Saturday, May 19, 2012

On Selecting A Physician

Finding a new doctor can be a daunting experience, especially with hospitals and clinics going all out with media campaigns to corral new patients. So, if you are unable to find a doctor, it's more than likely that one will find you. 

A favorite method to capture patients is to circulate filmed interviews of doctors that can be widely seen on television, the internet and DVDs.

The clinicians are asked in the filming to reveal their values, interests and style of practice; giving the patient a brief look under the hood.  

Somehow, most of the interviewed seem to say more or less the same things: they like to take walks (by a lake is best),  read books, drink fine wines, bicycle and play with their Labradoodles.  None have yet referenced pub crawling or pick pocketing as forms of recreation and fulfillment.  Their style of practice is relentlessly collaborative - a partnership, whether you want to be a partner or not. 

Altogether a picture of sameness and similarity emerges from the interviews, right out of the Big Mac playbook, which seems to make choosing a new doctor less burdensome, less of  a choice.

The interviews suggest clinical competence which should be true for the vast majority of doctors.

Still, sniffing out a good doctor from advertisements can be perilous, especially at a time   when medicine has evolved from craft, to profession, and now to commodity.

So what strategies exist as an alternative to the media blitz?

One tried and true method is word of mouth recommendations, which generally expose the fakers (uncommon) and bloviators (not so uncommon).

Nurses, moreover, are excellent referral sources as they, more than most, get to see physicians with the mask off.  Most doctors I know are flattered when a patient is referred to them by a nurse.

Furthermore, don't hesitate to take the measure of the doctor yourself by scheduling a getting to know you appointment.  Your intuitions and observations can be telling.

And don't forget the medical assistant.  If they are bruised, the doctor probably is and you, by fallout, might be too.  If the assistant cares about whether your dog recovered from his accident, the doctor probably does too.  If the assistant seems out of control, the doctor might well be out of control too.

The point is that the assistant's manner and style often reflects the doctors, giving a sense of how the doctor's practice is run, a key variable in picking a doctor (read does it take four days for the doctor to return phone calls).

Finally, advice from George Bernard Shaw, who counseled patients to acquire a doctor whose father was rich, believing such a caregiver would order tests and procedures in a more measured way and might be able to spend more time with patients.

Outrageous, of course.

Worth a thought, of course.

Tuesday, May 8, 2012

Not So Fast

Dear Reader -

The link which follows is to an important and welcome article in the New York Times.  Nine premier medical societies have joined forces and endorsed frugality in the ordering of forty-five commonplace tests, scans and medications.

For example, sinusitis is rarely improved with antibiotics and MRIs of the back are much overused.

Some of us, brought up in the more is better school, might want the targeted tests regardless, believing they are an unmitigated good, especially attractive for individuals with health insurance.

Misguided use of monies is a big concern, but an even bigger one is that inappropriate testing can lead to errors of thought and judgement which can cause significant harm.

What you will read in the article has been known by the majority of physicians.  The issues have remained under the radar for a number of reasons, none more compelling than the staggering profitability of testing.

So here is the link Link NYT Article.

Your opinions and comments are hoped for.