Fibromyalgia is a painful, exhausting, and often misdiagnosed disease that affects up to 12 million Americans (90 percent of them women). But finding a doctor who knows how to treat this disease isn’t always easy. Here are the 10 most important questions to ask when you’re searching for a health care provider to help. From The 10 Best Questions for Living with Fibromyalgia.
1. Are you board certified? What are your other medical credentials?
Board certification matters.
Board certification assures that the doctor has passed the board requirements for her specialty. In the United States, medical specialty certification is voluntary. Doctors receive their medical licenses after completing medical school and residency requirements. But this doesn’t apply to medical specialties like rheumatology, and only sets the minimum competency requirements to treat patients.
The successful completion of the examinations for board certification demonstrates a doctor’s exceptional expertise and dedication to a rigorous, voluntary commitment to lifelong learning. This is especially important with fibromyalgia, because of the need to stay current with fast-moving research advances in this field. To maintain board certification, doctors must complete specialty training and periodic exams to demonstrate their ongoing competency. Use the search services of the American Board of Medical Specialties (www.abms.org) to check for a specific doctor’s certification.
A valid state license is also very important. Go to the American Medical Association’s Web site for links to your state’s medical board (www.ama-assn.org/ama/pub/category/2645.html).
Checking on past disciplinary actions and malpractice suits is tougher because most medical professionals don’t readily disclose unclean histories. See ChoiceTrust (www.choicetrust.com) or HealthGrades (www.healthgrades.com), two comprehensive Web sites that charge a small fee for their services. Other sources for checking on prior complaints or disciplinary actions are free at Administrators in Medicine (http://docboard.org) and Health Care Choices (www.healthcarechoices.org).
2. What is your experience with fibromyalgia? How many patients like me have you seen during the past twelve months? Are you comfortable diagnosing and treating people with fibromyalgia?
Experience matters, too — a lot. The number of years of total medical practice is significant, along with the years of specialized practice a doctor has in treating fibromyalgia and related conditions. Keep in mind that fibromyalgia is a relatively “new” syndrome. The condition was first described in the 1880s, named fibromyalgia in 1976, and its diagnostic guidelines (still used today) were established by the American College of Rheumatology in 1990.
It’s very important to determine this doctor’s prior experience with fibromyalgia and his beliefs about it. Ask this follow-up question: “What percentage of your practice is devoted to treating fibromyalgia and/or chronic pain patients?” The higher the number, the better it is for you.
A good bedside manner can be very comforting, but don’t confuse it with competence. A doctor’s personality should be your secondary, not the primary, consideration in making your choice. Don’t rely on your doctor to be your sole source of hand-holding.
National Fibromyalgia Association’s president, Lynne Matallana, offers more advice. “Find out their attitudes about fibromyalgia. Make sure that a doctor’s personality or approach is consistent with what you are looking for.” There’s no sense in seeing a doctor who doesn’t want to see you or doesn’t believe in fibromyalgia.
3. May I speak to at least one of your patients to see how he or she made out in these same circumstances?
This Best Question was suggested by former surgeon general Dr. C. Everett Koop. He believes it’s very important to follow through on patient referrals.
Asking for a referral is more common than you might think. Be sure to follow through and make the phone calls. Chapter 2 gives you specific Best Questions for getting highly reliable referrals.
4. Which hospitals are you affiliated with?
Although people with fibromyalgia generally don’t need hospitalization, this answer could be important later. You have two choices: You can choose your doctor first and then go with the hospital where she has admitting privileges. Or you can choose the hospital or fibromyalgia treatment center first and then find a top doctor there. If you live in a rural area or choose not to travel far for treatment, your choices may be more limited.
Ask this follow-up question: “What is the accreditation status of this hospital or medical facility?” See The Joint Commission’s Web site (www.jointcommission.org) for more on accreditation.
5. Are you affiliated with any medical schools?
A teaching affiliation with a prestigious medical school is the gold standard when looking for a top doctor. It’s a fairly reliable indicator that a doctor is considered by her peers to be a leader in this
field. However, it’s not a deal breaker, especially for primary care physicians.
The academic doctors who also practice medicine are the most likely to be well informed about the latest research, diagnostic tools, and treatments. This is important to you because new breakthroughs in fibromyalgia treatments are now happening at record pace.
6. Are you involved with any ongoing research projects or clinical trials on fibromyalgia or related diseases?
Experts suggest that you look for doctors who have written about fibromyalgia or related conditions and whose work is often cited in medical journals. If a doctor you are considering has been published, ask for copies of those articles. Even if the articles are written for medical professionals and are very technical, you can learn a lot about this doctor’s interests and approach to treating fibromyalgia. Go to PubMed Central (www.pubmedcentral.nih.gov) for a free archive of medical journal abstracts.
7. Are you part of a referral system of medical specialists that I might see for overlapping conditions?
Having fibromyalgia usually means you have other medical problems (called overlapping conditions) as well. Ideally, you want to assemble a multidisciplinary medical team including fibromyalgia and sleep specialists, perhaps another doctor for related symptoms, and then such experts as a dietician, personal trainer, acupuncturist, or massage therapist.
At the least you want your primary doctor to be a good team player and communicator. Dr. Brent A. Bauer, director of the Complementary and Integrative Medicine Program at the Mayo Clinic explains, “I think the most important issue is to make sure that all of the care team members are communicating. It’s very frustrating when a physician tells a patient one thing, their chiropractor another, and their acupuncturist yet another. Finding providers who are willing to work with you and with each other may take more time, but in the end, the team approach is going to have the greatest chance of success.”
Author and fibromyalgia patient advocate Devin Starlanyl advises, “You need to be the coordinator of your medical team.” As you see different experts, make sure they are sharing your medical records, test results, and medications history.
8. Do you offer support services and more information about fibromyalgia?
The doctor’s answer to this question will indicate if she is patient centered. If you have choices, go to a doctor who emphasizes patient involvement and offers referrals to support services, such as physical therapists, nutritionists, and family counselors.
The best doctors are also good teachers at heart. As former acting surgeon general Dr. Kenneth P. Moritsugu comments, “When the doctor seeks to educate the patient, they are not merely engaging in a two-way conversation. Rather, the doctor is taking it beyond the conversation in order to teach the patient about their medical options and how to take control of his or her own health and well-being.”
9. Please describe your preferences for communicating with your patients.
Communication obstacles rank high on patients’ lists of complaints. Most people highly value how well a doctor communicates. Just keep in mind that communication is a two-way street, and you can’t expect any doctor to just drop everything in response to your calls, questions, or e-mails, especially on a frequent basis.
10. Who covers for you when you aren’t available or are on vacation?
This is another question that most patients don’t think to ask until they can’t reach their doctor when they really need to.
Be sure that your doctor tells you how she will communicate with you if unanticipated problems come up or when she’s unavailable or on vacation. Also ask how (calls or e-mails) and when (best times of day) she can be reached.
ABOUT THE AUTHOR
Dede Bonner, Ph.D., aka “The Question Doctor” and the author of The 10 Best Questions for Living with Fibromyalgia (Copyright © 2008 by 10 Best Questions LLC), specializes in creative breakthrough and money-saving Best Questions for corporate clients and CEOs. She is on the graduate business faculty of Curtin University in Perth, Western Australia, and is an internationally acclaimed expert in questioning skills and management. A former political analyst for the federal government, Dr. Bonner is the owner of New Century Management, Inc, and 10 Best Questions, LLC. She has a doctorate of education in executive leadership.