How Good Is Your Doctor?
Travis RathboneYou know your primary care doc should test your cholesterol and vitals; you're aware your gyno should do a breast exam and ask about your cycle, and you realize your dentist should clean and examine your teeth. But there are other things an internist, a gynecologist or a dentist does (or doesn't do) that can set her apart as a truly great caregiver. Bookmark this page and reread it before your next visit.
A great primary care doc should...
Chat before you change.
If you're not wearing that awkward gown, you'll likely feel more comfortable letting your physician know what your concerns are. "Discussing things with you while you're clothed shows that the doctor is taking the time to really listen," says Glen Stream, MD, board chair of the American Academy of Family Physicians.
Be up on the latest testing recommendations.
For instance, last year the Centers for Disease Control and Prevention broadened its recommendation for hepatitis C testing to everyone born from 1945 to 1965, since deaths from liver disease and liver cancer caused by hepatitis C are on the rise. That age group has the highest rates of infection, and most people who have hepatitis C don't even know it.
Stick you with a shot or three.
In addition to a flu shot, if you never got a Tdap vaccine—which has been in use since 2005 and protects against tetanus, diphtheria and pertussis (whooping cough)—then your doc should be on you to get one (along with any other vaccines you might need).
Have good follow-through.
As you're wrapping up, your doctor should ask if there's anything else you want to discuss, Dr. Stream says. She should also contact you with the results of any tests.
Say bye till 2015 or later.
"There's no evidence that going for yearly checkups is any better than less frequent visits," Dr. Stream says. If you're between 30 and 50 and have no medical problems or risks, you may be able to wait as long as three years between visits—two if you're over 50.
Next Page: A great gyno should... [ pagebreak ]
A great gyno should...
Travis Rathbone Your gynecologist should ask (and you should be honest!) about what's going on in your personal life, like changes in your sexual habits and your state of mind. After all, these can be important indicators of your physical health. Mood changes, for instance, could be related to your cycle, menopause or other hormonal factors.
Make suggestions for bone health.
A good gyno will dispense advice about keeping that skeleton strong—like eating right and doing weight-bearing exercises—as you inch toward 50. "The more bone you have at the start of menopause, the better your chances of fending off osteoporosis," says Peggy Norton, MD, chair of the American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice.
There's disagreement on when to start getting screening mammograms and how often to get them, with some medical experts recommending them yearly, starting at 40, and others every other year starting at 50. What's essential, though, is that your doctor get the conversation going by the time you're 40. She should discuss your personal risk and go over some of the trade-offs of getting screened earlier, like the risk of a biopsy that turns out negative versus the risk of missing a cancer by waiting, says Jennifer Griffin, MD, co-author of the ACOG guidelines on breast cancer screening.
Skip the yearly pelvic exam and pap test—maybe.
Surprise! If you're symptom-free, "there isn't good evidence that a routine pelvic exam picks up on much, including ovarian cancer," Dr. Norton says. If you're healthy, your doctor may discuss waiting between pelvic exams. And per last year's ACOG guidelines, women 30 and over who previously have had negative test results can safely get a Pap and an HPV test once every five years, or a Pap test alone every three.
A great dentist should...
Keep track of gum recession. Nearly half of Americans 30 and older have gum disease, and the risk for women increases during times of fluctuating hormones. The dentist or hygienist will check your periodontal health by measuring the distance in millimeters between the top of your gum and where it attaches to the tooth.
Take X-rays only when needed. Expect full-mouth X-rays every five years, depending on your individual risk factors, says Kimberly Harms, DDS, national spokesperson for the American Dental Association. If you have a history of decay, you might have bitewings (the X-rays you bite on with your back teeth) every six to 18 months, while those with great oral health may wait two or three years.
Screen for oral cancer. Your dentist palpates your neck, checking for lumps, then eyeballs the exterior of your lips and the inside of your mouth and throat. Most head and neck cancers begin in the oral cavity, so this hunt for unusual lesions is important for early detection—and allows you to rest easy knowing that you have a savvy dentist on your side.
Should you fire your physician?
If your MD skipped one of the items on this list, there's no harm in asking her why, says Leana Wen, MD, emergency physician at George Washington University and co-author of When Doctors Don't Listen. "But if she doesn't listen to your concerns, that's a red flag that you're not getting the best care."