When selecting a Podiatrist, several concerns must be addressed in order for the patient-doctor relationship to be strong, honest, and respectfully secured. These concerns are at times shackled by the boundaries of availability, contractual agreements, and personal choice. Podiatrists vary, as do the patients they serve. Overwhelmingly, patients want a caring, gentle, and experienced Podiatrist to attend to their needs. Doctors understand that relieving a patient's suffering quickly and with a cost-effective approach will secure the referrals of that patient's family and friends by "word of mouth." This is by far the greatest compliment that a Podiatrist can receive and should serve as a gauge of that physician's performance. This method of practice building, however, can be hindered by many other factors.

One such hindrance is the limitation of physicians on your company's HMO (Health Maintenance Organization) insurance panel. The doctors who have contractually agreed to participate in such a plan do so under the assumption that they will inherit the care of the patients covered by the said plan. This would increase the physician's volume of patients, thus offsetting the decreased reimbursement, or payment, he receives from the insurance company for the services rendered to the covered patients. This agreement will thus limit availability of physicians from which the covered patients may seek treatment and theoretically the expenditure for which the insurance company is liable. Due to the guidelines set forth by the selected insurance company, patients must either seek treatment from a panel physician or be willing to pay as much as 100% of the incurred charges. Although this is a financial symbiosis between all parties mentioned, it has lead to disappointment and "non-personal" approach to your care, as patients are not always able to seek treatment from a physician who came highly recommended by family or friends.

In a PPO (Preferred Provider Organization), the concept is similar; however, there is often less limitation imposed upon the patients and doctors. Chances are, you will have more physicians from which to select and the penalty for seeking care on your own from a non-participating physician is less. Most physicians, in order to attract new patients, will publicly display the names of the PPOs in which they participate. The PPO will also publish a manual listing the names of the participating physicians. 

If, after the above scenario, you still have the option to choose a physician, personality comes in to play. Keep in mind that physicians are human with all of the same needs, insecurities and personal strengths as patients. The first question you should ask yourself is "Do I feel comfortable with this physician?" Answering this question begins the first time you have contact with the physician's office. The attitude and demeanor of each of the physician's employees is a direct reflection of the physician's sphere of control. For example, the receptionist should be pleasant and inviting. If rude or curse, you will most likely have a negative impression of the physician.

Once you enter the physician's office, assess its physical appearance and mood. Is it still inviting? A physician entrusted to control and eliminate your disease or disorder needs to control his or her environment. The office should appear neat and clean. The staff should be well groomed and professional, in appropriate attire. Are they smiling? The facial expressions of the office staff reflect the tone and mood of the environment in which they work, where you will be receiving care. Prior to meeting the doctor, you should be treated in a courteous and efficient manner by the office staff.

As you wait, remember that the physician is seeing to the needs of others. Your wait, however, should not be excessive. Delays that are not under the control of the physician do occur. In this instance, members of the office staff should inform you of how soon the physician will be available, and perhaps, offer to reschedule your appointment. Typically a 10-15 minute wait is reasonable; however, it can become 40 minutes of delay. Any more that that.reschedule. Your time is as important as the time of the patient with whom the physician is involved.

Once the physician enters the room, just relax and observe. He or she should be clean, professional, organized, and welcoming. The examination he conducts should be thorough and proceed smoothly and efficiently. If x-rays are taken, your physician should review them with you. You should also be given a complete explanation of your condition, with treatment recommendations and alternatives. Although conservative care should most always be explored first, do not be surprised if immediate surgery is recommended for treatment of potentially life-threatening conditions, such as infections. Upon the completion of your encounter with the physician, you should have a thorough understanding of your condition and suggested treatment. This component of your examination establishes a trusting relationship between you and your physician.

Do not be afraid to inquire into the cost of your treatment. In fact, do this during the initial encounter. Your physician should not "squirm," although he may defer his commentary to his or her office manager, who is usually more familiar with over all costs and insurance boundaries. The cost of medical treatments can be expensive. The reasons for this are many: office staff salaries, expensive supplies, rent, legitimate and frivolous lawsuits, continuing education, student loans, business loans, and of course, taxes, taxes, taxes. If your physician is honest and "non-fraudulent," he or she will not "cut deals." These "deals" can lead to criminal allegations of collusion to defraud insurance companies. If you participate in this behavior you may be indicted as well. The possible rewards are definitely not worth the financial penalties and possible imprisonment. The office manager or billing personnel will help you to understand the esoteric language and codes of your insurance company. Do not hesitate to ask for help when encountering confusion, as all offices vary in handling the reimbursement responsibility between the patient, the physician, and the insurance company.

Reappraise your encounter after you have left the physician's office. If your visit was favorable, then you have more than likely found a good physician. Following are a few points to look on with scrutiny. Does the office display the physician's license, board certificates and diplomas with pride? Is literature available to further explain your problem? Does the doctor keep up with the latest treatments? Just ask him or her about the latest seminar he or she attended. What are the latest treatments? Your physician, if not threatened, will divulge the information. Has your physician achieved board certification? This is in no way a guarantee that you will like the physician, but it does provide reassurance that he or she has made a great effort to prove that he or she is minimally competent. [See article on Board Certification. The referrals from this website are based solely on members of the American College of Foot and Ankle Surgeons (www.ACFAS.org) and the American College of Foot and Ankle Orthopedics and Medicine (www.ACFAOM.org).] Please remember that this credential is important, although not the sole criterion in selecting a physician for your care.

Choosing a Podiatrist, the first step you must take when dealing with the care of your foot and ankle, is very important. There are many factors that enter into the picture for which you alone are responsible. A successful Podiatrist has the delivery of your care as the top concern of his or her practice. If you have found this quality in a physician, you will promote him or her well as an excellent foot and ankle specialist.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

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