Response To An Important Reader's Comment

An anonymous reader commented: "How does a patient determine the factors you mentioned? A modestly sophisticate patient may determine these things over time, perhaps too late. Many patients do not have sufficient sophistication to determine and evaluate these factors. In the past, not too long ago, doctors' advice was taken quite uncritically. LCB"


My response invokes  recent experience. The story is real.

Like all of us, I develop  health problems from time to time.  In anticipation of my needing consultation from a  physiatrist or subspecialty surgeon, my internist ordered an MRI and  I visited a physiatrist to receive a series of treatments. These treatments failed; I needed a subspecialty surgical consultation. In discussing my expectations of the consultant with my referring internist, I said: I expected the consulting physician to: (1) be highly knowledgeable and experienced in the surgical subspecialty; (2)  have "good hands" (which to other physicians, means that he or she has excellent surgical dexterity and technique); (3) have a good base of medical knowledge and (4) good judgment. My internist (who at the time was being "trailed" by a medical student from a nearby university medical center) seemed a little surprised by my statement of expectations, but  gave me the name of two consultants, one within his group practice and the other outside. He asked me to see both physicians. The subspecialty surgeon within his group focused on the presenting diagnosis and told me that it was not the source of my problem but went no further, providing me with enough information to know that I was not going to receive the complex care I needed from him in that medical group.  I proceeded to the university medical center (to which my internist had sent a letter of referral) where I found a subspecialty surgeon (recommended by the department chairperson) who immediately demonstrated his qualifications to meet the expectations described above and will follow through with my care.

Readers can apply the same techniques. Tell the referring physician or other person what your expectations are. Ask for the names of several consultants and do not allow yourself to be locked into one medical group (may be difficult in an HMO setting).  Check your state medical board listing of disciplined physicians to learn if the doctor to whom you are being referred has had medical disciplinary or competency problems. Google the doctor and the practice. Ask friends, colleagues and others in your business and personal circles if they have had experience with the physician(s) to whom you have been referred. Pay attention to what they say about competency, focus, judgment, practice habits, experience as patients billing fairness and outcome.  Find out if the physician practices in a hospital and get an assessment of the quality of the institution (states have information about morbidity and mortality for certain procedures done at hospitals throughout the state and you can also ask to speak to the hospital's "Chief Medical Officer" for similar information).  If you will require surgery, get the statistics on frequency of the proposed surgery at the hospital or facility at which the doctor practices and the institution's and doctor's complication or failure rate.  Choose a physician who proposes to perform a procedure which he or she has performed many times before in an institution which has extensive experience with the proposed procedure: experience counts! And ask about the quality of the anesthesia services since anesthesia has its own serious set of risks.

These are some of the things a sophisticated, non-sophisticated person, or family member, can do.  Much of the important information is internet-available.

And finally, pay attention to your instincts: if you are uncomfortable with the doctor or your perception ofthe facility, find someone else or go somewhere else.