By Sara L. Merwin and Dr. Liron Sinvani for Next Avenue

Most older adults remember when care was managed by a general practitioner. Things have changed a great deal in the last half century. Today's versions of these doctors are referred to as primary medical doctors or primary care providers.

Fifty years ago, half of all physicians were primary care physicians. Today over 75% are specialists. That imbalance has led to a shortage of primary doctors; as a result, new types of medical professionals have emerged to fill the gap.

Many patients now receive care from physician assistants and nurse practitioners. These health care professionals are also called primary care providers.

No matter who you choose to oversee your medical care, finding someone you feel comfortable with and trust is the key to preserving your health and avoiding unnecessary tests, procedures, medications and even hospitalizations.

The importance of selecting the right primary care provider cannot be overstated.

What to Look For

It's a matter of fit, chemistry, compatibility, comfort and mutual respect. Notice that these characteristics go beyond diplomas and medical training.

If your primary care provider does not let you get a word in edgewise or does not appear to respect and understand your needs or what matters most to you, it may not be the right fit. If you feel apprehensive or hesitant about visits or you don't feel comfortable asking questions or raising concerns, that could be a sign you should look elsewhere for care.

Many people may not realize that it's perfectly all right, and in fact recommended, to be selective about your choice of health care practitioner. Just as you would choose a plumber, lawyer, architect or other caretaker, it makes sense to seek external information (word of mouth and reviews) about a potential primary care provider.

While some health care plans assign a primary care provider for you, if the person does not meet your needs, you should request a different one. The relationship with your practitioner has to feel right and only you can decide that.

When establishing care with a new practice, it is important to understand its working structure. Consider asking:

• How many physicians and practitioners work there?
• Who performs new patient intakes?
• Who sees urgent visits (for an acute illness) as well as follow-up visits (repeat blood pressure checks)?
• Who oversees annual well visits?
• Who takes after-hour phone calls for urgent matters?
• How are prescription refills and test scheduling managed?  
• How long does it take to get through the phone tree to reach a human voice?

What is a Geriatrician and Who Should See One?

Geriatrics is the medical specialty that focuses on the health care of older adults, with the aim of preventing and treating diseases and disabilities.

While there are more than 49 million older adults in the U.S., there are fewer than 3,600 practicing geriatricians (meaning there are almost 14,000 older adults per one geriatrician). Clearly, it is not possible for geriatricians to see all older adults.

Patients who require a multidisciplinary approach to deal with multiple, complex health problems may be best served by a geriatrician. This may include people who suffer from dementia or other debilitating neurological disorders, such as Parkinson's disease, those with severe functional problems or those that require nursing home care.

Geriatrics embraces a team-based approach to caring for patients. A good geriatrics practice will include a group of health care providers and therapists from different disciplines working together to provide comprehensive care.

While a conventional doctor's office usually allots a 15-minute follow-up visit and 30 minutes for new patients, a geriatrics practice will usually allot 30 minutes for follow-up and one hour for a new patient intake.

When you come to a geriatrics practice, expect to undergo numerous clinical examinations including those for memory, mobility and mood. There will be a thorough review of medications and the team will ask about care needs and available resources. They will also want to know if you have a health care proxy (someone to speak for you in a medical emergency), a living will or other advanced directives.

Finding a Geriatrician

If you live in a city or near an academic medical center, there is most likely a geriatrics practice nearby. However, in less populated areas, finding a comprehensive geriatrics practice may be more difficult. It is important to note that some nurse practitioners have specialized training in geriatrics.

There are a few ways to find a geriatrician. You can discuss obtaining a geriatrics consultation with your primary care provider. Most will gladly make this referral, just like they make a referral to a cardiologist for heart problems and a pulmonologist for lung issues.

Another way to find a geriatrics practice or a geriatrics-trained provider is to contact your health insurer (including Medicare) to obtain a list of practices in your area. You can also go to the website HealthinAging.org, which provides a directory of geriatricians that's searchable by state.

Word of mouth through friends, colleagues, staff at assisted living facilities or nursing homes and the internet can also be great ways to find a geriatrics practice.  

Making the Most of Your Appointments

Most health care professionals have limited time in which to see their patients. You will want to get your message across as thoroughly and succinctly as possible.

The best thing you can do ahead of time is prepare for your appointments by organizing your thoughts and writing them down on a note pad, index cards or smart device.

Be mindful that your provider likely has a waiting room full of patients and numerous hours of note-writing that will take them into the night and weekends. Therefore, although your provider might want to hear about every detail of your past, present and future, this may not be the right time.

Your medical conditions, living situation and psychological well-being are all important; you will want to give the full picture. The right health care provider will gently bring you back to important topics and will spend time listening to you.

To recall information, write down what was discussed during your visit or bring a friend or family member to scribe for you so you can concentrate on what the doctor is saying.

Other things to consider during appointments:

• Do you feel rushed?
• Does the practitioner sit next to you, listen closely and make eye contact?
• Are you given time to answer questions or raise concerns without interruption?
• Does the provider ask you about and demonstrate an understanding of your preferences, priorities and values?
• Does the provider talk down to you or use confusing language without explaining?
• Does the provider explain and take the time to make decisions together?
• Is there adequate support staff? (Receptionist, nurse, other specialists like dietician, social worker, pharmacist)
• Do they answer the phone? (You may want to call the practice and see how long it takes for someone to answer the phone and how responsive the staff is when you have a question.)

Convenience Matters

Finding a primary care provider in a convenient location is important. If you have to take four buses and a train for visits, you might want to rethink if this is the right provider for you. Perhaps you or your partner are still driving, but if that were to change, ask yourself how you might get to your appointments.

Additionally, telehealth visits have increased greatly in the last year. While there can be great value in an in-person visit, a telehealth visit may be a convenient and safe alternative. Ask if your practitioner provides this service.  

There are many important aspects to consider when choosing the practitioner to suit your needs and situation. Finding the ideal one may take some research and legwork, but it will be well worth the effort to identify the individual who will play a key role in your health care.

Sara L. Merwin, MPH is an epidemiologist.  Previously she was Director of Clinical Research in Orthopaedic Surgery at Montefiore Medical Center in New York. Her professional focus includes quality improvement, patient education and professional communication. She publishes in the scholarly literature and has presented at national scientific meetings.  She is co-author of The Informed Patient: A Complete Guide to a Hospital Stay, Cornell University Press, 2017.

Dr. Liron Sinvani is a fellowship-trained geriatrician and hospitalist at Northwell Health and Feinstein Institutes for Medical Research in New York. She divides her time between patient care and research, and is currently funded by the National Institutes of Aging at the NIH. She has published widely in the scholarly literature and is passionate about helping older adults learn about enhancing health and wellness.

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