Patient Power

Taking charge of your health

Looking for the Right Doctor? Pick a Babysitter

Finding the best physician partners is critical, so own the process.

Your children are precious to you. You are responsible for the development of their character and values, for their safety and protection. In return, they bring you joy and pride and the opportunity to live life anew (I know…not always!). So when you and your spouse have that rare opportunity for an adult evening out, you only do so when your are absolutely certain that you are leaving your little ones in the hands of a trustworthy, competent babysitter.

Your health is precious to you. You have obligations to care and provide for your family, and you want to share in all of the wonderful events and milestones associated with a long life. So when you are diagnosed with a significant, chronic, or life-threatening condition, you make absolutely certain that you are leaving your health care (and potentially your life) in the hands of a…physician you know little about.

More often than not, cancer patients appeared in my surgical office knowing little if anything about me, other than that another physician had referred them. Few of these new patients had any meangingful understanding of my medical skills, experience with their disease, or surgical results, let alone if I was arrogant, pleasant, rushed, or a good communicator.

But, you counter, they were referred to me by their primary doctor. Certainly he or she knows all about me.

Not likely. Most physicians refer to doctors within their medical network (group of employed or associated physicians) and with whom they have limited familiarity. For example, I recently spoke with a woman who had been diagnosed with a relatively rare cancer. She was afraid that the general surgeon to whom she had been referred might not be the best choice. With guidance, she rapidly confirmed her fears. Her referral was based on the lack of surgical specialists within her medical network. Fortunately, we were able to move her care to an out-of-network surgeon possessing significant experience in performing the challenging operation that offered her the best chance at survival.

Even more surprising to many is that physicians often don’t truly know “how good” the specialists to whom they refer really are. Virtually none of the physicians who referred to me had any objective data regarding my surgical outcomes. They knew I was a nice guy, and that my patients seemed to like me. They knew that their daughter and my daughter were on the same soccer team. We enjoyed some laughs together over an occasional quick lunch. But they didn’t know how often my patients suffered from surgical complications. Or my cancer recurrence rate.  Or my number of deaths. They didn’t know if I had ensured that my patients clearly understood the potential risks and benefits of the treatment options I was recommending.

Nor do most primary care physicians really “know” their patients. Most people interact with their primray doctor for fifteen minutes a year (at best). Your doctor knows your medical status, but that’s not the same thing as knowning you. Doctors rarely know much about your support network (family, friends, or the lack thereof) or fincancial situation (other than insurance). Doctors don’t truly appreciate the emotional impact your illness may have on your work or family life. Doctors often don’t understand how you as an individual learn and process information. To be fair, the enormous time constraints placed on today’s physicians make it virtually impossible for them to learn these things about their patients. Still, that doesn’t change the reality:  doctors don’t know you

Thus, based on a referral from a physician who knew little about them (other than medical condition) and little about my true professional capabilities, men and women, young and old, mothers and fathers, laborers and professionals and unemployed all landed in my exam room, waiting to hear (and in all likelihood agree to) my surgical recommendations for their care and, potentially, their survival.

I’d venture to guess that if you picked your babysitter this way, you’d be missing at least one kid by now.

So pick every physician partner like you pick your babysitter. When you needed a sitter, you began by asking your trusted friends what sitters they used and how things went. Your friends know and care for you and your kids.  They know that your son can be mischevious. They know that your daughter is a finicky eater. They know that your oldest loves reading and that your youngest shouldn’t watch scary movies. Thus, your friends offer meaningful referrals.

When picking your physician partners, there are two aspects to consider. First, you need to determine if a doctor is a “medical fit” for you. Review the physician’s professional website to better understand his or her interest and experience in caring for patients with your type and severity of illness. When first meeting, dig deeper into this critical question, asking about his or her interest and experience in caring for patients who are medically like you. Be respectful, but remember: it’s your health and your life. Accepting an oncologist who focuses on lung cancer when you're battling stomach cancer, or staying with a physician with limited experience in treating advanced kidney disease when you have advanced kidney disease is, well, ridiculous. Now, I understand that you didn’t complete medical school, but you are certainly bright enough to appreciate whether a physician is truly interested in and routinely cares for people suffering from your specific kind and severity of disease.

Secondly, you must determine if the physician is a right “personal fit.” For your personality. For your style of taking in information and evaluating options. A physician who accepts (better yet, desires) your active participation in your treatment decisions. No one can better make this determination, because no one knows you better than you do.

Think of the physician to whom you are referred as a candidate, and the first office visit as their interview. As the candidate doctor talks, listen as much to how they speak and interact as to what they say. Think about their style and manner. Is he or she too serious for you? Too casual? Does he or she explain things clearly? Is he or she open to questions (even repeated)? Do you feel rushed? Does the doctor exhude confidence? Over-confidence? Does he or she include your spouse in the discussion?

Remember, if you have a chronic condition, you’ll likely be partnering with a physician for years, even for the rest of your life (or their career). So don’t let a doctor who doesn’t know you select your long-term physician partners, critical players in your long-term health and quality of life. The first part of “owning your health” is you selecting your partner physicians.

Like your kids, your life is precious to you and your loved ones. So find a babysitter.

Own Your Health!

Peter Edelstein, M.D., is a passionate patient advocate, former Associate Residency Director at Stanford University Medical School and current Chief Medical Officer for global publisher, Elsevier.

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