Seeing the Right Person – First Time!

Sunday, 24 January 2021

The past year has seen a shift in how patients access healthcare. With limited access to GPs and challenges in getting seen and referred to NHS specialist care, more patients are choosing to take matters into their own hands and self refer for private healthcare. But how do you know who to see? You might assume the hospitals or their referral management call centres or even the insurers will direct you to the best person. However, this is not always the case. Insurers generally do not know much about the consultants registered to see their patients other than when they applied for recognition with them. Newer consultants with some of the major insurers have to agree to lower consultation fees and the insurers will prioritise them (as it costs them less) over more established (experienced) and possibly more expensive consultants. This maybe why you are not offered a particularly consultant to see unless you ask directly to see them. Hospitals and their call centres may have a bit more knowledge about a specialists areas of expertise but offering the first appointment to any available consultant is often a higher priority so that the patient doesn’t go elsewhere.

This is my brief guide to help you navigate this potential minefield.

  1. Word of mouth/GP recommendation
  2. Look and see if they have local NHS commitments and do they reflect what you are going to see them about
  3. Do your own research
  4. Choose someone that specialises in the problem you have
  5. Look at Independent reviews
  6. Availability & Parking
  7. Make an enquiry

1) Word of mouth is the best type of referral method. If you know someone who has seen the same specialist and recommended them then they are likely to be a good fit for you. It does depend a little bit on what the problem is and you will still need to do your own research but you now have a head start on where to look. Your GP may know local specialists so ask them for advice or to refer you directly.

2) Look and see if the specialist has a local NHS commitment and does their NHS job reflect their private practice? Not all treatments are available in the private sector, for example phototherapy for psoriasis. If the dermatologist has local NHS connections, they will be able to inform you of the NHS services available and ease the onward referral path. It is also helpful for skin cancer patients who need to be discussed in cancer multidisciplinary team meetings or need specialist NHS services, such as sentinel node biopsy in Melanoma. If you are going to have an operation in the private sector, does your specialist do operating as part of their routine NHS service and how many patients are they treating a year? If they don’t advertise this, then ask – they should have nothing to hide and should be willing to share their annual audit data to anyone that asks.

3) One of my first bosses told me it took 5 years as a consultant to actually know what you were doing. Experience is key. Dermatology has several thousand diagnoses, all with varying presentations and every dermatologist will still be learning and seeing new things right up until they retire. Years of experience is one guide but also what work do they do? Some consultants will focus on certain areas like Paediatrics, Medical Dermatology,  Skin surgery or cosmetics and their experience will reflect this. Does a consultant have a website? Have a nosey and read up on their experience and interests. Alternatively, put their name into an internet search engine and see what pops up. Look for specialists who are engaged with regional or national organisations such as the British Association of Dermatologists or specialist societies or members of dermatology organisations.

4) Whilst looking for a dermatologist that specialises in your problem sounds obvious, it is not always clear. Booking centres don’t necessarily know the areas of expertise of the doctors that work at their hospitals! If you have a small child with an odd rash, it makes sense to see a Paediatric dermatologist. You wouldn’t though choose to see that specialist with a skin cancer requiring surgery. Most dermatologists will see general rashes and be confident in diagnosing lumps and bumps, but they may not all do minor procedures or skin surgery. You may prefer to see one person who can diagnose and treat rather than being referred on to another colleague and this is where your research is key. A number of specialists will have areas of interest or you may be more comfortable seeing a dermatologist of the same sex. Not all dermatologists practice cosmetic dermatology (Botox, fillers, lasers, peels etc). Try and find the best fit for you.

5) It is very common now for doctors to seek patient feedback. We have to do this as part of our five year appraisal and revalidation cycle. In the private sector look for membership to independent review companies like Doctify – this is the doctors equivalent to Checkatrade. These are reliable and are independently verified direct with the patient. Unfortunately, it is all too easy to put quotes on a website and there is no way to check authenticity.

6) Whilst availability and parking are top of the list from a patient perspective, they really should be demoted in my opinion. Obviously, if you have an urgent problem then the first appointment with anyone may be the most important thing for you. However, most things are not that urgent and seeing the right person will be better in the longer term, even if you have to wait a few weeks to see them. There is probably a reason they are busy!  Parking can be stressful, but a couple of pounds spent on street parking is a small fraction of your healthcare costs, so the free car park shouldn’t be your deciding factor.

7) If you are still not sure, make an enquiry. There should be no commitment to see someone just by asking if they offer a certain service. Any reputable dermatologist should redirect you to a colleague if they feel that your needs would be better met by someone else. For example, I received an enquiry via my website of someone wanting a female doctor with an interest in Hidradenitis Suppurativa (HS), a condition that causes boils and abscesses in the armpits and groin. It makes no sense for me to see and then refer on, when I can suggest a colleague who is both female and a regional expert in HS, so we passed on the name of the right expert for the patient to see.

I hope this is helpful. If my website doesn’t offer enough information on my interests and expertise, then I would welcome an enquiry and I am always happy to share my surgical audit data for anyone that asks.

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