Saturday, August 15, 2009

Talking To Your Doctor..............Sorry, I mean your provider

Most people struggle with this concept of how to talk to your doctor. What questions do you ask? Are you even seeing a doctor, or a provider? Are you seeing a prescriber? If it is a doctor is it a DO or an MD? If it is a provider, can they prescribe medication? Are they a PA that is a physician's assistant? Are they a Nurse? An RN with a Master's Degree? A nurse prescriber? An RN-C a clinical nurse specialist?
Ask their educational background.
If they are not a physician, are they supervised by a physician? That level of supervision will depend on which United State you are living in.
If it is a physician are they board certified by their specialty board. Board Certification varies, you don't have to be board certified to practice in a specialty, and it is extra credentialing. Personally I prefer someone who is a board certified physician in that specialty. The credentialing for this involves extra testing and competency.
The physician specialties that generally treat AD are Neurology, Psychiatry, (Same certifying board for these two specialties, different competencies though-more on this later), Family Practice, and Internal Medicine, For these specialties it means a doctor has gone to four years of medical school, and then performed a residency in that specialty generally another 3-4 years. In addition after four years of residency there are Sub-Specialists, which is another fellowship of one to two years is performed in for example Geriatric Psychiatry, which is a specialty in a specialty.
Physicians (those that have gone to medical school) are generally MD's- Allopathic medicine, or DO's -Osteopathic Medicine. There are a few other disciplines that have not gone to medical school like chiropractors with a DC degree. They often refer to themselves as chiropractic physicians.
If you have a PhD in anything history, philosophy microbiology, you are addressed as DOCTOR.
This is relevant in AD because there are many Neuropsychologists that evaluate and treat patients with AD. In addition there are a whole host of other PhD backgrounds that may be on the treatment team, depending on how subspecialized you treatment facility is. Generally the more larger and urban a facility is, the more subspecialized PhD's you will find.
This may or may not be important to you.
A "provider" provides care.
A "prescriber" is a provider that can prescribe medicine. Not all providers can prescribe medicine, but all persons that can prescribe if practicing are providers.
When my mother was diagnosed back in 1979, there was no such thing as differentiation of providers and prescribers. You simply had doctors.
My how far we have come.
Medical School is still really hard to get accepted into.
Example- It is hard to say find a an MD who settled for medical school, because they could not get accepted to some other school like dental, law, chiropractic, school. Horribly politically incorrect statement, (but the honest to God truth) perpetuates the myth of the "ARROGANT" doctor on the golf course driving around in a Ferrari etc. We love to romanticize our stereotypes.
You would probably find more dentists and lawyers on the golf course on a Wednesday afternoon than MD's. Most other disciplines get the last laugh financially, is it important to know your prescribers background? I like to, but obviously I am biased. The indoctrination process, the training in decision making, the commitment and "the way of life" assumption of bottom line responsibility and liability mean something to me.
There are MD's who are terrible providers (not all), and non-MD's who are wonderful providers (not all). Generally speaking because I have a bias, having given 15 years of my life devoted solely to the pursuit of medicine, I prefer to seek my medical care from an MD if at all possible.

1 comment:

David Thomas MD said...

Hi Doc! I really love this post. Am glad you started a blog on dementia. I wish more Docs would take more of an interest in it.

But spreading the word and educating is the only thing I can do now.

David Thomas

Talking about the book with the Lake Superior wind....... a calm day