A doctor? The hospital? Or 911? How to choose your health-care provider.

A Doctor? the Hospital? or 911?

When you have a medical emergency the number to call may be 911, but whom do you call when your child is running a high fever and vomiting? What about a persistent cough? Should you see a doctor if you occasionally feel a pain in your chest when you take a deep breath? It might be an unnecessary visit for which you have to pay. Is it worth it?

Finding the right health-care provider for your family is obviously more complicated than memorizing a three-digit phone number. Yet most of us don't think about finding health care until we are desperately in need of it. Months later, as we sort through a stack of medical bills, we lament, "If I had only known what I know now, I could have saved a pile of money."

The time to learn about the vast number of health-care providers available to you and your family is now, before you need medical attention.

When the Dan Clifford family moved to the suburbs, they were too busy getting established in new jobs, finding out about the school system, and searching for a new church to make any provision for their health care. Then it happened. Ten-year-old Sally caught her toe in the rotary lawn mower. Along with blood there was pandemonium. Grabbing their daughter, the parents rushed to the local hospital emergency room, and 45 stitches later the still-whimpering child was virtually whole again. For this emergency the Clifford family made an expensive but appropriate choice. The problem is that too many families are using emergency room care when other choices would be more appropriate.

Hospital emergency departments are efficient but expensive. Visits should be truly urgent, not simply convenient. Ask yourself, Is a life or limb threatened? Are fractures or internal injuries likely? Is pain severe? Is the patient's condition growing rapidly worse? Is the physician likely to hospitalize the patient? If your personal judgment suggests an affirmative answer to one or more of these questions, then hospital emergency care is probably the right choice. But once you step in the door, it's almost impossible to get out for less than $200 to $300--maybe a lot more. One reason for the high cost is that the emergency room physician is at high risk of a malpractice suit if he misses a diagnosis. Therefore, for your safety as well as his, he orders enough tests to rule out every possible injury, thus increasing your costs.

Neighborhood urgent-care centers are well staffed and equipped. These centers are appropriate for immediate care when it might take weeks to get an office appointment. They are also excellent for after-hours, holiday, or weekend problems that simply can't wait until morning. However, these centers are sometimes used inappropriately for chronic or routine health care, simply because the patient has no personal physician.

Individuals with medical insurance coverage such as Medicare or Medicaid are prone to misuse this service because of its convenience.

Use the 911 number when you can't take time to deliberate; when minutes count against possible disaster. Once 911 is called, emergency vehicles (ambulance with paramedics and a fire truck with emergency equipment) are immediately dispatched to the location of the call, even if you can't stay on the line or you don't know your address. Don't hang up thinking your call will be canceled because you didn't say anything. Once 911 is activated, emergency vehicles will be dispatched, unless you immediately report that the call was a mistake. And like hospital emergency care, 911 is expensive. Don't misuse this service!

How do you go about choosing nonemergency health care for your family? One good choice for entry into the maze of the United States health-care system is to select an HMO (health maintenance organization). For a yearly fee you are provided "free" health care at a certain location. Or you may wish to select a PPO (preferred provider organization), in which you choose a physician who is paid by the organization and offers you care at a reduced rate. (See boxes for more information on HMO and PPO.) Or you can go the more traditional route of choosing a family or personal-care physician. Usually this is a physician with one of the following specialties: a family-practice physician's training includes the fine art of disease prevention as well as diagnosis and treatment of most (if not all) of the illnesses experienced by humans. A general internist specializes in the diagnosis of unusual diseases that involve multisystem analysis; he or she is the apt sleuth of the uncommon--the "doctor's doctor." A pediatrician is best for children and adolescents until they become uncomfortable going to a "baby doctor." A family physician is a sensible place to begin your search for a health-care provider, because he or she can usually give top-of-the-line care for 85 percent to 90 percent of all health-related problems brought to the office.

When a specialist is required, your family or personal-care physician can decide the nature of the care you need and the physician best able to provide it. Does your illness require a rheumatologist or an orthopedist? A urologist or a nephrologist? A neurologist or a neurosurgeon? Choosing can be confusing!

To find a family or personal-care physician, call your county medical society. You will be rewarded with a list of skilled physicians willing to accept new patients. This approach is far safer than the "fingers walking through the yellow pages" method. The county medical society knows its physician members, their skills, and their special interests. The society also knows whether they are willing and able to accept new patients.

Remember, whomever you choose, you must like and respect each other. The give-and-take of the physician-patient relationship must permit and support idiosyncracies and differences of opinion. For instance, some patients may see abortion and birth control in a different light than their physician. Others may hold certain philosophical or religious positions regarding blood transfusions.

Why is medical care so expensive? Complaint over the high cost of medical care is understandable! But there are reasons--some profound, some tragic, some avoidable. For instance: The cost of insuring against malpractice suits is enormous, even though many suits are groundless. In some states an obstetrician or neurosurgeon must pay up to $100,000 yearly for malpractice insurance. In addition, every year billions of dollars' worth of medical tests are ordered by physicians to protect themselves or the hospital where they practice from a possible, often frivolous, suit. Just one example of this is the common practice to X-ray the skull of most patients coming into an emergency room for minor head injuries. Even though the X-rays may be of little value in treating the patient, they may be vital evidence if the physician is summoned to court.

Medical costs have also mushroomed as a result of new technologies. The famous CAT scans, the magnetic-resonance scans, the ultrasonic scans, the coronary bypasses and heart replacements, the corneal transplants--none of which we would want to do without--add billions per year to the cost of medical care.

And then there is the high tab associted with the demise of our elderly. In generations past, the weak and aged simply died of pneumonia. Today, life after pneumonia brings another bout of pneumonia, and another. Antibiotics and life-support systems prolong marginal life in the fragile elderly long after life is desirable--and at massive expense.

Yet none of us would want to return to the "good old days," when medical miracles were unknown.

How can you save money on medical care? You can take charge of yourself and pursue with vigor a healthy lifestyle. Eat less fat, protein, sugar, and salt. Eat more fresh fruits, vegetables, and legumes (peas, beans, lentils, and garbanzos). Research suggests that foods such as broccoli, brussels sprouts, cabbage, and cauliflower help prevent certain intestinal cancers. Subscribe to a good health journal (such as VIBRANT LIFE) so you can keep up-to-date on the latest health findings.

In addition to eating right, get plenty of sleep, drink eight glasses of water daily, avoid tobacco, alcohol, and caffeine drinks, and exercise vigorously for 20 to 30 minutes at least five days a week. Living a healthy lifestyle is the best way to save money on medical care. It's really quite uncomplicated and marvelously effective.

When you are experiencing a medical problem, don't try to save money by making your own diagnosis and prescribing your own treatment. Hesitating to get the medical attention you need may mean greater pain and medical bills in the future. There are many conditions that, caught early and treated early, can be cured. Why take a chance? Remember: "He who is his own doctor has a fool for a patient."

Finally, when it comes to taking control of your own life and health, vitality and longevity, be aware of the guise and glitter of health care that is fraudulent. Let's call it by its real name: quackery. If a cure-all is proposed, if one form of treatment can do it all, if a cure is promised, if a healer has a "new" remedy not recognized by his trained peers, if testimonials are provided to show the worth of the remedy without scientific evidence--beware! Chances are it's quackery.

Ambroise Pare, a remarkably perceptive French physician in the sixteenth century, characterized the work of a physician as follows: "To heal sometimes, to relieve often, and to comfort always." Healing, relief, and comfort--we'll all need them sometime in the future. Why not start now to find a healthcare provider who will give you and your family the healing, relief and comfort you deserve.

Raymond O. West, M.D., is "mostly retired." He taught many years as professor of family medicine and epidemiology at Loma Linda University, Loma Linda, California. Presently he is a free-lance writer and medical columnist.