1. Science-Based Health Care
Consumer Health
Science-Based Health Care

2. Science-Based Health Care
Personnel
Choosing a physician
Basic medical care
Surgical care
Quality of medical care
Disciplining of physicians
The intelligent patient
Agency for Health Care Policy and Research (AHCPR)
Under the Evidence-based Practice Program of the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research—AHCPR), 5-year contracts are awarded to institutions in the United States and Canada to serve as Evidence-based Practice Centers (EPCs). The EPCs review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments. The EPCs also conduct research on methodologies and the effectiveness of their implementation, and provide technical assistance in translating the reports and assessments into quality improvement tools and in helping to inform coverage policies.
Agency for Healthcare Research and Quality (AHRQ)
Outcomes research seeks to understand the end results of particular health care practices and interventions. End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditions—where cure is not always possible—end results include quality of life as well as mortality. By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care. Supporting improvements in health outcomes is a strategic goal of the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research).

3. Health Care Personnel Medical doctors Podiatrists Nurses
Medical & osteopathic
Podiatrists
Nurses
Allied health providers
Undergraduate Education--4 years at a college or university to earn a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry, and physics (some students may enter medical school with other areas of emphasis). Medical School  (undergraduate medical education) -- 4 years at one of the LCME-accredited US medical schools, consisting of preclinical and clinical parts. After completing medical school, students earn their doctor of medicine degrees (MDs), although they must complete additional training before practicing on their own as a physician. (Note: Some physicians receive a doctor of osteopathic medicine [DO] degree from a college of osteopathic medicine.) 
Osteopathic medicine is a distinctive form of medical practice in the United States. Osteopathic medicine provides all of the benefits of modern medicine including prescription drugs, surgery, and the use of technology to diagnose disease and evaluate injury. It also offers the added benefit of hands-on diagnosis and treatment through a system of therapy known as osteopathic manipulative medicine. Osteopathic Medicine emphasizes helping each person achieve a high level of wellness by focusing on health education, injury prevention and disease prevention.
Residency Program (graduate medical education) -- Through a national matching program, newly graduated MDs enter into a residency program that is 3 to 7 years or more of professional training under the supervision of senior physician educators. The length of residency training varies depending on the specialty chosen: family practice, internal medicine, and pediatrics, for example, require 3 years of training; general surgery requires 5 years.  (Some refer to the first year of residency as an "internship"; the AMA no longer uses this term.) Fellowship   -- 1 to 3 years of additional training in a subspecialty is an option for some doctors who want to become highly specialized in a particular field, such as gastroenterology, a subspecialty of internal medicine and of pediatrics, or child and adolescent psychiatry, a subspecialty of psychiatry. After completing his or her undergraduate, medical school, and graduate medical education, a physician still must obtain a license to practice medicine from a state or jurisdiction of the United States in which they are planning to practice. They apply for the permanent license after completing a series of exams and completing a minimum number of years of graduate medical education. 
The majority of physicians also choose to become board certified, which is an optional, voluntary process. Certification ensures that the doctor has been tested to assess his or her knowledge, skills, and experience in a specialty and is deemed qualified to provide quality patient care in that specialty. There are 2 levels of certification through 24 specialty medical boards -- doctors can be certified in 36 general medical specialties and in an additional 88 subspecialty fields. Most certifications must be renewed after 6 to 10 years, depending on the specialty.   
Learning does not end when physicians complete their residency or fellowship training. Doctors continue to receive credits for continuing medical education,   and some states require a certain number of CME credits per year to ensure the doctor's knowledge and skills remain current. CME requirements vary by state, by professional organizations, and by hospital medical staff organizations. 

4. Choosing a Physician Steps Getting more information Check insurer
Yellow pages
Talk with friends and coworkers
Meet with physician
Verify license
Getting more information
Medical Board of California, Healthgrades, Physician Reports, Choice Trust, AMA
Doctor Access critical background and performance data on doctors.
Find & Compare Doctors Get critical quality information on current or new physicians.
Check Out Your Physician Search discipline records for physicians nationwide.
See Doctor Credentials Make sure your doctor does not have disciplinary actions.
Matching Sites About This
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American Medical Association The AMA Web site.
Choosing a Doctor HOW TO CHOOSE A DOCTOR? Choosing a qualified medical doctor is important to your health care. Everyone should have a primary care ...
How to choose an eye doctor for a child. Eye Doctors, Pediatric ... How to choose an EYE DOCTOR for your child. ... Choosing An Eye Doctor By Patricia S. Lemer, M.Ed., NCC Executive Director, Developmental Delay Registry (DDR) ...
Medical Board of California - Services for Consumers - How to has a pamphlet titled Services to Consumers from the Medical Board of California which contains more detailed information about choosing a doctor, checking on ...
I need to find a new doctor.  How can I make a good choice?
The Medical Board does not provide a referral service for consumers who need to choose a doctor.  However, the following information may help you make a choice.
If you have health insurance, the first place to check is with your insurer or your employer's benefits office.  Many insurance plans now limit your choice to a list of doctors who agree to certain requirements.  Many plans also require you to select a primary care physician (PCP) from their list.  The PCP is then responsible for your care, and must make any necessary referrals to specialists or other health professionals.
If you are not limited to a list of doctors, most physicians are listed in the telephone yellow pages and, in larger communities, they are listed by specialty.  For your main physician, you should consider a Family Physician or Internal Medicine Specialist (Internist); you also may want to choose an Obstetrician/Gynecologist if you are a woman, or a Pediatrician for your children.  All of these doctors are considered primary care practitioners, in that they can provide overall management of your health care.  If you are elderly, and have conditions associated with aging, you may want to seek a specialist in geriatrics as your PCP.  Regardless, be sure your insurance will cover the doctor's services before you incur any charges.
You may want to talk with friends or co-workers about physicians they like.  If this is not feasible, most county medical societies will give you names of physicians in your area who are in the specialty you select.  Look in the white pages for your county medical society or association.
Once you have some names, call the doctors and ask if they are accepting new patients. 
Be sure to ask whether they will accept your insurance plan (insurance plan lists often are outdated, as physicians are added or deleted from the plan).
Ideally, you should meet the physician and discuss your health concerns while you are well.  This may be a good time to have history and physical examination performed, but, again, make sure your insurance will cover it.  Most plans will not cover an informal visit just to get acquainted.
Before you make an appointment, call the Medical Board to verify that the doctor has a current California license.  Also, ask if there have been any disciplinary actions, or if any charges are pending.  This service is available by calling (916)  For more information:

5. Basic Medical Care Complete medical exam needed? Targeted evaluations
Periodic Interventions
Age Specific Charts
US Preventive Services Task Force
Put Prevention into Practice
Searched on “annual check up” and found “Time to Check Your Checkup Schedule “
Here's some good news for Walter, and for the two-thirds of Americans who don't get annual physicals: You have one less thing to feel guilty about. More and more public health researchers are now saying you don't need a yearly checkup.
The annual checkup is "a dead concept," says David Atkins, MD, the coordinator for clinical preventive services at the U.S. Agency for Healthcare Research and Quality. And he has company.
"The annual physical is a waste of time, money, and effort," adds Donald B. Louria, MD. He's chairman emeritus of the department of preventive medicine at the University of Medicine and Dentistry of New Jersey. "It makes fortunes for laboratories, but it does nothing for public health."
In 1947, the American Medical Association (AMA) recommended an annual exam for adults over 35. The recommendation was changed in the 1980s to a checkup every five years before age 40 and every one to three years thereafter. Today, the AMA doesn't suggest a recommended interval, saying it varies with a patient's age, socioeconomic status, heredity, and other individual factors.
USPSTF -
An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.
Recommendations Topic Index: A-Z Clinical Categories
Features About USPSTF Methods and Background Questions and Answers Resource Links
PIPP -
A program to increase the appropriate use of clinical preventive services, such as screening tests, immunizations, and counseling, which are based on USPSTF recommendations.
Tools & Resources Health Care Systems/Clinicians/Office/Clinic Staff, Health Care Consumers Ordering Information How to Obtain Prevention Materials
Implementing Preventive Care Prevention Program Fact Sheets
Features About PPIP News Questions and Answers Bibliography: Prevention
Guide to Clinical Preventive Services
Left frame has links to age group tables

6. Basic Medical Care Guide to Clinical Preventive Services Frequency
Age Specific Charts
Barriers to patients getting preventive services
Frequency
Infants & Young Children: annually
Young adults (symptom free): every 5 years
years: every 3 – 5 years
years: every 2 – 3 years
60+: annually
Guide to Clinical Preventive Services: Second Edition (1996) - but updated regularly on the web
INTRODUCTION
i. Overview
. . .
Value of Prevention
Clinicians have always intuitively understood the value of prevention. Faced daily with the difficult and often unsuccessful task of treating advanced stages of disease, primary care providers have long sought the opportunity to intervene early in the course of disease or even before disease develops. The benefits of incorporating prevention into medical practice have become increasingly apparent over the past years, as previously common and debilitating conditions have declined in incidence following the introduction of effective clinical preventive services. Infectious diseases such as poliomyelitis, which once occurred in regular epidemic waves (over 18,300 cases in 1954), have become rare in the U.S. as a result of childhood immunization.1 Only three cases of paralytic poliomyelitis were reported in the U.S. in 1993, and none was due to endemic wild virus. Before rubella vaccine became available, rubella epidemics occurred regularly in the U.S. every 6-9 years a 1964 pandemic resulted in over 12 million rubella infections, 11,000 fetal losses and about 20,000 infants born with congenital rubella syndrome.2,3 The incidence of rubella has decreased 99% since 1969, when the vaccine first became available.4 Similar trends have occurred with diphtheria, pertussis, and other once-common childhood infectious diseases.1
Preventive services for the early detection of disease have also been associated with substantial reductions in morbidity and mortality. Age-adjusted mortality from stroke has decreased by more than 50% since 1972, a trend attributed in part to earlier detection and treatment of hypertension.5-7 Dramatic reductions in the incidence of invasive cervical cancer and in cervical cancer mortality have occurred following the implementation of screening programs using Papanicolaou testing to detect cervical dysplasia.8 Children with metabolic disorders such as phenylketonuria and congenital hypothyroidism, who once suffered severe irreversible mental retardation, now usually retain normal cognitive function as a result of routine newborn screening and treatment.9-16
Although immunizations and screening tests remain important preventive services, the most promising role for prevention in current medical practice may lie in changing the personal health behaviors of patients long before clinical disease develops. The importance of this aspect of clinical practice is evident from a growing literature linking some of the leading causes of death in the U.S., such as heart disease, cancer, cerebrovascular disease, chronic obstructive pulmonary disease, unintentional and intentional injuries, and human immunodeficiency virus infection,17 to a handful of personal health behaviors. Smoking alone contributes to one out of every five deaths in the U.S., including 150,000 deaths annually from cancer, 100,000 from coronary artery disease, 23,000 from cerebrovascular disease, and 85,000 from pulmonary diseases such as chronic obstructive pulmonary disease and pneumonia.18 Failing to use safety belts and driving while intoxicated are major contributors to motor vehicle injuries, which accounted for 41,000 deaths in Physical inactivity and dietary factors contribute to coronary atherosclerosis, cancer, diabetes, osteoporosis, and other common diseases High-risk sexual practices increase the risk of unintended pregnancy, sexually transmitted diseases (STDs), and acquired immunodeficiency syndrome.23,24 Approximately half of all deaths occurring in the U.S. in 1990 may be attributed to external factors such as tobacco, alcohol, and illicit drug use, diet and activity patterns, motor vehicles, and sexual behavior, and are therefore potentially preventable by changes in personal health practices.25
Barriers to Preventive Care Delivery
Although sound clinical reasons exist for emphasizing prevention in medicine, studies have shown that clinicians often fail to provide recommended clinical preventive services This is due to a variety of factors, including inadequate reimbursement for preventive services, fragmentation of health care delivery, and insufficient time with patients to deliver the range of preventive services that are recommended Even when these barriers to implementation are accounted for, however, clinicians fail to perform preventive services as recommended,28 suggesting that uncertainty among clinicians as to which services should be offered is a factor as well.
Part of the uncertainty among clinicians derives from the fact that recommendations come from multiple sources, and these recommendations often differ. Recommendations [a] relating to clinical preventive services are issued regularly by government health agencies and expert panels that they sponsor,5,36-42 medical specialty organizations,43-50 voluntary associations,51-53 other professional and scientific organizations,54,55 and individual experts [a] The recommendations cited here are illustrative only. Listings of recommendations made by other groups for each condition considered are cited in the relevant chapter.
A second major reason clinicians might be reluctant to perform preventive services is skepticism about their effectiveness. Whether performance of certain preventive interventions can significantly reduce morbidity or mortality from the target condition is often unclear. The relative effectiveness of different preventive services is also unclear, making it difficult for busy clinicians to decide which interventions are most important during a brief patient visit. A broader concern is that some maneuvers can ultimately result in more harm than good. While this concern applies to all clinical practices, it is especially important in relation to preventive services because the individuals who receive these interventions are often healthy. Minor complications or rare adverse effects that would be tolerated in the treatment of a severe illness take on greater importance in the asymptomatic population and require careful evaluation to determine whether benefits exceed risks. This is particularly relevant for screening tests, which benefit only the few individuals who have the disorder but expose all the individuals screened to the risk of adverse effects from the test. Moreover, because recommendations for preventive services such as routine screening often include a large proportion of the population, there are potentially important economic implications.

7. Surgical Care Types Preparation for surgery Responsibilities Emergency
Ambulatory
Preparation for surgery
Responsibilities
Physicians
Patients

8. What’s a “Complete” Medical Exam?
Medical history
~20 to 100 questions
Physical exam
Clinical and laboratory tests
Report to patient

9. Quality of Medical Care
Means doing the right thing at the right time in the right way for the right person – and having the best possible results.
Agency for Healthcare Research and Quality
Quality health care means doing the right thing, at the right time, in the right way, for the right person - and having the best possible results.
Although we would like to think that every health plan, doctor, hospital, and other provider gives high-quality care, this is not always so. Quality varies, for many reasons.
Fortunately, there are scientific ways to measure health care quality. These tools, called measures, have mostly been used by health professionals. They use measures to check on and improve the quality of care they provide.
But there is some quality information you can use right now to help you compare your health care choices. And more and more is becoming available all the time. Many public and private groups are working to improve and expand health care quality measures. The goal is to make these measures more reliable, uniform, and helpful to consumers making health care choices.
There are two main types of quality measures that can help you choose quality health care: consumer ratings and clinical performance measures. Consumer ratings, or "consumer satifsaction" information look at health care form the consumer's point of view. For example, do doctors in the plan communicate well? Do members get the health services they need? Clinical performance measures, sometimes also called "technical quality" measures, look at how well a health care organization prevents and treat illness.
Here's some information to help you make an informed choice:
Your Guide to Choosing Quality Health Care, (AHCPR Consumer Publication) presents an overview of what health care quality means, and how to find and use information on quality when chossing health plans, doctors, treaments, hospitals or long-term care.
Agency for Healthcare Research and Quality (AHRQ)
Healthfinder®
Medicare Compare
Health Care Financing Administration

10. Disciplining Physicians
Agencies involved
Medical associations
Hospitals
State licensing boards
Discipline
Reprimands, expulsion
Privileges
License

11. The Intelligent Patient
Effective communication
Access to medical records
Telephone tips
Handling a grievance

12. Issue 7 Intelligent Consumer Behavior
Seek reliable sources of information
Maintain a healthy lifestyle
Select practitioners with care
Assess own health
Active health & illness management
Use scientifically substantiated health products and services
Understand costs of health and illness
Report fraud

13. Summary Personnel Choosing a physician Basic medical care
Surgical care
Quality of medical care
Disciplining of physicians
The intelligent patient