The Bay Area's Best Doctors

How to Change a Physician

A Seamless Switch
Sally Metcalf of Mill Valley favors alternative medical treatments over conventional ones. So, for many years, she put her faith in an M.D. whose practice offered an integrative approach to patient care. “When I first started with her, my cholesterol was sky-high,” Metcalf recalls. “She prescribed a bunch of neutraceuticals. Within two years of starting my numbers were totally back to normal.”

But as time went on, Metcalf’s health issues grew more complicated. “I suffered from debilitating PMS as well as depression,” she says. “The doctor kept pushing all these alternative treatments on me that were extremely expensive, not covered by my insurance and, ultimately, ineffective in treating my condition.” Eventually, Metcalf decided it was time to find a new doctor. 

Metcalf is hardly the only Marin resident who’s had to fire her internist. People switch for a variety of reasons. Physicians retire; insurance policies change, as do people’s financial circumstances. Occasionally, a conflict in personalities or philosophies can be the impetus. Whatever the reason, there’s a right and a wrong way to switch providers. We asked local medical experts for their best advice on how to smooth the way from one practice to the next. Here’s what we learned.

Do Your Homework
For starters, it’s imperative that you find a new doctor before leaving your old one. Health problems can develop suddenly, and a doctor who lacks good bedside manner or  doesn’t return calls promptly is still preferable to no doctor at all.

Keep in mind that finding a new doctor can take some time. “It’s not uncommon for physicians to close a practice to new patients if they feel they have a full caseload,” says Marcy Territo of Marin IPA, a health care network that administers benefits for HMO subscribers countywide. In fact, the number of medical students choosing a career in primary care has plummeted in recent years, according to Dr. Josh Adler, professor of clinical medicine and chief medical officer at UCSF.  “As doctors retire, there simply isn’t a sufficient supply to replace them,” he says.

So you’ll need to do a little reconnaissance—in other words, network. “The best way to find a new doctor is to ask family, friends and colleagues for recommendations,” says Territo. Co-workers can be particularly helpful if you’re on the same insurance plan, since they can provide names of good in-network doctors.

If you still come up empty-handed, Adler says, try the 21st-century approach. “Consider using Yelp,” the consumer-reviews website, he says. “I don’t know if I would trust this method in terms of gauging a doctor’s competence, but with regards to the service component, it’s incredibly relevant—it provides you with real-patient experiences.”

Ironically, Adler puts less faith in the seemingly more scientific site, which provides reports and ratings on more than 750,000 doctors nationwide. “I think at some point it might become a useful tool,” he says, “but at the moment the information simply isn’t robust enough, and some of the reports can be misleading, meaning you might end up passing on a really good doctor because the information about him or her isn’t altogether accurate.”

Once you’ve assembled a short list, contact physicians you’re considering to see if they’ll schedule a “meet-and-greet,” a short interview appointment to help you decide if the doctor might make a good health care partner. “Some doctors charge a flat fee for this meeting; others will do it for free,” Territo says. “It’s not a time to discuss medical issues, but rather to see if you have good chemistry together.” Adler agrees that can be useful, but warns that it’s not at all standard for doctors to offer this option. “So I wouldn’t eliminate a person simply because they don’t do meet-and-greets.”

Prepare for Departure
Once you’ve decided on a new physician, call your current doctor’s front office staff and let them know you will be leaving the practice. “If you’re leaving because you were unhappy, it’s helpful to give the doctor feedback as to why,” Adler says. “If you are uncomfortable doing this face to face, a letter or e-mail is usually appreciated.” Next, ask the new physician’s office for a transfer of records form. This is a legal document that compels your old doctor to forward your medical files to the new office. Unfortunately, says Adler, filling out a records transfer form doesn’t always yield quick results. As a fail-safe, he advises going in person to the current doctor’s office and requesting a condensed version to take away. “The staff may not have time to copy 20 or 30 pages on the spot, but you can ask them to at least give you notes from your last several visits, radiology and lab reports as well as reports from specialists that you have seen.” You’ll also want to notify those specialists you’ve switched doctors so future reports aren’t sent to the wrong office. 

Also, if you regularly take medications, make sure you have a sufficient supply to get you well past your first appointment with the new doctor. “You’ll need a month beyond what you would expect you would need,” cautions Adler. “You don’t want to cut it close in case you need to switch the appointment or your new doctor has to reschedule.”

Communicate Openly
Once you’ve switched practices, keep in mind that as with personal relationships, a good doctor/patient relationship requires work on both ends. If you left your last doctor because you were unhappy about something, let your new doctor know what that was, so that all parties are clear on expectations. Also, remember that while your doctor can give advice on how to stay healthy, it’s up to you to comply.

Metcalf, for her part, embraced her new doctor’s medical direction and couldn’t be happier with the results. “The new doctor took one look at my history and got me on a bioidentical hormone patch. I’ve never felt better in my life,” she says. “I still favor alternative cures, but I realize now that sometimes you have to find the right balance, and in this case a doctor willing to use a conventional treatment was the right one.”     

 Wireless Medicine

There’s an app for that!
Recent years have seen an explosion of growth in the field of wireless medicine. New inventions include everything from digestible smart pills to implantable network devices to smart phone applications. Here’s a sampling of the ways wireless technology has revolutionized the way we now detect, diagnose, analyze, treat and monitor our health conditions.

Since its debut in the 1800s, the stethoscope has been a fundamental tool for assessing patient health. Over time, this simple instrument has been refined to improve sound quality. Newly introduced electronic stethoscopes offer even further enhanced audio, but that’s just the beginning. These instruments can record body sounds for later review and wirelessly deliver them to Bluetooth-enabled PCs. Some even feature software that automatically identifies suspected heart murmurs.

Another huge leap in 21st-century medicine is the wireless heart monitor. The 15-cm sensor, which can measure respiration rates, activity level and even the accumulation of body fluid, adheres to a patient’s chest and transmits data 24-7 to a server. That could mean fewer hospitalizations for at-risk patients since problems can be detected before they become symptomatic.

Meanwhile, as use of smart phones escalates, so does their potential for helping you monitor your own health. A company called Lifescan is poised to release an iPhone application that lets patients upload their glucose readings and wirelessly transmit the data to physicians and caregivers. “Wireless technology allows diabetics to track how different (factors) such as food and stress affect their body,” says E. Ann Myers, an endocrinologist at St. Mary’s Health Cntr. in San Francisco. “It also allows closer interaction between doctors and patients.” And while not every app can be called revolutionary, there are hundreds of mobile software programs that in some small way can help a user stay healthy. The product iTreadmill lets runners and walkers measure pace and distance. Allergy Alert provides up-to-date, location-specific information on pollen counts and air quality. Is That Gluten Free helps consumers quickly determine whether a particular product contains wheat, rye or barley.

Developers are also creating apps to help health care providers improve patient care. Medscape and Epocrates let doctors access a wealth of information without ever leaving the examination room. “I utilize this software daily,” says Myers. “It allows me to check drug interactions (and) pill dosages and even lets you know which drugs are approved by each insurance plan.” 

What’s next? Hard to say. But what was 20th-century science fiction is quickly becoming a 21st-century reality.

The Fastest Growing Health Concerns

Thanks to modern medicine, dangerous diseases such as polio have been all but eliminated from the Western hemisphere. Antibiotics have turned life-threatening illnesses into nuisance infections. But while researchers dream up cures for what ails us, new threats keep erupting. Below are some of the fastest-growing health concerns.

According to a report by the UCLA Cntr. for Health Policy Research, diabetes cases increased by 26 percent between 2001 and 2007. Most experts link this rise to unhealthy diet and insufficient exercise. If those trends persist, a predicted one third of the population will develop diabetes in the not-too-distant future. “People are born with a genetic tendency for the disease, but when we consume enormous amounts of high-calorie foods and have a sedentary lifestyle the condition is more likely to manifest sooner,” says E. Ann Myers, an endocrinologist at St. Mary’s Medical Cntr. in San Francisco.

 The U.S. Department of Education estimates that autism is growing nationally at a rate of 10 percent a year. In California, the rate is even higher. According to one source, enrollment of autistic students in special education more than doubled between 2001 and 2007. What causes the condition is still unknown, but theoretical explanations include environmental toxins, viral infections, metabolic imbalances and genetic vulnerability.

Celiac Disease
 New data suggests this autoimmune condition, which prevents the body from metabolizing gluten (found in foods containing wheat, barley or rye), is showing up at a rate four times higher than 50 years ago. Experts suspect as many as 1 percent of Americans have celiac disease, but because symptoms can be subtle and vary from person to person, most don’t even know it. Scientists do agree cases are on the rise but have not determined why.

The Cntr.s for Disease Control and Prevention reported that 3.6 percent of U.S. children had asthma in 1980; by 2003 the number had increased to 5.8 percent, which represents a 60 percent rise in incidence. As it turns out, clean living may be the cause. “It’s called the hygiene hypothesis,” says Michael Reid, an immunologist in private practice in San Francisco. “The theory goes that when people live in an environment that’s too sterile, it can prevent the immune system from maturing adequately.”

Thyroid Cancer
Thyroid cancer is not nearly as common as skin, breast or lung cancer—but the latter three are on the decline, while thyroid cancer cases are diagnosed with ever-increasing frequency. According to the National Cancer Institute, cases rose by 6.5 percent between 1997 and 2006, a faster increase than for any other form of cancer. There is no definitive explanation, but among the possible factors are environmental pollutants, obesity, iodine deficiency and increased exposure to CT scans.

Health Savings Accounts

As health care costs continue to skyrocket, many people are searching for ways to keep coverage affordable. One way to do this is by taking advantage of an opportunity that allows eligible Americans the option of opening a health savings account, a product that functions much like an IRA. “Health saving accounts became available in 2004, but awareness of the product is still in the early-adopter stage,” says Elizabeth Ryan, senior vice president and head of health benefits services for Wells Fargo. “Currently, there are 10 million Americans eligible, but only 4 million using them.”  Are you missing out on this government freebie? Here’s a quick summary of what it is and who can benefit.

In a nutshell, it’s a tax-advantaged medical savings account available to any U.S. taxpayer holding a high-deductible health insurance policy. The government defines high deductible as anything over $1,200 for an individual or $2,400 per family. The funds contributed to the account are not subject to federal income tax at the time of deposit. And here’s the best part: the money can be withdrawn without penalty, at any time, provided it’s used to pay medical expenses. Unlike in a flexible spending account, the funds roll over and accumulate year to year if not spent.

Individual policyholders can contribute up to $3,050 annually. For families, the maximum contribution is $6,160. For people already enrolled in a plan like this, it’s a no-brainer. For others—particularly the self-insured—it’s worth running the numbers to see whether switching to a qualifying plan may ultimately be financially advantageous.