Sunday, May 2, 2021

Choosing the Right Doctor for You.

As my readers know, I have been a parsimonious practitioner during my entire career.  By this, I mean that I believe that less medical care leads to superior medical outcomes.  I have devoted several dozens of posts on this subject within this blog.  This is my medical philosophy.   Other physicians who see the world differently would challenge me suggesting that I deny patients necessary diagnostic tests and treatments.  Personally, I think that I have the better argument, but so do they.

Interestingly, over time patients tend to select and stay with physicians who share similar philosophies.  For example, a patient who believes that regular diagnostic testing, frequent labs, a CAT scan now and then, prescriptions for various symptoms is unlikely to remain my patient because of a philosophical gulf between us.   If that individual, for example, expects antibiotics – as his former physician obediently provided – for what the patient believes is ‘diverticulitis’, and I demur, then this patient will be dissatisfied.  Assuming that I am correct that antibiotics are not needed, it remains a difficult task to disabuse such a patient from his belief.   First of all, many patients want medication despite the absence of supportive medical evidence.  And, if a previous physician has prescribed medicine for the very same symptoms, it stands to reason that the patient expects a similar response from me.   What I regard to be overdiagnosis and overtreatment, is described by these patients as thorough and appropriate medical care.  

Sir William Osler
Physician, Teacher, Philosopher and Parsimonious Practitioner 

Conversely, if a patient is circumspect about exposing himself to the medical industrial complex – subjected to diagnostic tests, medications and specialist consultations – then he will not mesh with a doctor who uses the medical accelerator more than the brake.

These philosophical distinctions I raise can also cause tension within the medical team.  A gastroenterologist may believe that his patient should have surgery the next morning.  The gastroenterologist’s partner sees the same patient the next morning and has a different view, even though the patient’s status has not changed.  And, just add some seasoning to this stew, the surgeon on the case may disagree with both of them.

Individuals need to consider philosophy when hiring a physician, an attorney or a financial planner.   How comfortable are you with risk?   Are you action-oriented or more deliberative preferring to see how events play out?   Do you worry that failure to act risks a worse outcome?  How many opinions do you need to feel secure?    Do you prefer advisers who mirror your own view or do you welcome a challenge?

It takes time to gauge your doctor's medical philosophy and your comfort with it.  But it is an essential element of the doctor-patient relationship.  Most patients have accepted, with great assistance from the medical profession, that more tests and treatments define higher quality care.  I've spent a career trying to explain to my patients why I disagree so passionately.

One of the first duties of the physician is to educate the masses not to take medicine.
Sir William Osler, 1910.

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