How To Choose A Doctor

african american smiling male doctor Choosing a primary care provider can be a confusing exercise, but it’s very important to feel that you are receiving care from someone with whom you can feel a certain level of comfort and trust. With some research and a modicum of effort, you can find a primary care provider that can serve your needs well for years to come.

Insurance

When considering finding a doctor or other provider, most people probably think first of the limitations that will be imposed by their insurance. Most insurance companies have very long lists of providers within their networks. These are generally listed by specialty, geographic area, and other helpful parameters.

MD, PA or NP?

In these days of broader choices, you are not limited to only being seen by a medical doctor. Nurse Practitioners (Masters-prepared nurses who can prescribe treatments and medications but are supervised by a doctor) and Physician Assistants (Masters-prepared “mid-level” providers with equal prescribing and diagnostic powers of Nurse Practitioners) can also serve as primary care providers under the rules of many insurance companies. While an MD may be preferable to some individuals, others might be more comfortable, for instance, with the nurse-based training and approach of a Nurse Practitioner. (And as of 2014, NPs will be required to earn a PhD, and will then confusingly be referred to as “Doctors of Nursing Practice”, or a DNP.)

Like any aspect of this process, it is a personal choice that can only be informed by experience and exposure to various types of providers.

What Type of Provider?

Many doctors who serve as primary care physicians have subspecialties within that category. Some may be “internists” specializing in the care of adults, while others may be doctors of “family medicine” who see both children and adults. Still others may have specializations in geriatrics and focus primarily on the elderly.

Likewise, some Nurse Practitioners are specially trained to work with children, adults, families, women or the elderly, so it’s important to understand your own needs.

Perhaps you would like the same doctor to see you, your spouse, your children and your elderly parent. If this is the case, you would need a Family Nurse Practitioner (FNP) or a doctor who specializes in family medicine.

Other Considerations

Whether you choose an MD, PA, or NP, there are many other aspects of this choice to bear in mind:

Location: Is the provider’s practice conveniently located for you? If you don’t have a car, is there easy access to public transportation?

Reputation: What is this provider’s reputation among friends, colleagues, and others? Does the office itself have a positive reputation? You can also check websites like Administrators in Medicine (http://www.docboard.org/aim/) to see if there have been complaints lodged against this provider.

Appointments: Are there readily available appointments for new patients? Also, what is the office’s policy about urgent appointments?

Staff: Stop by the office. Is the staff friendly and helpful? How are you treated?

Office: Is the office comfortable? Is it clean and organized? Is it warm and inviting or cold and clinical? Are there contemporary magazines available, or is there a television blaring in the corner?

Hospital affiliation: What hospital(s) is the provider affiliated with? Do you like that facility enough to have it be the place you go when you need hospital-based treatment?

Supervising MD: If you choose a PA or NP as your primary provider, who is the supervising MD for that provider? Will they be available to you as needed? Can you also meet with them?

On-call: What is the on-call policy of the practice? Who responds to you—and how quickly—when the office is closed?

Insurance: If the provider accepts your insurance, do they process the claim, or do you have to pay up front and be reimbursed (this is uncommon these days).

Cash: If you are paying out of pocket, are the charges relatively reasonable?

Subject to Change

Like any other decision, the professional you use as your primary provider can always be changed. It isn’t always possible to do a thorough check prior to making that first appointment, so if you eventually feel that your provider is not meeting your needs or has a personality or style that doesn’t suit you, it is your prerogative as a health care consumer to seek another provider at any time. Remember that this is your health care, and you can always be in charge of who cares for you and your family.

Do You Know Your Target Heart Rate?

A doctor taking a teenager's pulse(BlackDoctor.org) — When you exercise, your body speeds up, and so does your heart as it
works to meet your increased energy needs. But how much speeding-up of
your heart is safe when you exercise? You need the answer to this
question in order to maximize your exercise benefits while not
overworking your heart.

How do you figure out your target heart rate? How long do I need to work out after reaching it? What is a target heart rate?

Target Heart Rate 101

Your target heart rate isn’t one rate but a range of rates (beats per minute, or bpm), expressed as percentages of your maximum heart rate, that are safe for you to reach during exercise. For most healthy people, the American Heart Association recommends an exercise target heart rate ranging from 60% to 80% of your maximum heart rate, which is normally calculated as the number 220 minus your age.

What’s Your Target Heart Rate?

There is a basic formula that applies to the average population (and is actually pretty accurate). Let’s use a 20-year-old as an easy-to-calculate example:

The formula:

Calculate your maximum heart rate: 220 – age = MAX heart rate (example: 220 – 20 = 200)

Calculate 60%-80% of this max: 200 x .6 = 120 beats per min and 200 x .8 = 160 beats per min

Therefore the TARGET HEART RATE range for a 20-year old, working at 60-80% of their max heart rate is 120-160 beats per min.

How To Check Your Heart Rate

You can feel your heartbeats in several ways, such as by placing your fingers lightly but firmly over the inside of your wrist or on your neck just below the angle of your jaw. Be careful not to put too much pressure on the neck; this can slow the heart down and can be dangerous in people with blockages of blood vessels in the neck. You can also place your palm over your heart and count the number of beats that you feel.

Once you’ve found your pulse, count the number of beats for 6 seconds. Multiply that number by 10 and compare to your recommended range. Using this method will prevent you from stopping exercise for more than a few seconds. You can take your pulse after you’ve been exercising for at least 5 minutes.

For example, suppose you take your pulse and count 13 in 6 seconds. Multiply by 10 to get 130 beats per minute. Now you know you’re in the right range. If you notice you are lower than the minimum, increase your speed/incline/intensity and try to count again. If you notice you are very high, decrease your intensity in some way.

* If you have high blood pressure, you should not be working out in this THR range.

As far as time goes, try to sustain this intensity (not including your 5 minute warm-up or cool down) for at least 20-30 minutes (minimum recommendations for health and weight loss), and up to 45-60 minutes. Of course, if you’re a beginner, you will not start an exercise program with that much endurance, but you’ll slowly build up.

Aim to reach this time/intensity 3-5 days a week.

Important health tip: If you have any questions or concerns about your exercise regimen and your target heart rate, especially if you are overweight/obese or have medical conditions, consult your doctor immediately.