DEAR DR. ROACH: How do you choose your own doctors? The old advice to interview doctors can’t be done within insurance constraints. I am an old Hispanic woman with a low income. I have Ph.D. in cell biology from a widely respected university, but I am treated just as I witnessed my own mother treated: My words don’t enter the doctors’ ears! I get smiles, nods and answers that do not apply. When I read my online notes, it is clear my concerns were not heard. I’ve had good care when I lived in an area with many immigrant doctors, but now I live in a state that doesn’t attract immigrant doctors. What should I look for when scrolling through the lists of doctors my HMO offers? —- S.P.

ANSWER: I asked my colleague, Dr. Susana Morales, for her advice, and she wrote this:

“I am sorry that you have had such a frustrating experience with doctors. Finding the right doctor can definitely be challenging.

“It sounds like there may be a language barrier when you meet with doctors. It is your legal right to have a trained medical interpreter assist with your visit, usually by phone nowadays. Sometimes doctors may assume they are communicating adequately, and that is just not the case. If language is an issue, I would consider routinely requesting a trained medical interpreter. You are right that not every locality has a diverse group of doctors, and Hispanic doctors are underrepresented in medicine. However, more and more, it is being recognized that all doctors need to learn how to provide care to patients from all racial and ethnic backgrounds, in a compassionate and effective way. That is called cultural and linguistic competence.

“You mentioned that you have a doctorate in cell biology. I wonder if doctors are assuming that because of this, medical issues and terminology are well known to you — which may not be the case, as you did not study medicine. It is difficult to speak up when doctors so often seem to be in a rush, but if you do not ask questions, they may not be aware that your concerns are not being addressed. It may also be they are treating you as unsophisticated.

You referred to medical notes that you have reviewed online, and that they have made clear that your concerns were not heard. Again, it is hard to challenge doctors, but part of the purpose of online notes WAS to ultimately improve communication and understanding between doctors and patients. I wonder if you have gone over the notes with the doctor. I certainly have had patients do that with me, and is has helped both of us. Doctors may use medical terminology that patients may not be familiar with, and they may not document every single issue that was raised in a visit, which may make patients feel that they were not listened to. I think that doctors and patients may need to get to know each other, including how best to communicate.

“The provider list that the HMO offers does not always give much information. Some doctors also have a website, which may give clues about their background and interests. Word-of-mouth referrals still have a role, if your family members or friends can recommend a doctor who they like. You mentioned that you are older: Geriatricians (also in short supply) may be a useful choice. When I choose a doctor, I follow this same advice. Sometimes I choose to go to someone affiliated with an academic medical center, especially if I have a specialized medical problem that I want to make sure is treated in the most up-to-date way, though not everyone may live near one of these medical centers.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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