Will you find the healthcare service you need, when you need it most?
None of us plan to be sick. We don’t think of our future and include doctor visits or hospital stays in between crossing off our bucket list to-dos.
But the truth is, sometimes we do get sick.
So, if you (or a family member) become ill, you want to be able to find the best care. And, I’m guessing you want the best care without the typical runaround?
Ok, about that. Yes, navigating the healthcare system can be complicated. That’s true.
So, you probably think you need an insider expert to do it. Well, that’s not always true.
Ok, again, yes. There are nurses and healthcare providers in almost every U.S. hospital or clinic office who perform this role. A few examples of how they help patients include:
- Plan their next steps after discharge from the hospital
- Follow their treatment for a chronic disease
- Lower their risk for hospital or emergency room visits
- Coordinate complex care needs between multiple providers
So, How Can You Possibly Do This For Yourself?
Well, you could try to learn everything there is about who the healthcare providers are. Or, how to navigate through your local healthcare system. Or study treatment options and specialty services.
But, all of this would be futile because like everywhere, change happens.
So what should you do?
How do I know? I am a registered nurse and spent half of my 25+ year career helping people find the best care for their situation (like in the list above).
And, this article will show YOU a basic formula to find helpful clues** to the best care. Because the truth is – even the experts have to dig for answers because no two cases are exactly the same!
**Look for ‘clues’ in the Pro Tips through-out this article.
In a nutshell, to find the best care, you need to start with the what.
Specifically, what do you need?
Let’s start with the basics.
Find the Right Doctor
The first answer to ‘what do you need’ is usually a doctor. The right doctor can help you get the details of what you need in your plan of care.
In case you do not have one, the very best thing you can do is to find a primary care physician or provider (PCP).
A primary care physician (M.D. or D.O) or a non-physician provider – like a nurse practitioner or physician assistant, is not the title of their specialty; it is their role or function in your care. (They can also fulfill most or some of the duties as described in the nurse case manager role – see below).
There are a few types of providers who commonly serve as primary care providers.
A pediatrician specializes in the medical care and treatment only for the pediatric population. They have pediatric-specific medical training and education. Pediatricians have the expertise and experience to ‘go deep’ when puzzling symptoms are present. They also have the training to manage patients with multiple pediatric diseases.
An internal medicine provider (also called an internist – [NOT an intern, who is a medical school graduate still under supervision]) specializes in the medical care and treatment only for the adult population. An Internist specializes in the complex care of adults including acute illnesses, or those with one or more chronic diseases.
An internist may also have subspecialty training in rheumatology, endocrinology, and infectious diseases. And, like pediatricians have the experience and expertise to ‘go deep’ if puzzling symptoms occur.
Internists are equipped to provide treatment through the progression of a disease(s) and focus on the growing needs of the patient as they age.
Family Practice Provider
Family practice doctors or providers specialize in the medical care and treatment of both pediatric and adult populations. Although family practice providers usually have more adults than pediatrics on their patient lists, they treat both.
Family practice providers specialize in a greater breadth of treatment options. Treatment can include the entire spectrum of medical issues that may be presented by each member of a family. Because they can treat a wide variety of medical problems, they may not have the training or experience to ‘go deep’ like the pediatrician or internal medicine providers.
Once you have a provider’s name, you can dig a little deeper by going to Healthgrades.com to look at online reviews about the provider.
All of these providers make excellent primary care providers. Choose which one best fits your needs.
Pro Tip: Ask your friends and family who they see AND if they like them. Word of mouth is another excellent referral source to consider with all of the above.
Pro Tip: Sometimes a new diagnosis occurs in a hospital, emergency room or urgent care. You may receive a temporary treatment plan from a hospitalist, emergency room or urgent care provider. But they are NOT a substitute for a primary care provider. You will likely only see these providers once.
Next, Other Options to Find the Best Care
Now, let’s say you do have a primary care provider. But, you need specialized treatment or a second opinion for a new diagnosis, symptom or treatment option.
Whatever the case, you need to use the right detective work. You want to find the right kind of specialist and one who has a personality that is a good fit with yours.
Find the Right Specialty Provider
As you know, some websites are more comfortable to use than others. And, sometimes you only have a symptom to start your search.
In the case that you only have a small piece of information, here is how to start.
Look for the department (some websites list it as a specialty) that treats a system, and then the symptom. For example, if your symptom is related to your lungs – first look for pulmonology and then the symptom relating to the lungs. Or, if it is connected to your stomach – see gastroenterology and then the stomach symptom and so on.
Most sites provide a helpful summary of primary conditions or diseases treated within that specialty.
After you have the right specialty of the primary symptom, look for a provider within the specialty.
Pro Tip: Use the name of the body system of the primary symptom.
Pro Tip: Take the time to read the areas of interest listed in the description, as it is likely also their area of expertise.
When ready, call to make an appointment. Ask the intake person which provider within their office has the most interest and or expertise in your symptom.
Many offices have processes where they will send patients to providers within their areas of interest/expertise at the first call. Intake people are not always clinical personnel (you will likely talk to a non-specialist). Ask to speak to a nurse if you feel like you are not getting enough information.
Pro Tip: Some specialty offices or insurance coverage plans require the primary care physician refer the patient to a specialist. You can still call the specialty office yourself and ask questions prior to the PCP making the referral and setting up the appointment.
Some people want the best clinician regardless of bedside manner. Others want to truly like their doctor personally so they can trust them. If you are in the latter club, you could consider asking to ‘meet the doctor’ (with an inexpensive office visit fee) before seeking treatment. Not all offices will offer this option, especially if the wait time for an appointment is long.
Pro Tip: Sometimes looking at the provider descriptions will highlight awards or other information which will give you an idea of their personality or expertise. Word of mouth is also a great resource.
Again, Healthgrades.com can be a great resource.
How to Find the Best Care for Complex Needs
Now, let’s say you have a great primary care physician and a reliable and trustworthy specialist. But now you need to find a provider for a complicated or unique situation.
Maybe you develop another disease or condition that complicates your current treatment plan. Or perhaps you have a rare diagnosis. Maybe you require a special surgery that is only available in a few health systems.
It might even be that you believe your health situation has exhausted the capability of your current team of credible and likable providers.
My next recommendation is to look for a Center of Excellence for your condition (more details below).
A Side Note – Look for a Nurse Case Manager
Several years as a nurse case manager (CM) taught me how to find the best care. If you can find one, you tap into a precious information resource!
A nurse CM can have several goals, and most depend on who their employer is (patient, hospital, doctor. or insurance provider). Interestingly, the primary goal is almost always to the find the best care for the patient.
Pro Tip: Finding the best care helps the patient have the best health outcomes and hopefully, also lower costs.
The better results and lower expenses occur through healing, and the prevention of inpatient hospitalizations, emergency room visits, or more health service needs.
Pro Tip: Unnecessary services usually happen as a duplication of a test or service because the ordering provider is not aware the action has been taken.
Be sure to access your records on an electronic medical record if it is available to you. And, keep an ongoing written (or printed) list of your tests and procedures if your provider doesn’t have access to an electronic medical record.
Nurse CMs help with provider communication, health system navigation as well as with the emotional and social needs of the patient and entire family.
A starting place to find a case manager is to call your:
- Primary care provider. The receptionist may not know so you may need to speak to your doctor’s nurse or an office referral coordinator. Before giving up, see your doctor or send an email to them.
- Your insurance company. Call the member services number and ask if they have nurse case managers and if you could be connected to one.
- Your local health system. Call the primary number and ask if there is a department called:
- Case management (for complex care or diseases – think car accident or several chronic diseases)
- Medical management or utilization, or discharge planning (for the management of how services are used – think the transfer to other departments, discharge out of the hospital or lots of diagnostic testing, or in the hospital a long time)
- Patient navigators (usually in oncology to help with complex cancer care)
- Names vary so say all of them.
Pro Tip: If none of the names listed are recognized ask for the social services department. There is usually at least one type of social worker in a hospital who may be able to offer help if you cannot find any of the above.
Most CMs are employed by hospitals or health systems and insurance companies. A few are available to hire by patients.
If you cannot find a case manager right away, keep asking as you see more healthcare providers. As your costs increase, they may find you!
Find the Right Healthcare System and Center of Excellence (COE)
Now we need to start looking for hidden clues. This step requires some searching on the web. It is super easy to become overwhelmed.
Pro Tip: My biggest tip is to avoid information overload.
It can be a challenge to find reliable and credible information. As you know, Internet content is not regulated so be sure to use credible sights.
Pro Tip: My other tip is to use a specific folder for notes, medical reports, bills, insurance statements, claim forms and payment records related to this illness episode.
To start, decide if you want to learn more about the symptom or diagnosis and treatment options.
If yes, be sure to use public sites like:
- National Institutes of Health
- Centers for Disease Control
- or even the American Heart Association
These sites offer general information to give a basic understanding of the condition and what type of care is required.
Next, you need to decide if you want to start with a health system close to your area or look for centers of excellence.
Pro Tip: I like to see if there is a center of excellence first.
Find the Best Care at a Center of Excellence
The first thing I search is whether there are COEs for the diagnosis or condition.
A Center of Excellence is a specialized program within a healthcare system which provides exceptionally high concentrations of expertise and related resources centered on a specific medical area.
Health services are typically delivered in a ‘team approach’ format. The team includes a mix of disciplines (nurses, doctors, therapists, nutritionists, etc.). And, this type of care typically incorporates more than just the physical needs of the patient.
If a COE is available, it serves as a resource or measuring stick, to use for your diagnosis or symptom. They have a level of expertise that is generally richer than non-centers of excellence and may have better patient outcomes. They also have lots of detailed patient education on their website to help you learn more about what to expect.
Pro Tip: A COE provides valuable information to use in your local healthcare systems. It can also help you look for comparable care closer to home.
Details – How to Find a Center of Excellence
I will share an example. Let’s say you or someone in your family is diagnosed with Parkinson’s Disease. You have seen a PCP and a specialist in your area for a couple of years. But, now the treatment is no longer working, and the doctor states there are only a few options to try.
The centers on this list are recognized for their exceptional expertise and outcomes. Depending on your coverage, it may be possible to seek treatment here.
How to Search
I entered ‘Parkinsons center of excellence’ into the search box and clicked ‘search’. I found a world-wide list of the Parkinsons Centers of Excellence.
If you DO find a Center of Excellence for a particular diagnosis, speak to your doctors about a referral. The center of excellence may want to see you for a consultation and treatment. This will depend on the complexity of the situation. It is possible you can go for just a consultation. They’ll expect treatment delivery to occur back home through the coordination of the treatment efforts and monitoring.
Pro Tip: Most Centers of Excellence have an intake process that requires confirmation of a diagnosis and a referral from a provider to ensure they are seeing the right patients.
This process can be beneficial when you are working with a primary care provider to find the best care. Time constraints may interfere with them doing a proper search to find the best care. The information is readily available to you online with a quick search.
(This is a lot of information to remember so consider pinning this article to your Pinterest board or sharing on your Facebook page so you can refer to it later!)
Finally, finding a primary care provider is the first step to finding the best care at every stage of life. In fact, the most important take away is to keep in touch with your primary care physician. The PCP is a pivotal partner to the coordination of complex care needs, so you find the best care. And, you now know more about how to find the best care just like a nurse case manager would. Finding a specialist or researching a Center of Excellence is no longer a BIG mystery if more care is needed in the future. Hopefully, you can focus more on your bucket list instead!
Oh, speaking of a bucket list, did you know that eating healthy is a great way to prevent numerous chronic diseases so you can stay healthy and check those bucket list items off?
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