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How Do I Choose A Gynecologist?

Different women need different things from an Ob-gyn, and most women's needs change throughout their lives. Take Dr. Donnica's Decisionnaire: Answer all of the following questions for yourself to create a checklist of your individual needs. This will help you choose the most appropriate gynecologist for you, now. Remember that your needs may change over time and you may have to review this process.

___   Do you have any limitations or guidelines for Ob-gyn selection or referral from your insurance carrier?
___   How important is "bedside manner" or personality to you? If this is very important, you may want to consider asking a potential Ob-gyn to meet you for an informational interview or "get-to-know-you" visit. Feeling comfortable with this person is paramount.

___   Is the doctor's gender important to you? Race, age, religion, and other specifics may also be (or seem) important to you. Some women feel more comfortable with doctors who are more like them; other women feel differently. Remember, however, that while sharing values is nice, feeling like you and your values are valued is much more important.
___   How important are logistical concerns? Consider how far you're willing to travel, whether you want your gynecologist to be closer to your home or office, whether you will need to get there by public transportation, whether you need someone with evening or weekend hours, etc.
___   How important are the gynecologist's affiliations to you? Some women prefer having a gynecologist who is based at an academic health science center or a hospital; some prefer gynecologists with private practices; some women are limited to the Ob-gyn's listed in their managed care plan manuals. Generalizations about the quality of care or qualifications of gynecologist based solely on these credentials is inappropriate, however, and often irrelevant.
___   Are you planning to get pregnant? If so, you may want someone who practices obstetrics (provides prenatal care and delivers babies). If this goal is far in the future, this may not be relevant now, but be aware that you would have to switch to an OB once you become pregnant.
___   If you are pregnant: Do you need an OB trained in high-risk pregnancies? Common reasons to consult a specialist in maternal fetal medicine include having multiples (e.g. twins, triplets), having or having had a serious medical problem (from diabetes to high blood pressure to certain surgeries), having had previous miscarriages, or if your mother was given DES (diethylstilbesterol) in her pregnancy. Choosing an OB requires all of the same questions as choosing a gynecologist when you're not pregnant, but some additional criteria may take precedence, such as:

___   Where do you want to deliver? Many OB's deliver at more than one hospital; it's important to identify an OB who delivers at the hospital of your choice. How far the hospital is from your home (in time more than in miles!) may take precedence over any other factors!
___   Do you have specific concerns about your needs for the hospital? Things to consider: Whether you have limitations from your insurance carrier, whether you want/need an Intensive Care Nursery, whether you want/need 24 hour in-hospital anesthesia coverage, whether you want/need 24 hour in-hospital neonatology experts, whether you want a birthing room, whether you want a midwife to deliver your baby and an OB to supervise, what the hospital's policies on visitors are, what the hospital's policies on the baby staying with the mom (or not) are, whether you want a circumcision performed on your son in the hospital, and whether you want a sterilization procedure after delivery.
___   Do you like all the members of the OB's group? Will you have the opportunity to meet all the OB's in the practice? Remember that you may not deliver when "your" OB is on duty. Even solo practitioners generally have cross coverage systems.
___   If you have had difficulty getting pregnant, you may want to consult a sub-specialist in infertility called a "reproductive endocrinologist". These are gynecologists who have extra training, experience, and further board certification. There is a difference between a gynecologist who has done a fellowship in Reproductive Endocrinology and Infertility versus a generally trained gynecologist who has a special interest in infertility. If you are being evaluated by your regular OB/Gyn for infertility, you should ask at what point they would refer you to an infertility sub-specialist. Generally, this should happen within 6--12 months of treatment with your OB/Gyn depending upon the particulars of your history, diagnosis, insurance coverage, and age. Particular concerns in choosing an infertility specialist include many of the same factors as choosing any gynecologist, as already discussed. Some unique considerations for infertility specialists include:
___   Questions about in vitro fertilization (IVF) treatment: Ask for the doctor's specific success rate for patients who have had similar circumstances to yours.
___   Questions about cost: Don't be embarrassed to discuss this frankly. Many costs related to infertility treatments are not covered by insurance, and this can be very expensive. Many specialists who perform IVF have financial counselors on staff to assist couples proactively in this regard. Make sure that the prices you are quoted include all the details; find out what your insurance will cover before initiating treatment. Remember that prices for IVF are often quoted per treatment cycle; most couples require more than one treatment cycle to achieve a pregnancy.
___   Questions about convenience: As with obstetrics, there are often many tests involved; convenience may be a concern. You should ask whether blood tests and ultrasounds, for example, can be performed at the office or if you will have to travel to another location for them. Many treatments must be carried out on a particular day of your cycle; ask if the doctor's practice has staff and technicians seven days a week and during holidays.
___   If you (or your mother or your sister) have had a gynecologic cancer (e.g. ovarian, cervical, or endometrial cancer), you may want a sub-specialist called a gynecologic oncologist ("Gyn Onc") to provide your routine gynecologic care. Alternately, you may want to choose a gynecologist who has had additional training in your particular kind of cancer, or one who has a good working relationship with a Gyn Onc with whom you're comfortable.
___   If you are sure (or at least pretty sure) that you do not want to become pregnant again, you may want to choose a gynecologist who no longer practices obstetrics. In some cases, these gynecologists are able to have more predictable office hours schedules and may be able to focus more on non-obstetric gynecologic or general women's health issues.

Created: 9/21/2000  -  Donnica Moore, M.D.

 Different women need different things from an Ob-gyn, and most women's needs change throughout their lives. 

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