Health Care on the Web

Washington Post staff writer January W. Payne was online Tuesday, Jan. 31, at 2:30 p.m. ET to answer your questions about Web sites that can help consumers find doctors and other health care providers with specified characteristics, including race, religion and sensitivity to sexual orientation.

Read More:

Your Kind of Doctor

(Post, Jan. 31)

The Transcript follows.

____________________

January W. Payne: Hello everyone - Thanks for joining me today. I'd love to hear your thoughts on choosing a doctor online based on the types of characteristics I discuss in the story. I'm here ready and willing to take your questions and comments. That said, let's get started.

_______________________

Philadelphia, Pa.: Very interested in which sites you think provide the best search tools to find doctors.

January W. Payne: Hi Philadelphia - Thanks for joining us. I don't have an opinion on which sites are the "best" -- but I can give you some options, in addition to those that were listed in my article today.

My main suggestion would be to consider what type of doctor you're looking for. A cardiologist? An allergist? A family practice doctor? Take this info and check to see if there are any professional membership groups for the specialty you're looking for. If there are, visit that group's Web site or call them for doctor referrals in your local area. In most cases, the docs they refer you to will be board-certified in whatever the specialty area is that you need.

Examples of such professional membership group Web sites include (just to name a few - but this is not at all a comprehensive list):

American Medical Association: http://www.ama-assn.org/

American College of Cardiology: http://www.acc.org/

American College of Obstetricians and Gynecologists: http://www.acog.org/

American Academy of Allergy, Asthma and Immunology: http://www.aaaai.org/

_______________________

Washington, D.C.: These "affinity-based" databases can be useful in other ways as well. For instance, I checked against the Christian Medical Association site when I was looking for a new OB-GYN because frankly I couldn't be sure that someone willing to be listed on that site would put my health care before their dogma. (I have a friend who nearly died at a religious-affiliated hospital after an ectopic pregnancy ruptured.)

As it was, I came across a physician I know in a work context, and have lost all respect for her integrity as a healer.

January W. Payne: Hi Washington, D.C. - Thanks for offering that perspective.

_______________________

Bluff, Utah: I'd like to know how, other than through word of mouth, someone seeking specialist medical care, can find "the top professionals" of that specialty.

January W. Payne: Hi Bluff -- Please see my reply to Philadelphia, above. I think that'll help answer your question.

_______________________

Long Branch, N.J.: How do you locate THE specialist you need. Web information lacks sufficient detail about subspecialties, insurance companies are no help, and doctors seem as clueless as patients about where to go for help with out-of-the-ordinary outcomes. Following two failed spinal cyst surgeries, much searching on the web, and many dead-ends with physicians who turned out to know less than we about the problem, I'm no better off than I was when the problem started 15 months ago. Thanks for listening.

January W. Payne: Hi Long Branch - I'm sorry to hear about the difficulties you've had. My advice would be to start off with searching the professional membership group's databases (see response to Philly, above) and then narrow your search from there. Also ask doctors/health care professionals you trust for referrals. See if they know of any of the names of docs you find on the membership group's databases -- Do they recommend them? Are there any support groups in your area that include patients with health issues similar to yours? Try calling them or going to a meeting to see if patients have any suggestions for good docs.

I wish you the best in getting help for your medical issues.

_______________________

Milwaukee, Wis.: From Milwaukee, where doctor's fees are the nation's highest. How can a person find out pricing on local doctors, hospitals, and clinics? Asking the doctor just doesn't work.

January W. Payne: Hi Milwaukee - I don't know of a shortcut way to get this info -- short of calling the individual offices and facilities -- but that doesn't mean there isn't one.

Any readers out there have any suggestions for Milwaukee?

_______________________

Jacksonville, N.C.: I believe that certain Web sites -- maybe WebMD -- are sponsored by drug companies. Are these unbiased sites as to the therapies for a disease? Would the site not promote the drugs the company produces and leave out alternatives?

January W. Payne: Hi Jacksonville - Yes, you're correct. Many Web sites have drug company sponsorship. (I am not sure about WebMD specifically, though.) And yes, often these sites will promote a drug made by the company that funds the site, though this isn't always the case. My best advice for consumers would be to check out the "About Us" page on any site you're visiting to see if there are any hints of affiliation with any particular companies. And don't rely on information you receive from just one Web site -- Be sure to cross-check the info in other places, and especially with your doctor.

And if you're looking for a site that tends to present comprehensive info, one good source is the federal government's portal, MedlinePlus. www.medlineplus.gov

_______________________

Boise, Idaho: So how does HIPPA play in to this? If there are sites that can refer you to the right healthcare provider, how much of this is anonymous, and if not, where do the HIPPA rules apply? If the site is using your personal data for future customized marketing purposes, can this be a breach of HIPPA?

Thanks

January W. Payne: Hi Boise - The Web sites -- at least the ones I included in my story in today's paper -- do not require you to input info about yourself in order to search their listings. So I don't think HIPAA applies. Thanks for your question.

_______________________

Annapolis, Md.: How can you learn about the quality that a doctor provides? Suggestions?

January W. Payne: Hi Annapolis -- Good question. There are a variety of ways to do this. In recent years a bunch of commercial Web sites have appeared that allow patients to rate doctor's care -- so you could check those out if you'd like (many of these sites are easily found by Googling terms like "doctor quality"). I'd also suggest checking to see if the doc is board certified in the field in which they practice (one way you can check this is by going to those professional membership groups I keep mentioning).

Also, many states allow you to search online to confirm a doctor is licensed in your state -- sounds basic, but it's good to check to make sure that your doctor has a valid license to practice medicine and to see if he/she has been sanctioned by the state for any reason. An example is the service provided by the Maryland Board of Physicians - http://www.mbp.state.md.us/index.html.

_______________________

Tallahassee, Fla.: I am specifically interested in Web sites with information on drug assistance programs for a young individual (30 years) without adequate health coverage and living on a minimal income recently diagnosed with early multiple sclerosis. This is a young mother of two.

I will not be able to enter this discussion.

If not, I will print your transcript of discussion. Many thanks for your help.

January W. Payne: Hi Tallahassee - Wish I could be of more help here, but drug assistance programs are outside the scope of what I researched for this article. But I did a little searching online to see what I could come up with and found the following. However, I must offer the disclaimer that I have not checked out these sites or the information they provide, so please keep that in mind.

1. RxAssist - This Web site's "About Us" page says it is run out of Brown University's Center for Primary Care and Prevention. The site, according to this page, "streamlines the application process for the pharmaceutical industry's patient assistance programs." www.rxassist.org

2. RxHope is the "only patient assistance Internet initiative financially supported by PhRMA (Pharmaceutical and Research Manufacturers of America) and participating pharmaceutical companies." www.rxhope.com

3. And the Partnership for Prescription Assistance's Web site "brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them," according to the site. www.pparx.org

---

Hope this was helpful.

_______________________

McLean, Va.: I am looking for a good Web site that compares different health plans. I am in the process of renewing my health insurance and I am not sure I have the best one.

If I have a pre-exisiting condition is it recommended to stay with my own plan?

Thanks

January W. Payne: Hi McLean - Thanks for writing. Unfortunately, since my article was about locating doctors, I didn't come across sites that compare health plans in writing the story. But I did do a little online searching in response to your question and I found a couple of federal government sites that might help you out:

How to Choose a Health Plan, from FirstGov for Consumers -

http://www.consumer.gov/qualityhealth/choose.htm

Choosing and Using a Health Plan, from the Agency for Healthcare Research and Quality -

http://www.ahcpr.gov/consumer/hlthpln1.htm

Hope these sites are helpful.

_______________________

Huntington Beach, Calif.: Dr Payne: Can you give some tips/links so I can find an expert for a medical condition that I have and several doctors I have seen do not seem to be able to help me with. There must be a better doctor out there...I just have to learn how to find him. I do have Medicare plus a supplemental PPO Aetna Medical Insurance. Thanks, Jose

January W. Payne: Hi Huntington Beach - I have to say I'm flattered at the suggestion, but I am not a doctor - though I guess you could say I play one in the newspaper.

Seriously though, it's hard to suggest specific ways to help you find a good doc without knowing what the medical problem is. So I'll go back to that professional membership group thing again -- Find the name of the professional membership group that specializes in your medical problem and search their Web site or call them for the names of good specialists in your area. Best wishes.

_______________________

Washington, D.C.: This may sound like a silly question, but are most doctors offices listed on the Web these days? What's a good way to get references while searching? Thanks!

January W. Payne: Hi Washington, D.C. - I think that all depends on what you mean by "listed on the Web." I don't think that we've reached the point where most doc's offices have Web sites, but I think it's fair to say that many of them do. But even if a practice doesn't have its own site, chances are you can find a reference to the doc or practice *somewhere* on the Web.

As far as narrowing down searches, I'd say to first figure out exactly what kind of doc you need and go from there. Then check for docs who might sub-specialize in whatever medical problem it is that you need treated.

_______________________

New York: Would a new search service like Healthline serve well for searching medical aid?

January W. Payne: Hi New York - I am not familiar with Healthline, but I assume you mean www.healthline.com. I just browsed the site really quickly and it strikes me as a WebMD-like portal, but without looking at it more thoroughly, I can't say much more.

_______________________

Woodbridge, Va.: My husband has severe back pain and has been told no surgery or physical therapy can help. He has been advised to have steroid shots in his spine. Is this safe and is there any long term relief of pain with these shots? Are there any negatives?

Any help you can provide will be appreciated.

January W. Payne: Hi Woodbridge - Wish I could help more, but I am not a doctor, so I'm not qualified to answer this in any more detail than I'm about to provide. I know a little about steroid shots, from having written about them before, and yes, there can be side effects, so it's up to your husband and his physicians to figure out if the benefits of the shots outweigh the risks.

Here's some more detail about steroids, from the Mayo Clinic. This site discusses all types of steroids, injections included: http://www.mayoclinic.com/health/steroids/HQ01431

_______________________

Long Branch, N.J.: Sorry if this sounds like criticism, but it seems that the real issue is NOT finding a specialist you like or with whom you identify, but the one who has the most experience with your health issue and is most likely to improve or solve the problem. How do you recommend patients do that?

January W. Payne: Hi Long Branch - Thanks for your question. I'd say the best way to do that is to start off by verifying credentials the way we've discussed here in this chat. After you're sure you have a list of docs with the credentials you need/want (board certified in whatever specialty you need and licensed in your state), you can start the process of narrowing that list down.

Unfortunately, that can be rather time consuming -- It might mean working the phone for a few days by calling doc's offices and asking specific questions such as: How long have they been in practice? How many patients have they treated with XYZ condition? Etc.

And most importantly, don't be afraid to keep asking these questions until you get the answers you're looking for.

_______________________

Washington, D.C.: I know that there are Web sites that also list "fat-friendly doctors" and I am curious if this is necessarily positive if it means the doctor is not willing to discuss what may potentially be embarassing/upsetting issues, but ones that will dramatically impact a patient's health, which is their responsiblity to discuss with them.

January W. Payne: Hi Washington, D.C. - Thanks for letting us know about this. I am not familiar with these kinds of sites, so I can only guess at what that term means. If it's similar to the "gay and lesbian friendly" doctors listed on a site I included in my story, then it probably means that docs listed on such sites are not likely to be overly critical of people who are overweight or obese. But since I'm not familiar with them, I can't say what it means about their willingness to discuss issues that could affect the patient's health.

_______________________

Washington, D.C.: Are there Web sites you know of that list doctors of other racial/ethnic backgrounds? Or that speak specific languages?

January W. Payne: Hi Washington, D.C. - I'm sure that there are many other sites that do what you've asked, but I am not familiar with them all -- The ones I am most familar with are listed in the story. I do know that *many* sites allow you to search for docs who speak certain languages, including some of those mentioned in today's article.

_______________________

Memphis, Tenn.: With the recent approval of inhaled insulin, how likely are payors going to be to add it to their formulary any time soon? It should make things easier for the users, but it is very likely to be much more expensive than the injectable form.

washingtonpost.com: FDA Approves Inhalable Insulin (Post, Jan. 28)

January W. Payne: I haven't researched or written about inhaled insulin yet, so my answer here is based on what I've read and my experience from previous reporting. The story the Post ran about the approval of inhaled insulin a few days ago said that the drug likely wouldn't be available to consumers until June or July, and it's hard to say before then if insurers are likely to pick it up on formulary drug lists until then. I'd check it out further as the summer approaches.

_______________________

Baltimore, Md.: Your article kind of highlights a point I'd like to make which is that African-Americans feel more comfortable with physicians of the same race. I feel (and note I am an African American) that this inherent position within the race is an impediment to getting/accessing the BEST healthcare. There are a LOT of good docs out there but only a fraction of them are practicing physicians.

Hopefully with the the sensitivity/bedside manner training of the newest generation of docs the race issue will cease to exist.

January W. Payne: Thanks, Baltimore. Posting your comment to share with the Web audience.

_______________________

Centreville, Va.: I have a question about eye care. I have always worn eye glasses (for seeing far away) and I am well overdue for a check-up and new glasses. Is going to the Mall doctors and eyeglass stores (Lenscrafters, Sterling Optical) just as good as going to a recommended eye doctor recommended by my health carrier? Which tends to carry the better selection and might be less expensive to by new frames?

Thank you in advance for taking my question.

January W. Payne: Hi Centreville - I'll answer this to the best of my ability, just based on what I know from reporting on eye health issues.

The main difference you might see between the eye docs you'll see at the mall and the ones you might find in private practice is that the mall docs tend to be optometrists (attend post-graduate optometry school), while the private docs your insurance company is recommeding are probably ophthalmologists (medical doctors who specialize in eye care).

I can't say which might offer you a better selection of frames or which might be the less expensive route, but that is the main difference to keep in mind when selecting an eye doctor.

_______________________

January W. Payne: That's all the time we have for today. Thanks again for reading the story and for joining me this afternoon. Take care.

_______________________

Editor's Note: washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.