How to Pick a Doc - Masked Sources Tell All in New York Magazine

The following entry is comprised of commentary based on the article "What's Up Docs? A panel of anonymous physicians cough up tricks of the trade" by Robert Kolker, published in New York Magazine's "Best Doctors 2007" issue.

The premise is brilliant - a panel of five docs spill the beans on how to pick a doc, get an appointment with a specialist (pray???), and why wait times resemble Dante's trip to the inferno.

Click here to read the article, published today. (Thanks SenorBuck for the link).

The New York Magazine recruited the following docs to act as sources:

Dr. Lung
. . . . . .Pulmonologist
Dr. Heart1 . . . . .Cardiologist
Dr. Heart2 . . . . .Cardiologist
Dr. Virus . . . . . . Infectious Diseases
Dr. Baby . . . . . . .OB/GYN

Some highlights:
  • Always Bring a Family Member/Friend to Act as Personal Patient Advocate: Dr. Baby relates a horror story on page 5.
  • Don't Go to a Hospital in July, or is That July Business an Urban Legend? You decide after reading page 3 (also, try not to get admitted on a Friday after noon).
  • Flattery Always Works: Want an appointment with a top-notch specialist? Tell them you're a fan and are glad to be there.
  • Don't Refer Difficult Patients: Docs (at least some in this article) don't want your hypochondriac sister-in-law, your multi-chronicity Grammy. They may, however, want your well-paid working professional book-club friend who arrives and pays on time. To be fair, I'm carrying this a bit far - Dr. Heart1 did mention referring good patients is appreciated.
  • Drug Companies & "Low Level Bribery": Dr. Virus has a great example of a steak dinner thrown by makers of an expensive antibiotic. Dr. Heart2 describes being 'wooed' and why we might take a closer look at Big Pharma's relationships with hospital purchasing depts.
  • It's All in the Degree: How to pick a doc? Check out where they went to med school (cardiologist).
  • Yellow Pages Anyone?: Picking a doc was compared to having a personal shopper, choosing a car mechanic, accountant, and lawyer.
  • Why Brand/Image Matters: Pick a doc by selecting a hospital 'brand' you like ("I think better doctors are typically at better hospitals"). Side note: I had an experience with one of the best ortho surgeons I've ever met at a tiny community hospital in the mountains of Cumberland, MD. His care and results equaled that of some more 'branded' physicians at a top trauma center in Baltimore, MD. Can't docs, like professionals of any other ilk, have stellar reps and pick an area based on familial ties, schools, quality of life, etc.?
  • Seek Those Who Teach: If you go to a teaching hospital "your statistical risk of turning up a clown is much lower" (infectious diseases doc). I'd like to see the aforementioned stats on this, but that would sort of defeat the whole masks-on-the-back-of-the-head, secret-agent anonymous-commentary angle.
  • Why You Want the Number 2 Heart Doc: Dr. Heart1 said don't pick the tip-top heart doc at a university hospital - this MD has published papers, talks the talk, but may not be able to walk the walk.
  • Use Referrals: "There can be good doctors in small hospitals and bad doctors in big hospitals. That’s why you also want a patient recommendation." - Dr. Lung
  • You Can't Escape It -Network, Network, Network: Getting in to see a specialist is all about the referral. Oh, and what type of insurance you have and how quickly they pay.
  • The 7 Minute Rule: "If you’re an HMO doctor, the network will tell you to see, on average, a patient every seven minutes."
  • Bring Jokes & Food: Shocker - like just about any other professional under the sun, docs spend more time with people they like. "You have fun with patients you like." - Dr. Baby
Favorite (?) SiCKO worthy quote (along with each doc sharing medical mistakes):

"HMOs tell us to see more patients; malpractice insurance tells us to take all the time we need."-Dr. Baby

Good Grief, There's More:

"Research is a real problem. Doctors just make up the data." - Dr. Lung

Favorite funny quote:

"You deal with professionals who know more than you in all walks of life, and you somehow learn how to find out who’s full of shit and who’s not." -

Well, that makes a great soundbite. But how much experience with the 'system,' i.e. what level of chronicity/acuity does a patient need to have before they can pick the good docs?

The doc who compared it to picking a lawyer or accountant did have an interesting metaphor - all things being equal (meaning I could hop online and find a complete, relatively accurate listing of docs in my area with 'ratings' from 'users' a la travel site Tripadvisor.com), I'd pick a doc based on their publications, reputation in the community, standing/awards, and referrals from trusted sources, including a PCP.

NOTE: RateMDs.com, a relatively new site, is one to watch. Also check out the graphically-clumsy HealthcareReviews.com. Revolution Health's Care Providers page shows some promise to further develop a rating capability, but there's room for an aesthetically pleasing, easy to use site to enter the market.

Oh, and I'd also consider price and whether or not the office accepts cash, my insurance, etc. Do they have convenient parking? A pharmacy in onsite/in the same building? A coffee machine in the waiting room? Just kidding (kind of).

How many of us really 'pick' our doctors in the same way that we pick car mechanics or realtors?

Is it realistic to believe many of us are finding a doc, who has approx. 5-40 minutes of room-time per patient during a PAYING appointment, based on his/her background, degree, areas of research interest, etc.?

Hopefully, you learn how to find out whether or not a doc is full of shit before you really need her to step in and dirty those gloves saving your life or limb.

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