The bottom line is that patients who want to make sure their doctor is competent have a lot of work to do. And the work should be done on the front end: experts emphasize that people should find a doctor and establish a relationship while they are in good health, so they don't have to scramble when they come down with bronchitis or find a suspicious lump.

Studies have found that it is hard to get an appointment at short notice when cold-calling, and that patients with a regular source of care get better care, even when they are uninsured. While some internists have additional training in cardiology or rheumatology, she went on, primary care physicians also have a network of trusted specialists for referrals.

Many women choose a gynecologist as their regular doctor, Dr. Gallin said, but should probably have a relationship with an internist as well. Next, review the list of doctors in your health plan. Consider their location as well as their hospital affiliations. You may want to cross-check your health plan's list with a top doctors list for your area; these lists (often published in regional magazines like New York and New Jersey Monthly) are usually generated by surveying physicians.

Check with your health plan to see whether it has good information on individual physicians (most don't, but many are working on it). Good quality measures include National Committee on Quality Assurance accreditation about whether doctors meet criteria for care for specific conditions like back pain or diabetes, and the Healthcare Effectiveness Data Information Set, which focuses on adherence to clinical guidelines, like prescribing a beta blocker after a heart attack. Some health plans also offer networks of high-performing or "honor roll" physicians; ask about the criteria.

If you're uninsured, you may be able to negotiate with a doctor and agree on a reduced fee, but remember that you will also be responsible for the cost of lab tests, blood work, X-rays, procedures and medications. These costs are more likely to be covered or charged on a sliding scale at a community health center or hospital clinic. (To find a location, see www.hrsa.gov under "Find Help", or the Families USA Web site, www.familiesusa.org, under "Resources for Consumers".)

Other factors to consider are whether the doctor has evening and weekend hours, whether the office leaves time open to schedule same-day appointments for urgent care, whether waiting times are reasonable and whether the doctor is in solo practice or a group practice. (Some experts say that group practices tend to be more efficient and that doctors in groups are more likely to stay up to date on current medical practice.) If the doctor uses electronic records, that's a plus, some experts say.

On the crucial question of whether you are comfortable with the doctor you've chosen, you won't know that until you meet with the doctor. Pediatricians will usually agree to an interview; busy internists often won't.