Many years ago a great teacher at Duke Medical School, Eugene Stead, told me “What every patient needs is a really good doctor.” That’s as true today as it ever was. Notice it’s not a really good MRI or other whiz-bang test, or a really good Accountable Care Organization (warmed over HMO), or a really good Hospital System, or a really good Population Medicine Analyst, or Scientist, or Insurance Company. No. What every patient needs today, as then, is a really good doctor.
So how do you find one? You already know the answer. You just have to think about it. A really good doctor is a doctor who puts your welfare above everything else, and isn’t afraid to ask for help. Not to be too dramatic about it, but that doctor asks himself or herself–“What would I do if that were my dad? Or mom? Or son or daughter? What would I want done for me?”
And you can’t depend on Academic Medical Centers, those who “train the doctors.” Because likely as not, if you go to one, you’re going to see a doctor in training. Or wet behind the ears. Or a doctor who’s as interested in publishing papers and career development as they are in you. I’ve trained at several of the top academic medical centers in this country. I know. I was on the faculty of one for awhile and could have stayed forever.
And how about a doctor employed by a big Hospital System? They must be good, right? The hospital wouldn’t hire them if they weren’t? But all doctors who work for Hospital Systems have one little problem, even though many of them are fine doctors. Their problem is that they work for systems where many times the cardinal rule is “keep the patient in the system.” If those doctors refer you outside their system, sometimes they could lose their jobs.
This “keep the patient in the system” mentality is true Whether you need surgery, testing, or a second opinion. Never mind the fact that those systems charge you 2-5 times what an independent doctor’s office charges you for the same service. And hospitals don’t want to tell you they charge more than anybody else. If you knew that, you might go someplace else.
What about Board Certification? That seems like a good idea. I have five board certifications, and that is extremely rare for any neurologist anywhere. Yet there really isn’t any good evidence that all those board certifications and all those tests makes me any better than one of my partners down the hall who only has three. And some of the best doctors I’ve ever known don’t have any.
What about where the doctor went to Medical School or did their training (internship and residency)? Maybe that helps, but many times these factors are due to chance alone.
So how can you find a really good doctor? You look for the sine qua non: that doctor must be willing to put your welfare above everything else, and can’t be afraid to ask for help. If a second opinion frightens a doctor, you need to move on.
So look for doctors who have stayed independent from hospital employment, especially the family doctors and internists. These doctors are usually good. Especially with all the pressure up to now for the hospital acquisition of medical practices (though that trend may be quieting.)
That’s not to say that hospital employed doctors are not good doctors. It’s just that they have that one little problem–their employers want to lock you in. And no person can serve two masters. See this article from the Kansas City Star