A question that I’m frequently asked by people is, “I (or family member or friend) have been told I have (name of condition or problem), who would be a “good” doctor for me to see?"
(Fun fact: The most common question I’m asked is, “What’s wrong with you?”)
The person always wants a “good” doctor. As opposed to what? A bad doctor?
The question seems so simple, yet, even as a physician, it is one of the most difficult for me to answer.
Let’s begin by attempting to define what constitutes a “good” doctor.
I look at it from 3 perspectives:
Note that I put personality (often referred to as “bedside manner”) last. Not because it’s not important, but because if I have something seriously wrong with me, I’m more concerned if this doctor can take care of it, as opposed to whether I’d enjoy hanging out at a bar with him.
So, let’s start with training, which usually means medical school and residency. What does one look for?
Here, I will interject my very strong, personal bias. (Don’t look so shocked!)
Medical school tends to be lower on my list. One reason is that I went to a “state” medical school, versus a private one.
The bottom line is that human anatomy and physiology don’t vary by where you’re taught, however, how much clinical experience you get in your 3rd and 4th years does.
For example, as a state school, with a VA, 4th year medical students were often doing things that many doctors didn’t get to do until residency at the fancy schools.
The reason was simple. The VA was understaffed, and when you were there you were effectively the doctor. At a more “elite” school, many patients were VIPs and sure as hell didn’t want to see a medical student.
Residencies, I believe, are another story. (“Sure”, you say, “Because now we get to hear you brag about going to Harvard, again.”)
Well, OK, yes, I went to Harvard. (“See!!?")
That does not mean that everyone who trained there was someone I’d go to. In fact, I nicknamed one of my fellow resident, “The Cretin”.
Similarly, one may go to a lesser known program, but be extremely good at what they do, because they worked their asses off.
But, as a rule, the better known programs offer more opportunities, and a chance to train with individuals that are nationally, or even internationally, recognized experts in their respective fields.
The second criteria is experience.
I remember how difficult it was for me when I started out getting people to believe I knew what I was doing.
It also didn’t help that I looked like I was 18 years old.
However, thanks to my job, wife and kids, I soon grew into an old man, and people didn’t question my experience as often.
But, experience is important.
How many patients a doctor has treated with your condition is important to know. Similarly, you need to know what their training and experience are with the tool they will use to treat you is.
Many patients are often too embarrassed to ask this question, but it is a very valid one, and most doctors don’t mind answering.
They will usually tell the truth as well.
The last component is the one that is the most difficult to measure, and whose significance can be debated.
Case in point.
Over the course of this blog, I’ve described many quacks. These were individuals who preyed on the weak. They are the scum of the earth, IMHO.
However, they were almost always described as “wonderful”. Their bedside manner was impeccable.
But they were very bad doctors.
On the other side, there are many superb physicians who truly border on having a significant personality defect, but to whom I’d go, or send a loved one without hesitation.
These doctors tend to be located at academic centers, because their lack of social skills is often a strength.
And what about me?
I can honestly say that my goal from the first day of medical school was to be a “good” doctor.
But, make no mistake, that along the way there were patients and doctors who did not think highly of me.
Why? I’m not sure. Well, I'm not completely sure.
Sometimes it was a personality clash, sometimes I was having a bad day, sometime my patient or the other doctor was having a bad day, and sometimes, just because.
Now let me finish this by addressing the original question.
If you want to ask me about a doctor recommendation, it had better be in the area of oncology (cancer). Then, I can help you.
But if you ask me for a good rheumatologist, or orthopedic surgeon, or cardiologist, then, unless I’ve used one I liked, I will have no clue.
Now, it’s true that I know enough people in the medical field that I can probably get a few recommendations, but that’s all they’ll be.
And, I’ve also had the experience where I have sent people to doctors that were truly experts in their field, only to be told how much they hated them.
So, when it comes to finding a “good” doctor, “good” luck, it’s not easy.
Not even for me.
Till next time, whenever you hear someone talk about a “good” doctor, remember what I always tell you: Stay Skeptical!
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Filed under: Health Care