Doctors For Runners
What Runners Should Look for In a Doctor

Although we hope that you're staying healthy and uninjured, at some point in time you're going to need the services of a medical professional. Choosing the right doctor can be downright confusing, even scary, these days. Managed care, HMOs, PPOs, utilization review, gatekeeper…and on and on! What's a runner to do?

I'm Special!
Yes, you are. As a runner you have special needs, it doesn't matter whether you can run a mile in 4:00 minutes or a marathon in six hours, the fact that you run sets you apart from many of the patients most doctors see. Keep in mind that physicians are used to seeing people who are sick. The average American is getting heavier and more sedentary, as a result many of the diseases they develop are illnesses that reflect their lifestyles: diabetes, heart disease, and some cancers. When a fit runner (or anyone who works out regularly) walks into their office, some doctors don't understand that their low blood pressure and pulse rate, enlarged heart, and perhaps small amounts of red blood cells in their urine (particularly if they're a distance runner) is perfectly normal.

When I was running three or four marathons a year, I once had a doctor order an EKG and extensive blood work when I presented with symptoms that indicated that I was dehydrated from a 22-mile run in 60+ degree weather the day before. She even questioned me over and over again about my "drug use", convinced that I was a regular cocaine user! Finally a nurse (who was also a distance runner) and had talked to me about my training, was able to convince the doctor that what I really needed was fluids and I would be fine. I appreciated the physician's concern and getting an EKG and having blood drawn certainly didn't hurt me, but my insurance company might have been spared the cost of all those tests if the doctor had had a better understanding of how "different" runners can be.

Who to Choose
There are many different kinds of health care professionals for you to choose from. They include:

Some of these doctors may be "sports medicine specialists", but keep in mind that as of only a few years ago, the American Board of Medical Specialties still does not officially recognize sports medicine as a specialty. Until recently "sports medicine specialists" have learned their specialty on-the-job, but luckily that has begun to change during the last several years. Fellowships are now available for interested physicians to apply for fellowships. Doctors who are trained in another area (perhaps orthopedic or internal medicine) spend one or two years training in a sports medicine clinic. Once the training is completed, they take an exam so they can receive a Certificate of Added Qualifications.

It pays to be aware that just because a physician or physical therapist is certified in sports medicine still doesn't guarantee that they will have experience treating runners. An orthopedist who treats your local high school football team may not be the best choice for you. Most football injuries are traumatic, while the majority of running injuries are caused by overuse. Find a doctor who has experience working with runners, you're more apt to get the proper care and treatment for your injury. Definitely steer clear of doctors who treat professional teams. Pro teams often choose their doctor group based on economics, rather than skill. Physician groups place bids with the teams, and a group may be chosen because its numbers look favorable.

Who Should I See First?
If you're a member of a health maintenance organization (HMO) or preferred provider option plan (PPO), which the majority of people are nowadays, you will have to see your primary care physician or "gatekeeper" first. They can refer you to other specialists as needed. A primary care doctor can be either a medical doctor or an osteopath. The main difference between medical doctors and osteopaths is in some aspects of the training. Osteopaths receive much of the same training, and are usually admitted to the same specialty residency programs as doctors who graduated from "traditional" medical schools, but osteopathic training emphasizes holistic medicine and manipulative treatments.

What to Expect if You're Referred
Whether your primary care physician refers you to another doctor depends on your injury and/or condition. He or she can probably treat you for most non-musculoskeletal problems. However, chronic overuse injuries such as Achilles tendonitis, plantar fasciitis, shin splints, and knee pain require a specialist.

Keep in mind that your primary care physician will probably not refer you to a chiropractor, holistic health care practitioner or a neuromuscular therapist if you're a member of an HMO or PPPO. If you want to explore one of these options, you will have to pay out-of-pocket for their services.