Sunday, July 20, 2014
Sunday, February 9, 2014
Sunday, January 12, 2014
Which of the following is the best measurement of quality of a pediatrician?
Sunday, January 5, 2014
Sunday, November 17, 2013
Sunday, October 27, 2013
- A surgeon removing your appendix in the back seat of your car.
- A psychiatrist hanging up on a patient who is threatening suicide.
- An internist invites recovering alcoholic patients to a wine tasting event.
Sunday, September 1, 2013
- Have you ever prescribed an antibiotic that was not medically essential?
- Have you ever admitted an individual to the hospital who could have been safely treated as an out-patient?
- Has every CAT scan you ordered been medically essential?
- Has every cardiac stent you have placed been in accordance with best practices?
- Do you consistently practice evidence based medicine?
- Has every batch of chemotherapy you prescribed been reasonably shown to improve patients’ lives?
- Is the scope essential to the patient’s care?
- Is there a safer alternative to answer the clinical question?
- When should the procedure occur? (We are often asked to do routine procedures on very sick hospital patients that should be deferred until after the patient is discharge and has recovered.)
- Has the patient provided informed consent to proceed?
Sunday, August 18, 2013
Sunday, April 7, 2013
- While residents work less at the hospital, they aren’t sleeping more.
- Residents are now required to do the same amount of work in fewer hours.
- Shorter shifts mean more ‘hand-offs’ of patients to the next crew of eager interns.
Sunday, November 4, 2012
On the day I wrote this post, I participated in a direct conversation with the treating physician at the hospital bedside which vexed me. This scenario would seem to be ideal from the patient’s perspective. At the bedside were the attending physician, the gastroenterologist (the Whistleblower) and the anesthesiologist who were conferring about the next appropriate diagnostic step in a patient who had experienced upper gastrointestinal (UGI) bleeding.
I was asked to evaluate this patient with UGI bleeding and to arrange an expeditious endoscopy to examine the esophagus and stomach region in order to identify a bleeding source. Hours prior to seeing the patient, I scheduled the procedure that I knew would be needed, a short cut that every gastroenterologist will do in order to be efficient. As the patient had other medical conditions, I requested that the sedation be administered by an anesthesiologist, rather than by me, to provide greater safety to the patient.
I arrived and became acquainted with the medical particulars. I agreed with the diagnosis of UGI bleeding and also that an endoscopy was the next logical step in this patient’s care. These observations are not sufficient, however, to proceed with the examination. There are other criteria that must be considered.
- Does the procedure need to be done now?
- Do the risks justify performing the procedure?
- Has the patient provided informed consent for the procedure?
We got to the right answer here, but had to set aside an unforeseen obstacle to get there. Communication means listening to another point of view and being able to change your mind. As a doctor, when it’s my finger is on the trigger, I call the shots. I this case, a doctor misfired.
Sunday, April 29, 2012
Only years later, as an adult, did I realize that history is a potent intoxicant that lured me into a deep addiction. Along with my Dad and brother, we sojourned many times across the country to many of our nation’s historical treasures. Most of these were civil war sites, which we properly regarded as hallowed ground.
Through happenstance nearly 2 decades ago, I learned of an aging physician in Saginaw, Michigan, Dr. Richard Mudd. I read that he had spent nearly his entire life trying to clear the name of his grandfather, Dr. Samuel Mudd, who was convicted as a participant in the conspiracy to assassinate Abraham Lincoln. My Dad and I drove up to Dr. Mudd’s home and listened to him tell his stories in in his parlor. The memory of this wonderful afternoon is vivid and indelible. This man, just 2 generations removed from the civil war, led me straight back to Lincoln.
As a physician, I also believe that history matters deeply, but it has been devalued. The medical history, the narrative that physicians elicit from our patient, remains the cornerstone of high quality medical care. Experienced physicians know, even if we often deviate from this practice, that a thorough medical history is the most significant and relevant data that will be available to us. Too often, short circuiting occurs, such as the hypotheticals listed below.
- A patient with chest pain is summarily referred for a cardiac stress test
- A patient with abdominal pain is whisked off for an ultrasound of the gallbladder (GB)
- A patient with a headache is sent for an MRI of the head
Using chest pain as an example, in many cases, a thorough history can lead to the diagnosis. While many diseases can be sly and masquerade as other conditions, experienced physicians can usually obtain solid evidence that chest pain is cardiac, pulmonary, gastrointestinal or muscular simply by listening to the patient’s story. A medical test should be ordered to answer a specific and significant question that remains after the medical history and a physical examination. (While the physical examination has real value, in general, it does not approach the worth of the medical history.) For example, we do not order an ultrasound of the gallbladder because a patient has a stomach ache. We do so because the history is suggestive of gallbladder pain, and the ultrasound will confirm the specific diagnosis under consideration. Here’s why this is so important. If an ultrasound of the GB is ordered casually on a patient with stomach pain, and gallstones are discovered, then it may be falsely assumed that an explanation for the pain has been found. This patient may be referred to a surgeon for a ‘curative’ cholecystectomy, or removal of the gall bladder. What should have happened at the initial visit was a careful medical history, which may have excluded the gallbladder as the culprit. Most gallstones found these days are innocent bystanders, and not a cause of symptoms.
Israeli researchers showed how powerful physicians’ basic clinical skills and acumen were in making a correct diagnosis, without scans and other imaging studies. It’s nice when a study confirms our gut instincts.
If a medical test is ordered, ask what specific question it is designed to answer. Is it a fishing expedition? Will it decide between 3 competing diagnoses? How will the test result change the care? If the results won’t change anything, then should the test be done?
Medical history counts in a big way, even if the pay-for-performance schemes can’t measure it. Will physicians still be taking old fashioned medical histories four score and seven years from now?
Sunday, June 26, 2011
There are some jobs where nodding off poses no risk. Let me test my readers’ acumen on this issue. Which of the following professions would not be at risk if an unscheduled siesta occurred?
- A race car driver
- A congressman
- A circus clown (not to be confused with above listing)
- A lawyer (not to be confused with the above listing)
- A school bus driver
We don’t know yet the reasons why folks are sleeping in the air traffic control towers. Maybe it’s the soft music they play. Perhaps, the sounds of incoming aircraft have a hypnotic effect. Or, maybe they’re just tired.
Indeed, the issue of control tower fatigue has been raised, among other potential explanations. It may be that their assigned work schedules are too demanding, and there are not sufficient work breaks. We’ll find out. Most of us who enjoying the luxury and comfort of air travel (turn on guffaw track now) are hoping that the air traffic controller who is guiding our plane to the runway is reasonably alert. However, I shouldn’t assume this. Choose from the following 2 statements.
I prefer that my air traffic controller be alert and well rested.
I prefer that my air traffic controller be in the 36th hour of his shift, with only a few pockets of interrupted sleep. I feel safe knowing that this battle hardened professional is prepared for any adversity. I don’t want some softie managing the radar. I want a tough guy who will do his job regardless of how fatigued and stuporous he is.
I’m afraid that many readers are now stuck, as they are agonizing over the above choice. If after 15 minutes, you still cannot choose an answer, then move on. You will have time later to return to this question.
The issue of fatigue is now recognized to be an important issue in the training of medical interns and residents. I remember when the tragic Libby Zion case in New York City occurred in 1984, which we all hoped would lead to reform in medical education. It is amazing how entrenched the medical education system is, and how difficult it is to modify it. New rules were issued to allow interns and residents more sleep and some mandatory time off, but there were exceptions and loopholes that are still used today. This was not simply an effort to introduce humanity into medical training. Relieving overworked medical interns and residents was designed to reduce medical errors and reduce medical malpractice. Even if I can't prove it, I maintain that a rested medical intern is more likely to avoid medical errors.
Why do so many still want medical interns and residents to work when they are exhausted? Is it for cheap labor for hospitals? Is it to test their mettle for when they become real doctors? Is it really so interns don’t ‘sign off’ at 5 pm and miss the natural history of their patients’ diseases? Are program directors trying to minimize patient ‘hand offs’ by having medical housestaff work extended hours? Or, do some senior physician educators advocate arduous work schedules because they endured it in their time?
All of the above reasons, and others I may have overlooked, can be refuted with sensible reforms, and everybody knows it. Sure, practicing doctors have to be sharp in the middle of the night, and we are. But, most nights we sleep comfortably at home. I don’t think the fatigue and ongoing sleep deprivation I suffered as a medical resident was necessary preparation for the nocturnal care that I am called to render now, from time to time.
I know that many physicians have strong opinions that oppose mine. I hope that they and others will express themselves here. I would like to close this post with the irrefutable evidence that supports my argument, but I feel myself starting to nod off. No worries. When a blogger bugs out for a few minutes, no one gets hurt.
Sunday, June 5, 2011
I remember a few decades interviewing at the medical school here. There are only 2 medical school interviews that I recall after all these years. At N.Y.U. School of Medicine, the canny interviewer asked me what the death rate of Americans is. I correctly responded, “100%”. I suppose that untangling enigmatic questions was an N.Y.U. admission requirement, since they did accept me, and I did attend. The other medical school interview I still recall was at Emory, although it’s not the questions I remember. Their unique interview format made the experience memorable. Three medical school applicants were interviewed simultaneously as we faced a bank of questioners. This was reminiscent of the ancient and popular TV show, The Dating Game, where 3 bachelors or bachelorettes heard their competitors’ responses and often had to respond to the same questions.
Emory University still has a strong pre-med focus in their undergraduate community, as do many other colleges. Do these idealistic kids have a clue about what post-med life will be like on the other side of the wall? Have they been reading newspapers (or iPads) about the convulsions the medical profession is experiencing, or have they been immersed in memorizing arcane facts about anatomy and pharmacology? Will they find medicine to be a satisfying career? What are their expectations?
In many ways, it will be easier for these new physicians than it has been for their ossified, older colleagues. You can’t miss what you never had. Their reality will be that they will be controlled by the government and insurance companies, if the latter still exist. They won’t be frustrated over loss of autonomy that they never had. They will regard absurd medical quality programs, such as pay-for-performance, to be necessary and integral components of quality medical care. They will routinely submit patient outcome data to payers who will link these outcomes to their reimbursement. These new doctors, who didn’t witness the evolution of these accountability initiatives, won’t recognize the gaping flaws and hidden agendas in these programs. They will likely be employed, and won’t harbor resentment and regrets of having been forced to leave private practice. There won’t be medical guidelines to consult designed by academics, but there will be medical mandates that will require compliance. Those who dare to deviate will have to submit volumes of documentation to justify thinking outside the mandate.
They will enter a profession very different from the one we did. They will be conscientious practitioners, but they won’t have the unbridled dedication to the profession that defined physicians for generations. They will value their lifestyles and their leisure time with friends and families. They will have more of a shift work mentality, which is natural for employees who don’t feel ownership of the operation. Increasingly, medicine will be practiced remotely from the patient, with telemedicine and robotics.
Of course, many of these changes will offer amazing medical benefits to patients. But, there will be a cost. Many of these advances will change what has been the core element of medical care – the doctor-patient relationship. This new paradigm is a difficult concept for many of us to accept, but it may not translate into inferior care. In many cases, medicine will be practiced without putting a reassuring hand or stethoscope onto the patient. Relationships will become more clinical and less personal, particularly as medical advice is offered from physicians in remote locations, who may not have met the patient. A skin rash in Cleveland may be evaluated by a dermatologist in New York City. An abdominal tumor in Topeka might be removed surgically by remote control by a surgeon in Chicago.
I think that physicians of the next generation can still find great fulfillment and reward in their work. Their satisfaction, however, will have to be linked to their expectations, which are quite different from those of their predecessors. There is another side of the equation that I have bypassed here, but is worthy of comment. The expectations of the public – our patients – will have to change also. The new rules of the game will challenge healers and those who come seeking their assistance. Will patients who have yesterday’s expectations be satisfied with tomorrow’s doctors?
Sunday, February 20, 2011
Assuming the facts are as presented, viewers are shocked to learn how long and how expensive it is to remove an incompetent teacher.
The New York Times reported that governors across the country are seizing on the public mood and are working to dismantle the teacher tenure system, where jobs are protected regardless of performance. As an aside, the Times’ headline reads G.O.P. Governors Take Aim at Teacher Tenure. You recall after the recent tragedy in Tucson, committed by an evil madman, some had criticized prior political ads that included crosshairs superimposed on political adversaries. Yes, these were Sarah Palin’s political ads. Critics suggested that these ads were not only tasteless, but created a climate of incitement. Should the Times’ phrase Take Aim in the headline above have been sanitized? Who knows? Someone might read ‘take aim’ and think it is a call to arms!
I was asked recently if the medical profession had a mechanism to verify if our older practitioners had the necessary cognitive and technical skills to practice medicine. The answer is, no we don’t. While other professions have mandatory retirement ages, we physicians are firmly on a tenure track that has no endpoint. Physicians can continue to treat patients, and even operate, without any limitation of age or requirement to certify that our skills are sufficient. I think a reasonable argument can be advanced that we could do better.
There is an emotional aspect of the argument advocating periodic assessments of physicians because lives are at stake. But many professionals who don’t wield scalpels or colonoscopes can also put our lives at risk. If an engineer, for example, designs a bridge and miscalculates, a tragedy could ensue. Before we all agree that physicians starting at age 60 should undergo testing every 5 years, let’s consider which other professions should be included in this effort. Nevertheless, I feel we have an obligation to our profession and to the patients we serve to assure them that we still have the right stuff.
Teachers’ unions have been recalcitrant and oppositional for decades and they have squandered the public trust. Their enemy is not the GOP governors or a public who is now hostile to them. Teachers are victims of their own self-interest. The medical profession has failed many times by not reforming ourselves proactively. Then, outsiders ‘reform’ us and we gripe about our loss of autonomy. Haven’t we learned what happens when outsiders heal us? I think that medical reform needs to be square in our own crosshairs before someone takes aim at us.
Sunday, July 4, 2010
More and more, I read about physicians who are ready to give it up. I hear similar views in the physicians lounge and in hospital hallways. These conversations are a modern phenomenon; they did not occur when I entered the profession 20 years ago.
They have germinated as a result of rising forces that have demoralized many practitioners. Some of them include:
• Loss of autonomy
• Loss of income
• Loss of stature and prestige
• Required ‘Quality’ initiatives
• Health care ‘reform’
• Infighting within the medical profession
• Medical liability system
• Insurance company hurdles to get paid
• General gerbil wheel existance
Luckily for me, I am still happy on the job. Of course, I am not immune to the above realities, and would readily accept a vaccine to protect against them, if one existed. I try to focus on the core purpose of being a physician, and work to sequester the noise and static, at least while a patient is seated before me. Since I am a member of the human species, I do not always succeed. Sometimes, stuff creeps out of a compartment at the wrong time, and I try to stuff it back in its place. It’s a struggle, but I usually prevail. So, with regard to being a practicing physician, I am not ready to give up. I keep my 'white flag' in the closet.
There is a part of the profession, however, that I have given up with zeal and enthusiasm. For me the decision was easy, but for some colleagues it is agonizing. A few years ago, I gave up performing a procedure that is essential for many gastroenterologists. It is called ERCP, which stands for a term that is so long, that I wonder if its practitioners thought they would be ‘paid by the letter’. To save you googlers a key stroke, here’s the term in full.
This is a fancy endoscopic event when the gastroenterologist passes one of our flexible black serpents down your throat and snakes it around corners to reach the small intestine. Then, tiny tubes can be inserted through the scope into the liver and pancreas to accomplish tasks that previously required surgery. This invention is a towering milestone in the practice of gastroenterology.
How important is this skill in my trade? Peruse the ads at the back of any medical journal under the gastroenterology section and you will read phrases, ERCP required or ERCP preferred.
Why would I give up performing a test that distinguished me in my specialty and made me a more marketable gastroenterologist? Would we expect a professional basketball player to eliminate 3 point shots from his game? Would we expect a concert pianist to declare a moratorium on playing any piece in the key of A flat? Would we expect a congressman to vote on legislation that he hasn’t read? (Yes, you may snicker now.)
It seems odd to voluntarily surrender skills that allows one to occupy a higher orbit in his profession; yet this is exactly what I have done. I gave up ERCP because I simply wasn’t good enough at it. I never killed anyone, and my complication rate was within the expected range for this procedure. It certainly was exhilirating when I was successful, and quite demoralizing when I couldn't get the job done. More and more, I realized that the ERCP field was advancing, but I wasn’t. My skills were acceptable, but stagnant. Why didn’t I simply incorporate the evolving technology and gadgetry into my practice? This response is a blog post in itself, but the summary statement is that it is extremely difficult for a practicing community gastroenterologist to stay current with evolving technical procedures.
So, I gave it up, not the professsion, but an important aspect of my practice. It was liberating as I now knew that any of my patients who needed ERCP skills would be referred to someone who did it much better than I could. The quality of a physician – or any occupation – is determined by the weakest element of his practice. I hope that pruning my practice has made it sturdier.
These are vexing issues. When does someone give up an essential element of his occupation? Sometimes, the answer is obvious. We don’t want cardiac surgeons with flapping tremors to perform delicate heart surgery. We don’t want airline pilots who suffer from sudden blackouts to be at the controls. However, sometimes the deficits are more subtle, and it is not clear that the practitioner is impaired to the extent that a professional change is required. Where is the boundary line and who should set it?
Quality measurers from the government, insurance companies and professional medical societies will soon be unleashed on a mission that they can't succeed at. They will fan out across the countryside claiming they can measure the unmeasurable. Those of us who understand the guts of medical care realize that what really counts, in medicine can’t be counted. For example, these qualitycrats might have deemed my ERCP skills to be acceptable, using their check-off boxes and quality rubrics. Indeed, I was granted privileges to perform this procedure in my local hospitals every 2 years through the perfunctory recredentialing process. The reasons that impelled me to set the ERCP scope aside are real and legitimate. But, they can’t be weighed and measured.
I hope that the quality buzzards who will suffocate the medical profession give up before we physicians do. I can loan them my white flag.
Sunday, May 9, 2010
There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want the absolute best performing individuals for the job. And so do the players. I wish this ethos were contagious to the rest of us.
The practice of medicine is not a meritocracy, either in the manner that students are accepted into medical schools, or in how we physicians practice. For example, what criteria do physicians use when they select a consultant? The ideal response is self evident. A consultant should be chosen because that specialist is the best qualified and is readily available to serve the patient. Medicine, however, is not an ideal universe. Consultants are not routinely selected solely for clinical skill. In my experience, availablity trumps clinical acumen for many referring physicians who want their patients seen expeditiously.
These points apply to all physicians who consult colleagues, but primary care physicians are the primary source of specialty consultations.
Here are some reasons, beyond medical quality, why certain medical specialists are chosen.
• Reciprocity – patients are referred in both directions
• Personal relationships
• Corporate enforcement keeping consultations within the network
• Economic pressure exerted by consultants to maintain referrals. I have seen this happen.
• Specialist willingness to do tests and procedures on request
• Patient or family request
Even if a consultant is selected for some of the above reasons, the patient may still be ably served. For example, if a patient needs a screening colonoscopy, it does not matter that the gastroenterologist be a world class endoscopist. A simple community scoper, even one who blogs, may be sufficient.
In my experience, most patients receive high quality consultant care. However, patients are entitled to know that there may be unseen reasons why their physicians choose specific consultants. We specialists are not entirely righteous either. When we consult other physicians, we are also responding to forces that are under the radar. I personally admit to this in my practice.
When I entered private practice 10 years ago, after 10 years of a salaried position, I naively believed that conscientious care and availability would be a winning strategy to build my practice. I have learned that the dynamics between primary care and specialty physicians are more complex, and that the path to private practice success is not linear.
In sports, it's all about winning. In medicine, it's also about how you play the game.
What’s your view?
Sunday, August 2, 2009
We can’t expect a patient to know if a CAT scan a physician orders is medically necessary. From a patient’s perspective, a test is medically necessary if the doctor orders it. However, physicians, with professional training and experience, know whether medical testing is urgent or optional. Isn’t that our jobs?
Of course, the practice of medicine often resides in the murky gray area where there is no single correct answer. In these instances, there can be several rational medical options available. Often, different medical studies examining a clinical question reach opposite conclusions. Sometimes, the medical issue at hand hasn’t been scientifically studied so there is no authoritative medical evidence to rely on. In these examples, differing medical recommendations are to be expected.
The bulk of excessive medical care I witness is not within the nebulous medical arena described above. These unneeded medical tests and treatments are black and white, not gray. It occurs every day in every doctor’s office, including mine. The most dramatic example of it, however, is the care rendered in our emergency rooms. The volume and expense of care given there routinely is absolutely astonishing. It is wasting a fortune of money and exposing patients to the risks and anxieties of extensive testing, even for minor medical conditions. Whenever one of my patients sees me in the office to review a recent ER visit, I try to disguise my amazement, as I look through all the lab results, x-ray reports, CAT scan interpretations and EKG tracings – often performed for some innocent complaint that has already resolved on its own. While this patient may believe that this medical pile on was great care, it wasn’t.
A serious risk of this buckshot-style medicine is that any one of the ultrasounds, CAT scans or other tests will detect an irrelevant and innocent abnormality that drags the patient to a brand new avenue of medical adventure. These new ‘abnormalities’, found by accident, create anxiety, cost money and mean more medical testing. This vicious circle is no merry-go-round carnival ride.
Why do ER physicians practice this way? Are they dumb? Hardly. In general, they are extremely capable and well trained. They perform well under pressure that can rival the tension found in any operating room. They make decisions routinely that determine whether a patient survives or succumbs. They have all of the necessary tools to practice judicious and conservative medicine, but they don’t.
They claim that the ER is a different medical universe, unlike primary doctors’ offices. They argue that they can’t miss serious diagnoses like heart attacks, strokes and blood clots to the lungs, all of which can be fatal. They need to test extensively because they have only one visit with the patient to get it right. Additionally, they point out that some of their patients may not follow up afterward with their primary physicians, even though they are advised to do so. Understandably, these physicians fear lawsuits against them if a patient they saw deteriorates after discharge. This latter reality motivates them to test patients aggressively.
I reject these arguments. In fact, the same ones could be applied to patients I see every day in my office. ER physicians should practice the same style of medicine that we all were taught to do during our medical training. Take a thorough history, perform an examination and then make appropriate recommendations. As a gastroenterologist, I see patients with chest burning in my office several times a week. The medical history allows me to determine if the chest discomfort is innocent or suspicious. In most cases, these patients don’t need a stat cardiac work up. Yet, if this same patient were seen in an ER…
Physicians, being members of the human species, are not perfect. It is not our task to test for every conceivable diagnosis in one visit. If an ER physician, or any doctor, thinks his patient’s abdominal discomfort is from constipation, then treat it accordingly and arrange for proper follow-up in the office. Don’t start a scan attack just because you can’t exclude appendicitis with 100% certainty. When we shoot for perfection, we are target our own profession.
I don’t think that the ER needs a different playbook. It just needs to play differently.
Tuesday, March 3, 2009
Here are some pointers in how to choose a good physician. Remember, while these tips offer guidance, there is no guaranteed method to rely upon.
- Ask friends and coworkers who their doctors are and why they like them. Keep in mind that they may like their doctors for the wrong reasons. If a neighbor recommends his doctor, because “he prescribes antibiotics over the phone whenever I want them”, then you may have learned something important – choose another physician. Conversely, a person may be dissatisfied with a doctor who truly performed well. For example, a patient may complain because his doctor wouldn’t give him a refill on addictive sleeping pills. While I encourage canvassing opinions about local physicians, use these recommendations cautiously.
- Ask hospital nurses for their advice. They see physicians working when doctors don’t know they’re being watched. They are an unrivaled source for obtaining a candid review of medical professionals. They know who is caring and conscientious, who spends time with patients and families, who communicates with consultants, who returns to the hospital when necessary and who puts patients first. Contact a few nurses at your local hospital and ask for 3 physician references. They will be delighted to speak with you. This is my hottest tip, yet, nearly no one follows it.
- Generate a list of 4-6 physicians to consider. Contact their offices and find out when the next available appointment is. If it’s in 3 months, then this physician might be too busy for you.
- Ask how much time the doctor allots for a new patient. If it’s 15 minutes, and you have chronic medical issues, then this might not be the right choice.
- Find out the logistics of the practice. Does the doctor see patients in multiple offices some of which may be far away? If a patient needs an urgent appointment, does one of the physician’s partners or a nurse practitioner see the patient? Does the doctor treat his patients in the hospital or does he refer them to other physicians?
- Who takes the doctor’s calls after hours? The doctor who will be taking your emergency call at night might be much more important to you than your regular physician.
- Narrow your list to 2 or 3 doctors and interview them. Get a sense of their style and manner. Does the doctor listen? Do you feel rushed? Is the office staff courteous and attentive? Can you picture yourself as a patient in this particular practice?
These tips will take you far, but not necessarily to the goal line. You may not get it right on the first try. Nevertheless, this is likely a better strategy to select a doctor than flipping through the yellow pages or resorting to eenie, meenie, miney moe.
Remember, you are not just trying to find a good doctor. You want to find one who is right for you.
Monday, February 23, 2009
So, if fame, notoriety and prestige are not the prescriptions for choosing a doctor, what should patients do? Check the next posting for some pointers.
Sunday, February 15, 2009
Here’s a list of attributes that define high quality physicians. This is not a controversial posting. After each entry, you will be nodding in agreement that it is an essential element of a high quality physician’s skill set. Here’s the unsolvable challenge. After reading each listing, decide how you could accurately rate a physician on the specific item and compare him to colleagues. I’ve been a physician for 20 years, and I have no idea how to do this. Perhaps, smarter folks can figure this out, since this is where true medical quality can be found, not in mindless, meaningless and downright dumb data and statistics.
Great physicians have many of the following skills and qualities.
- They are skilled at palpating abdomens and hearing subtle cardiac and pulmonary abnormalities with a stethoscope.
- They know when not to prescribe an antibiotic.
- They know when a symptom can be safely observed and not investigated immediately.
- They know whether a CAT scan finding should be ignored or pursued.
- They are expert communicators who sense when a patient harbors an additional concern.
- They have an adequate and current core of medical knowledge.
- They can skillfully manage a medical issue on the phone after hours.
- They understand and counsel that more consultants and tests often mean less care and healing.
- They tell the truth when a patient asks if the surgeon he has seen is the best choice.
- They are compassionate.
Of course, this list could be longer. The point is that what truly defines good and great doctors, can’t be calculated and entered on a spreadsheet. Don’t let the government or the insurance companies fool you on this one. Besides, are these institutions of such high quality that we should trust them to measure medical quality?
On the next posting, some physicians who might be too good to be true.