When your life hangs in the balance, you should not trust your doctor. There is too much at stake. If you are a defendant in a criminal trial confronting a life sentence, you should not trust your lawyer either. You need to get involved personally. You need to check on everything that is being done. Consult other doctors. If your problem is legal, consult with other lawyers. For that matter, I don’t think you should trust your accountant if there is a lot of money involved-- if, for instance, the I.R.S. has attached your bank account and is claiming that you owe them more money than you make in a year. Important matters should not be left entirely in the hands of professionals who work for you. As everyone knows, professionals who are expert—including doctors—have been known to make egregious mistakes, and, in the case of doctors, fatal mistakes.
We all know stories about doctors who gave their patient a clean bill of health only to see that patient drop dead at their doorstep. Of course, this does not mean the doctor made a mistake. People get sick suddenly and unpredictably. But there are also documented accounts of doctors who read an X-ray as normal, when it plainly showed a cancer. I know of a doctor who claimed a patient’s eye was diseased, when it was not; and then proceeded to operate on the wrong eye! Luckily the eye he wanted to remove was normal. Over the years I have had a number of malpractice lawyers in my practice, so I have heard numerous stories of this sort—some that would make your hair stand up on end.
But doctors can make a different kind of mistake. What I found strange when I first started running the health anxiety clinics was how many patients had been told they had a fatal disease when they did not! Rather than making the mistake that everyone worries a doctor might make, namely missing the diagnosis of a deadly disease, their doctors worried them unnecessarily by diagnosing deadly diseases that were not present. That happened to me once. I had a swollen leg. Being a health worrier myself at that time, I had already made sure by repeatedly testing myself that I did not have the fatal kidney disease the doctor, when I finally got around to visiting him, informed me blithely that I had. I was able to dismiss his opinion out of hand. But I have had patients who forever after worried about the disease they were told they had.
But we all depend to some extent on doctors—and lawyers and accountants too. Most of them are competent. But it is difficult for a lay person to judge whether a particular practitioner is one of them. I have gone to the same dentist for forty years. I like him. My teeth are in good shape. I have even recommended him to friends. But I really don’t know if he is a good dentist. What I would need to know to make that judgment would be how he handled difficult cases—and I don’t even know what a difficult case is.
Most of the time we judge these professionals by their reputation. That is the best we can do. We ask a doctor what he thinks of other doctors; but we can be misled sometimes anyway.
When my wife was pregnant for the first time, she complained of a pain in one of her ribs. There was a hard lump there. Being the health worrier I was, I started worrying about malignant bony tumors that are found sometimes at that location. Even my wife was worried a little. I asked a surgical resident, who was a friend, whom he would go to see for a consultation if it were his wife. He told me about the surgeon who had the very best reputation at N.Y,U. When this man examined my wife, he went “hmmm.” He said he wasn’t sure about what this lump was. I asked him about the possibility of it being the bony sarcoma I had fixed on. That tumor was uncommon, he said. He recommended watching it for a while.
When we were walking home, I was fuming. I wasn’t a surgeon, but I knew that if it was a possibility she had cancer, we did not want to wait around to see if it got worse! A moment later we happened to walk by the radiologist’s office that my wife had gone to in connection with her pregnancy. I suggested stopping in to see him. The radiologist did an X-ray and told us that the lump I was concerned about was the end of her rib. A normal bump on the normal end of a rib. It was unequivocal. He showed it to me on the X-ray. My God, I thought, shouldn’t a surgeon with a good reputation by able to decide how to tell a cancer from the normal end of a rib? Why didn’t he order an X-ray?
All right. I don’t want to overstate this problem. Most doctors I have known—and I have known a lot of them—were competent and responsible. But some surely were not. So, what advice do I give to someone who is looking for a physician?
Look up the doctors in your community. Limit your choices to those who are board-certified. See if they have had particular clinical training and experiences relevant to the sorts of problems you have. Ask other doctors in the community about him/her. Go see the doctor. Does he/she see patients more or less on time—and make a point of being reachable by telephone? Is he/she friendly? Does he/she listen? (good) Is he/she arrogant and unwilling to consider your concerns, however outlandish they may be? (bad) Do records get lost? Does he/she call with laboratory results? Is he/she rude? (very bad, but not uncommon.) Does the doctor do tests just to reassure you or because you ask for them? (bad.) Does he/she prescribe drugs just because the drug rep left free samples? (I am particularly annoyed by general practitioners who give out anti-depressants carelessly without arranging for proper follow-up.) In the end, it is reasonable to go to a doctor whom you like.
Choosing the right doctor is often put in terms of trust. Can you trust the doctor to do the right thing? Start off with the idea that even very good doctors do the wrong things sometimes. There is so much to know. They may not know as much as someone else—but the good doctors will go out of their way to learn what they may not know. And they will ask for help from other doctors. I would trust some doctors to treat some conditions out of their area of specialization more than I would trust a specialist in that field whom I knew was careless. They can be relied on to approach a medical problem carefully. I cannot describe what goes into having good clinical judgment, but it is a real thing. I am not sure exactly what quality of mind and character it involves. It is a kind of being sensible.
And good doctors care.
I saw one of the many patients who have been told in error that they have hypoglycemia-- low blood sugar. Some studies suggest that this diagnosis is made incorrectly about 95% of the time. The symptoms of hypoglycemia seem similar to those of the anxiety disorders, particularly panic disorder, so the two conditions can be confused easily, especially for someone who knows only one and not the other.
This particular patient had been told by a doctor that she had hypoglycemia. She became frightened and carried snacks around with her wherever she went. Given her blood sugar level, I could not understand the doctor’s thinking. I called him up and asked him.
“Well, I think there really is something like reactive hypoglycemia,” he said, indicating that he knew that others did not think so. Reactive hypoglycemia is a precipitous drop in sugar levels simply as the result of eating. (True hypoglycemia is a serious condition and can result from acute alcoholic intoxication or endocrine tumors—or a number of other illnesses.)
“All right,” I said. “But her blood sugar is well within the normal range!”
“Okay, what do you want me to do? Send her back and I’ll tell her she doesn’t have hypoglycemia.”
I was shocked. Didn’t he care one way or the other?
But this doctor sticks out in my mind because he was so unusual.
The real issue is not which doctors can be trusted, but which conditions are such that you can trust any doctor and which conditions are so significant and so difficult to manage that they require going to a particular—especially competent—physician. You can trust any doctor to treat a sore throat or an ear infection (not that there are not controversies even in the treatment of these commonplace conditions.) When it comes to replacing your aortic valve to ward off heart failure, you should travel wherever you need to go to see one of the three or four surgeons in the country who specialize in that operation. This is a commonsense idea.
Of course, in the end, if you grow dissatisfied with your doctor, you should find another. (c) Fredric Neuman 2013 Follow Dr. Neuman's blog at fredricneumanmd.com/blog