By Writer: Lani Luciano Reporter associate: Cassie Sauer

(MONEY Magazine) – Dotty Bowers had suffered severe headaches since childhood, and they only got worse with time. No one seemed able to help -- not her family doctor in Middlebury Heights, Ohio, who prescribed ever-stronger pain relievers; not her dentist, who thought the trouble might be her teeth; and not Dotty, who -- like many sufferers -- blamed herself. ''I was sure the headaches were my fault,'' says the 58-year-old librarian, ''a result of my inability to handle stress.'' For Dotty, as for many of the estimated one in 10 Americans with persistent health problems, relief came only when she stopped taking a scattershot approach to treatment and turned instead to a multidisciplinary group of experts for help. Enrolling in the headache program at the nearby Cleveland Clinic, she put herself through months of counseling, food-allergy screening, biofeedback and meditation training that cut the number of headaches by 90%. Five years later, she still says the experience changed her life: ''I used to live in fear of headaches and hate myself for having them. Now they're less painful and less frequent.'' Success stories like hers help explain why specialized medical clinics -- once run only by a limited number of major research centers like the one in Cleveland -- are increasingly common. For pain alone, there are now more than 1,000 clinics nationwide. Countless others are devoted to asthma, allergies, insomnia, over- and undereating, sexual dysfunction, infertility and so on. The theory behind the clinics is sound: persistent problems often respond only to a combination of advanced treatments. But clinics can be expensive -- anywhere from several hundred dollars up to tens of thousands, though health insurance often covers them. Quality of care varies from state of the art to run of the mill. And the worst of them may be no more than marketing gimmicks in which doctors or hospitals hang out a shingle saying CLINIC and then boost their fees 20%. Here, then, are some ideas on seeking a clinic for whatever ails you: When should I consider going to a clinic? Simply, when you've tried and failed to find help for a problem that you feel is spoiling your life. ''Unfortunately, most doctors aren't prepared to treat the complexity of chronic problems, and that includes many specialists,'' says Dr. John Bonica of Seattle, founder of the International Association for the Study of Pain. ''There are orthopedists, for example, who think that surgery is the answer to everything. If you've been to more than two doctors and you haven't been helped, it's time to try a clinic.'' How can I find a clinic that specializes in my problem? The best way is to be referred by your physician or someone else whose medical judgment you trust. And the self-help groups that specialize in your malady (several are listed at the end of this article) may also give valuable guidance. How can I tell whether a particular clinic is a good one? Accrediting agencies can provide a list of approved clinics for certain problems. Pain clinics, for example, are judged by the Commission for the Accreditation of Rehabilitation Facilities (101 Wilmot Rd., Tucson, Ariz. 85711); sleep clinics by the American Sleep Disorders Association (604 Second St. N.W., Rochester, Minn. 55902). But the best indication of quality is a clinic's reputation among experts in the field. What things should I look for in the clinic itself? Many of the best offer a ''treatment team'' approach that combines providers from many specialties. Also important: seek a clinic that lets patients help decide about their own care and one that emphasizes therapeutic techniques that you can continue to use later at home. Are there any danger signs? Some operations that call themselves clinics are really more like franchises sold to hospitals or individual doctors. Optifast and Medifast weight-loss clinics, for example, rely on prepackaged liquid- protein diets -- and not much else -- to produce results. A three-year study published in March in the Medical Letter of Drugs & Therapies found that less than 20% of patients on liquid-protein diets were able to sustain weight loss 18 months later. In contrast, the Duke University Diet and Fitness Center's two- to four-week resident program provides intensive, 30-hour-a-week counseling and re-educates patients on the role of food in their lives. It can even train a spouse or companion to help. ''About 70% of our patients keep the weight off after one year,'' says John Carmel, director of admissions. Will my insurance cover the bill? Doctors' fees and services ordered by doctors are generally covered. But insurers may balk at the tab for boarding at a special facility. Your safest bet is to get the clinic pre-approved by the insurer before you enter. Should I expect a cure? Probably not, but you should aim to turn an unlivable situation into a livable one by reducing symptoms, changing your perceptions or both. That was Bobbye McGhee's experience when he sought relief at the Central DuPage Hospital sleep clinic for his apnea, a condition that forced him to wake frequently to get his breath. After being fitted with a special mask, McGhee -- a 50-year-old Chicago insurance claims manager -- now dozes hours at a time. ''I'd like to sleep through every night,'' he says. ''Maybe someday I will. Still, it's a terrific improvement over what I had.''

Here are sources of more information: Anorexia or bulimia. Anorexia Nervosa and Related Disorders, P.O. Box 5102, Eugene, Ore. 97405 (free list of clinics) Obesity. Overeaters Anonymous, P.O. Box 92870, Los Angeles, Calif. 90009; 213-542-8363 (referrals to local chapter) Pain. The National Chronic Pain Outreach Center, 4922 Hampden Lane, Bethesda, Md. 20814 (pamphlet How to Choose a Pain Clinic, $1); American Academy of Pain Medicine, 43 E. Ohio, Chicago, Ill. 60611 (free list of doctors) Sexual dysfunction. Sex Information and Education Council of the U.S., New York University, 32 Washington Place, New York, N.Y. 10003 (free list of clinics) Sleep disorders. American Narcolepsy Association, P.O. Box 1187, San Carlos, Calif. 94070; 800-222-6085 (referrals to local clinic)