop that insurance in the next year? If I need to go on medical assistance, can I continue to see you?
7| What is your policy for working out a payment plan if I fall on hard times?
8| Is there a fee for an interview with a doctor?
9| Do any of the doctors treat patients with fibromyalgia? How many patients with fibromyalgia do they treat?
10| Which doctor do you think will suit my needs best? Explain briefly the style of practice you are looking for. Be specific. State, for example, I want a doctor who is direct and to the point. The office manager can certainly identify the doctor with the sense of humor, but she cant really judge which doctors listen well or respect their patients. Some questions are better asked of other patients.
11| Is there anything else I should know about your practice?
Finish this step by asking to make an appointment to interview a doctor in the group. Make it clear to the scheduler that you want a no-cost interview with the doctor, not an exam. On your interview list, jot down the appointment date and time as well as a few notes from your talk with the office manager.
After interviewing the managers of all the offices on your list, choose the doctors you want to interview. Be sure to call back and cancel the appointments for the other offices.
Interview the doctors.
This is the trying-on time. Trust your gut feeling. Your main goal is to interact with each doctor, checking for a comfortable fit and the ability to work together as a team. This is not the time, however, to ask about specific problems, such as why your knee is swollen today. That would require an examination.
Plan to arrive early and listen to the conversations in the waiting room. Are the patients complaining? Can you overhear conversations from the front desk? Observe the facilities for cleanliness, privacy and accessibility. In the interview room, can you overhear nurses talking, or worse, arguing? Is the staff pleasant and happy to be there?
When you greet the doctor, give her two lists. 1. A list of your current medications. 2. A short list of your medical problems or symptoms. Be brief. You just want to know if the doctor treats the disorders that you have. For example, state gall bladder removed 1996, not every belch that led up to the surgery.
Also prepare a list of specific questions you want to ask the doctor. Remember, this is a 10 to 15 minute interview. You want to address your biggest concerns, so list your most important questions first. Then be sure to take your list with you! Examples of questions to ask the doctor:
Are you comfortable with diagnosing and treating fibromyalgia?
How many FM patients have you treated?
Are you familiar with my other conditions?
What medications do you usually prescribe for fibromyalgia? Do you have a problem with prescribing the medications that I am taking? What is your policy on refills? (Be specific, especially with narcotics.)
What do you feel is adequate pain control?
Can you treat depression or must I see a specialist?
Are you familiar with alternative therapies? How do you feel about _______? Fill in any alternative therapies you currently use or are interested in trying, such as herbal supplements, massage therapy, acupuncture, etc.
One of the problems I had with my last doctor was feeling that she didnt really listen to me. How can you and I communicate best?
Do you do any teaching?
I have disability papers to be filled out every month. How would that be handled?
Sometimes I find articles on fibromyalgia that are helpful. Would you be willing to review them?
Lastly, ask any questions the office manager couldnt answer.
Be honest with yourself about what did not work with your last doc- tor. Whether experienced in treating fibromyalgia or not, you want a physician who is willing to take the time to learn from you and with you. A doctor who teaches keeps up-to-date. At the very minimum, you need a doctor who believes that fibromyalgia is a real disorder!
Reflect upon the visit and jot down your impressions. Did the doctors sense of humor hit you just right or seem offensive? Pay attention to body language. Did you get good eye contact and a smile that crinkled the eyes? Did she believe in fibromyalgia? Were your questions answered? Did she listen with patience? Importantly, do you and she agree on the topics that concern you the most?
This is an important, but often overlooked, step. Anyone can put an ad in the phone book or hang a sign on the office door. Heres where you can check a doctors credentials:
State or county medical society
American Board of Medical Specialties (http://www.abms.org/)
Specialty licensing boards (www.abms.org/member.asp)
A lawsuit does not necessarily mean a doctor is incompetent. Some physicians are willing to take on especially challenging cases and may be sued more often, even if no wrongdoing occurred. You should expect, however, that your doctor has not had serious disciplinary actions, such as sexual misconduct or narcotics offenses.
Talk with your insurance company.
Policy limits and approved providers vary widely and change frequently, so call your insurance company to be sure you have the most up-to-date information. Questions for the insurance company:
Are these doctors on my plan?
Do I need a referral to see any of them?
If they are not on the plan, what is the policy for seeing a doctor out-of-network?
Seeing a doctor who is not on your plan may be allowed, but usually requires a higher co-payment or deductible. Do not cross the doctor off your list just yet. If this is the best physician for you, then perhaps it is money well spent.
Choose the doctor you would like to try and schedule an appointment for a complete evaluation as a new patient.
Be sure to tell the scheduler you are a new patient with multiple problems and will need 1 – 1 1/2 hours. Request a copy of your medical records from your previous doctor. If your medical chart is complex, allow the new doctor a few weeks to review it. Deliver it in person and ask for a receipt. Remember to bring your referral slip and insurance card on the day of your first visit. Also, bring three papers for the doctor, preferably typed:
A summary of your complete medical history. Be as concise as possible.
A complete medication list that includes: current prescription medications, herbal supplements, vitamins, over-the-counter and topical medications; allergies and previous adverse reactions, prior medications and why they didnt work at that time.
A page listing todays concerns, changes since your last visit to a doctor, medications for which you need refills today and forms you need filled out.
Keep your medical history and medication list in the computer. Update and print them for each doctor visit.
During your exam, be clear about your expectations. Statements such as, I need a diagnosis, or I need better pain control, or I need help deciding whether to cut back at work, will tell the physician exactly what you require. At this visit, you can focus more closely on the cleanliness, privacy and confidentiality of the office. Also note the doctors listening skills, attention to detail and respect for you. Did she handle your whole case, not just focus on depression as the cause of all your ills? Did she offer ideas and suggestions? Did she exit before all your questions were answered? If you are not pleased with the results of this visit, keep interviewing other doctors until you are satisfied.
Well, you made it. And it was well worth your effort. You found a gem of a doctor. Like new shoes, the fit may not be perfect at first. Adjustments are necessary for you and your doctor to become a team. Do not give up too easily. Remember, you are the one who needs to be in control of your health care so, when you run into problems, do not feel intimidated. Instead, address concerns frankly with the doctor and work out a solution together. Before long, you will be recommending your doctor to other patients.
Finding a Doctor on the Web
These Internet resources allow you to search for a doctor by name, location or specialty:
American College of Rheumatology:
American Medical Association Online Doctor Finder:
Fibromyalgia Resource Center: