Doctors today aren't just doctors. There are "primary," "secondary" and "tertiary-care" physicians with jaw-breaking titles like traumatologist, oncologist and neonatologist. There are specialists, super-specialists and -- as some doctors will tell you -- super-duper-specialists.
What kind of doctor should you have? What most of us need is one who will, first, give us most of our care and, second, become our arranger and manager when we need other parts of the health system.
What we need, says Dr. William Matory, a Howard University surgeon and medical educator, "is one who will serve as the shepherd of our health . . . a general or family or primary-care physician."
You may find this kind of all-around doctor in one of four main groups: family physicians, internists, obstetrician- gynecologists (ob-gyns) for women and pediatricians for children and adolescents.
Family physicians were once known as general practitioners. Until a few decades ago, many GPs had just a one-year internship after medical school before setting forth to attack almost all human ills -- from delivering babies to performing surgery.
In all but a few states, a doctor can still legally hang up a shingle as a "physician and surgeon" after a mere one-year internship. Be wary of such skimpily-trained MDs. Today's fully qualified "FPs" take three years of internship and residency, rotating through several medical and surgical services, such as pediatrics, internal medicine and obstetrics-gynecology. Many never do surgery in their subsequent practices. Many deliver babies, some do not.
Just over half are board-certified, like other specialists. This means they have passed a tough qualifying exam after their residencies and a recertifying exam every seven years. FPs who belong to the American Academy of Family Physicians must attend at least 150 hours of recognized lectures or training every three years.
Internists are specialists in "internal medicine," the medicine of all the body's internal organs -- just about everything inside the skin but the bones. Some internists mainly sub-specialize in one organ or system -- they are cardiologists, rheumatologists, gastroenterologists and the like. But many of these specialists offer general care too.
Who makes the better family doctor, an internist or a family practitioner?
FPs have more training in obstetrics, gynecology, dermatology and pediatrics. They are more likely to want to look after all your family, including the children.
Internists are mainly adult doctors. They have more training in the serious diseases: heart, lung, liver and stomach or intestinal problems, for example. They usually charge more and spend more time with patients. Some internists see only 12 or 15 patients a day, while some family practitioners see twice that many. But there are many exceptions: slow FPs and speed-demon internists.
Internists also are more likely to refer you to a specialist out of their field. Some patients like this kind of "referral medicine," with your main doctor acting as manager and giving an overall picture of your condition.
This can make for superb medicine. For example: An internist once treated me for a bladder infection, but when it didn't clear up, he sent me to a urologist who prescribed a drug that cured me in a few weeks.
But if the patient is tossed from specialist to specialist without coordination by one physician, care can become fragmented, with no one treating the whole person.
"Your general doctor should be able to take care of 85 percent of your problems," says Howard's Dr. Matory. "We hear from a lot of people who are tired of being referred from doctor to doctor."
Two other kinds of doctors give general care:
OB-GYNs. Nine out of 10 now offer general medical care, too. They are often the only doctors women see. Most have not been trained to give overall care as their main job, but many have conscientiously made themselves good all-around doctors.
Pediatricians believe they are the best doctors for the young. They have had the best training for it. Some specialize in adolescents -- many teens balk at sitting in a waiting room full of toddlers. But many families prefer a family practitioner who's good with youngsters and is willing to call in a pediatrician for serious or stubborn problems.
Which doctor is right for you and your family?
Most physicians agree that the best doctor for you may depend on the kind of person you are, the kind of attention you want and whether or not a doctor provides it, regardless of his or her label.
Coming Nov. 21: Your next step -- the get-acquainted visit.