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How to choose the right doctor for you, a guide to help you know whats what.
Published 19/06/2006
Remember your family doctor when you were a kid? He was a kindly, paternal, white Anglo-Saxon protestant, who did house calls any time, knew everyone in your family, and expected to look after you from cradle to grave – if not yours, then his. You never questioned his judgment, or dreamed of going to anyone else if you weren't satisfied. You never even dreamed of not being satisfied.
How times have changed. Thanks to gradual reform of trade practices and competition laws, and a desire to take responsibility for our own health, these days accessing medical services is all about choice.
You might go to an after-hours medical centre on the weekend. You might call a home visit service. You might try an obesity clinic or an impotence clinic.
But choice is a double-edged sword. Those of us who like to feel the family doctor is our friend can find it all a bit impersonal. And yes, it empowers us, but it also means we have to find out what services are on offer and make a judgment about their merits. What sort of medical service suits us best, and how do you tell the good from the bad?
Different types of surgeries suit different people. A good way to start is to ask yourself what sort of service you want.
The traditional type of practice is the 'cottage industry' model – small solo or (increasingly these days) group practices located on suburban street corners, high streets or shopping malls. The doctors tend to own the practice themselves or in partnership with the others, and they're usually there for the long term, possibly their entire working lives.
Then there are the large corporate medical centres. These arrived in Australia about 20 years ago and have grown to account for about 30 per cent of general practices. Not only do they offer GP services, but also pathology, radiology, pharmacy, and even alternative health practitioners, all under the one roof. They're usually open extended hours – some 24 hours a day.
As a general rule, medical centres have a higher turnover of patients (and doctors) than the traditional practice. The doctors in the practice often prefer to treat acute problems – temporary illnesses requiring shorter consultations. High throughput is the order of the day. This can suit people who like anonymity and don't want to spend a lot of time with the doctor – who don't like waiting, and aren't too bothered if they don't know the doctor on duty.
But medical centres don't tend to suit someone who wants to spend a lot of time with their GP – someone with a serious illness, a chronic condition, or a range of concerns they want to discuss. For these people, continuity of care (seeing the same doctor every time) is important, and they may be prepared to make an appointment and perhaps wait a few days to see the doctor. This type of person is probably better off seeing a doctor in the more traditional practice.
Many people use both. They may have an ongoing relationship with a particular practice that they'll see for more serious problems, and then drop in to a medical centre if they need a prescription or a medical certificate, for example.
When you've chosen the type of practice you want to visit, it's time to choose between the practices themselves.
It isn't as easy to tell the good from the bad as say a plumber or a builder. Everyone can pick a shoddy building job and some of us know a little about double-entry bookkeeping, but few of us can understand how a particular treatment works or whether it's better than another.
A good way to check doctors' skills and experience is to look at their qualifications. These will usually be next to their name on their name-plate outside the surgery and on their letterhead.
All doctors trained in Australia have a medical degree. In most cases, this is an MBBS (Bachelor of Medicine and Bachelor of Surgery), although doctors trained at Flinders University of South Australia are awarded a BM,BS (Bachelor of Medicine and Bachelor of Surgery), and graduates of the University of Newcastle in New South Wales are awarded an equivalent BMed (Bachelor of Medicine). If they're trained overseas it may be different, for example 'MD' in the United States.
On top of their basic qualification they may have a speciality qualification, like membership of the Royal Australian College of General Practitioners (RACGP). To gain such a qualification they must study and pass a series of exams in postgraduategeneral practice education. These days, new GPs aren't allowed to access Medicare payments (and hence effectively can't commence general practice) unless they have a specialty qualification. Older doctors don't necessarily have to have it, though they must undergo continual training to stay registered.
Many GPs also have a specialty qualification, like a diploma in obstetrics or paediatrics. This can be useful if you have young kids or you're a woman in her reproductive years.
Some GP clinics specialise in providing certain types of services – travel medicine or weight loss, for example, and they'll openly advertise these services. Traditionally, doctors' professional bodies have placed restrictions on their members advertising (believing it unnecessary and vaguely distasteful), but they relaxed these restrictions in the 1990s and now doctors' surgeries can advertise just like any other business.
Bear in mind though, as with any business, these advertisements can be misleading. Under the Trade Practices Act 1974 it's illegal for a business to engage in false or deceptive advertising and medical practices are no exception. In the past few years, the Australian Competition and Consumer Commission (ACCC), which enforces the Act, has taken action against weight loss, hair restoration and impotence treatment clinics, amongst others, for breaches of the Act.
Clean, pleasant, well-lit and spacious premises send a signal to patients that the doctors have the comforts of patients uppermost in their minds.
Printed health materials on offer in the waiting room are a plus, even if you don't read them – they show the practice is aware of the importance of public health education. Toys and a children's play area in the waiting room suggests that the practice is attuned to the special delights of being trapped in an enclosed space with kids.
If waiting times are short and you can easily get an appointment at short notice, that's obviously good. But bear in mind, a high demand for appointments and long waiting times can also mean that the doctors' skills are highly valued and in demand. It may be worth the wait.
Is the practice open after hours? Extended hours are an advantage if you have a chronic condition that tends to flare up at odd times. Medical centres tend to be open longer hours, but traditional surgeries usually have a back-up service that may be just as good.
If you're a woman, you may want at least one female doctor in the practice. If you're from a non-English speaking background, then non-English language skills will obviously be important.
There is no independent rating system for doctors and practices, but there is an accreditation scheme administered by the Royal Australian College of General Practitioners. If it comes up to a benchmark quality standard, the practice is awarded a certificate of accreditation, which it will usually have on display.
Most city-based medical practices bulk bill most of their patients (about 70 per cent of all consultations are bulk billed).
Bulk billing is great for patients – it costs them nothing out of pocket, and they don't have to go to the trouble of claiming fees back from Medicare. However due to economic pressures, some practices that mainly bulk bill may find themselves under pressure to see more patients more quickly to remain viable. This may mean patients have less time with the GP.
Because of these economic pressures, many GP practices are electing to charge privately to remain viable (though most still continue to bulk bill concession card holders). So the proportion of privately charged consultations is steadily rising.
Doctors who charge private fees usually charge around $40 to $45 for a standard consultation (up to 20 minutes). As patients only get a $25.70 rebate from Medicare, this does leave them out of pocket. On the other hand, as the AMA (the Australian Medical Association, which represents doctors) argues, charging fees does allow doctors to spend more time with each patient. And a practice that charges fees also usually has to offer premium services – better qualified doctors, for example – to justify this premium, or risk losing patients to bulk-billing surgeries.
If you don't want to pay a higher fee and go to the trouble of claiming a rebate through Medicare, a bulk billing practice may be the way to go. Alternatively, if you want more time with the doctor and are prepared to pay a premium for what you think may be a better service, you might prefer to pay a fee. (Bear in mind though, that there are many fine GPs who prefer to bulk bill because it's a service to their patients).
Outside of the cities you may not have as much choice. Most doctors in rural and regional charge privately, because there's less competition and they have a freer hand in setting their own fees (though they usually bulk bill concession card holders).
Word of mouth is also a great way to find a good GP, especially if the recommendation comes from someone who has a similar profile to you – someone with children if you have kids yourself, for instance. Other medical professionals such as pharmacists and nursing staff can also be a good source of recommendations.
Then take the plunge and go in for a consultation. There's no obligation to go back to that doctor if you're not satisfied.
You probably have a good doctor if he or she