The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

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motorcyclesarecool
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The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by motorcyclesarecool »

In accordance with the forum guidelines, I am not seeking medical advice. Rather, I am seeking actionable ideas for how I can choose which practice/practitioner to perform an upcoming procedure.

Does anyone, especially any MDs on the board, know how I can go about finding out who to use for a given procedure and who I should avoid?
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.
nimo956
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by nimo956 »

I'm not a doctor, but someone once told me to ask an anesthesiologist for a recommendation on a surgical procedure.
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TheNightsToCome
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by TheNightsToCome »

motorcyclesarecool wrote: Sat Sep 23, 2017 10:38 pm In accordance with the forum guidelines, I am not seeking medical advice. Rather, I am seeking actionable ideas for how I can choose which practice/practitioner to perform an upcoming procedure.

Does anyone, especially any MDs on the board, know how I can go about finding out who to use for a given procedure and who I should avoid?
If you know any physicians, ask them who they would trust to do the procedure on their own family members.

It will be tough if you don't know physicians who can provide recommendations, but I would make sure the physician is board-certified.

For procedures, you will probably be better off choosing someone with some seasoning (e.g., >= five years out of residency/fellowship) who does a high volume of that particular procedure, at an institution that also performs a high volume.

When I attempt to make recommendations for out-of-town family members I also look at the physician's medical school and training program, but a layman probably can't make much use of that information.

If you need a cardiac procedure in Cleveland or Rochester you'll be in good hands.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by randomguy »

TheNightsToCome wrote: Sat Sep 23, 2017 11:09 pm
motorcyclesarecool wrote: Sat Sep 23, 2017 10:38 pm In accordance with the forum guidelines, I am not seeking medical advice. Rather, I am seeking actionable ideas for how I can choose which practice/practitioner to perform an upcoming procedure.

Does anyone, especially any MDs on the board, know how I can go about finding out who to use for a given procedure and who I should avoid?
If you know any physicians, ask them who they would trust to do the procedure on their own family members.

It will be tough if you don't know physicians who can provide recommendations, but I would make sure the physician is board-certified.

For procedures, you will probably be better off choosing someone with some seasoning (e.g., >= five years out of residency/fellowship) who does a high volume of that particular procedure, at an institution that also performs a high volume.

When I attempt to make recommendations for out-of-town family members I also look at the physician's medical school and training program, but a layman probably can't make much use of that information.

If you need a cardiac procedure in Cleveland or Rochester you'll be in good hands.
I think to some extent that is still a crap shoot. It isn't like physicians hang out with each other while they work and the farther you get from a speciality, I am guessing the ability to judge competence also drops. And there also is a big difference between doing the procedure well and being a pleasant person. The last influences a lot of peoples views and recommending the nice person over the rude one is a pretty understandable bias.

Experience is definitely good but you can also run into the people that haven't adapted well to changes in the 20 years since they did their residency.

To a large extent I think your goal shouldn't be to find the best person. It is to avoid the bottom 5%. Not sure if that is much easier.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by JoMoney »

Not a doctor, but I'll point to this:
Consumer Reports: How to find the right surgeon

When it comes to "experts" I prefer experience and high rates of success/accuracy to credentials/education or agreeableness/likable personality.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by mouses »

If you have an excellent internist, he or she probably knows who the good specialists are, because they get a lot of feedback and see the results of work on their patients.

Before I had a good internist, I looked at where the person was educated, if they had gone to a top ranked school as opposed to the University of the Philippines or the like. I also looked at web reviews; sure those have to be taken with a grain of salt, but there is likely some worthwhile information in there.

One thing I found completely useless is a state magazine that has an annual issue of "top docs" in the state. They have awful doctors in that list, and did not include ones I knew were good. How those lists are made up I have no idea. The magazine claims it polls doctors to make up the list.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by tubelight »

As a physician, generally I've seen patient's are happy with the recommendation of their internist. As others have suggested, educational background with a good medical school/residency program are somewhat helpful. More would be probably a physician/hospital which regular performs the procedure in a decent volume. For Eg one of the best interventional cardiologists I know did his training at Temple Univ due to the sheer volume of cases they see (more than UPenn which may have a better name). Also a lot of foreign trained physicians are incredibly talented (trainee at my wife's hospital was a trauma surgeon from Afghanistan, who the senior surgeons would defer to on bad trauma cases) and many times are trained twice (because they do residency in their own country and have to repeat it here). But you wouldnt recognize their medical schools.

Online reviews arent really helpful because they seem more to focus on mannerism's and bedside manner than competence. In the end unfortunately not aware of any real accessible measure out there for you to pick. Would suggest to go with the rec of you internist.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Pajamas »

I have had excellent luck with referrals from doctors I already know and trust. When looking for an internist, I have asked my specialists for suggestions or gone to another doctor in the same office who treated me when my regular internist was away.

For a procedure, you also want a doctor who does that procedure frequently, if that is possible.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Cruise »

Don't forget to rule out the physicians who have had disciplinary actions against them and have been sued too many times. You can get this information from licensing boards and state court records.

Not yet mentioned (IIRC), if you are having an orthopedic issue, physical therapists know which patients come from which physicians, and whether the surgical outcomes have been good.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by motorcyclesarecool »

mouses wrote: Sun Sep 24, 2017 12:10 am If you have an excellent internist, he or she probably knows who the good specialists are, because they get a lot of feedback and see the results of work on their patients.
So, how do I find an excellent Internist without being a physician myself? :oops:

I live in a region where Internists who are accepting new patients are hard to find. My PCP is a Family Practitioner, and I am sticking with it because although I'm dissatisfied, at least I'm seeing an MD. The sticking point is: the Family Practice I use also does the procedure I'm interested in (simple outpatient urology procedure) and I see an inherent conflict of interest asking him for a referral to his competition.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by veindoc »

So, how do I find an excellent Internist without being a physician myself? :oops:

This is when you take advantage of six degrees of separation. Someone you know knows someone who knows someone who works in a hospital. Look for nurses, ER docs, and referring physicians. They know who does the procedure you are interested in with the least amount of complications and bounce-backs. In these cases people can tell you a lot more than a website listing training and education.

I had an issue that I thought might require a lawyer. I didn't know any, but I talked to neighbor's friends and found somebody who knew somebody else etc etc that helped me towards resolving the problem.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by mmcmonster »

motorcyclesarecool wrote: Sun Sep 24, 2017 5:41 amSo, how do I find an excellent Internist without being a physician myself? :oops:
Ask your neighbors and friends. If you have access to hospital staff, ask the staff on a telemetry floor or ICU. Particularly the older nurses. They'll tell you who they use and who they would recommend for their family (not always the same!).
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by climber2020 »

Ask a nurse. If you're looking for a surgeon especially, the nurses who work in the operating room will know which surgeons have a cool head and which ones freak out and panic.

If you have an internist you trust, I agree that that is also a reliable way to find good specialists. I've had to do that myself, and I'm an MD.
mouses wrote: Sun Sep 24, 2017 12:10 am
One thing I found completely useless is a state magazine that has an annual issue of "top docs" in the state. They have awful doctors in that list, and did not include ones I knew were good. How those lists are made up I have no idea. The magazine claims it polls doctors to make up the list.
Those lists are pure advertising. Has nothing to do with quality of care. If you pay the money, you can be on the list. It's like The Who's Who of high school students scam from back in the day.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Marylander1 »

tubelight wrote: Sun Sep 24, 2017 12:33 amOnline reviews arent really helpful because they seem more to focus on mannerism's and bedside manner than competence.
There's a myth of the cowboy surgeon who is horrible to patients yet somehow the best at medicine.

It's just a myth. Medicine requires communication. Communication requires listening, which is most of what we call "bedside manner".

A physician who is rude to their customers is also likely rude to their staff and colleagues, who can't do their best unless they are treated with respect.

Online reviews will also tell you whether a patient who had a medical issue after a procedure is effectively treated—or ignored by rude or overworked staff.

Online reviews must be considered with care, but are critical for dealing with another unfortunate aspect of being an American patient: Many physicians are ignorant about billing. While the best practices take care of ensuring billing goes well (look for these!), some leave patients in the lurch. Patients, often stuck with thousands of dollars of bills because the anesthesiologist or assistant surgeon or some other mandatory component of care was out-of-network, have to protect themselves from overbilling and—for some—financial ruin.

The same subset of doctors who don't have time for bedside manner certainly won't have time to care about that surprise $40,000 bill you get months later.

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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by BogleFanGal »

Do PCPs who recommend a specific specialist ever receive financial incentives to do so?
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by dbr »

nimo956 wrote: Sat Sep 23, 2017 10:52 pm I'm not a doctor, but someone once told me to ask an anesthesiologist for a recommendation on a surgical procedure.
Actually, I got my recommendation for a successful surgery that way. Especially appreciated was the recommendation to avoid another surgeon in the same group.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by staythecourse »

Unfortunately, in the end you don't. This is no different then any other field of life. I'm a physician and have wondered how to find a great estate lawyer and CPA in recent past and it is hard without having an "in".

I usually tell folks this is where having a great PCP comes into the picture. If they are good they will only refer you to good consultants as they have the first hand experience. Without a great PCP it is at best a word of mouth situation. Of course, this is outside of checking on board certification and experience (5-10 years is best less is inexperienced and too old is "stuck" in their ways despite better ways of doing "x"). I also would look at where they trained for residency and fellowship. Medicine is not that different then A LOT Of apprenticeship type of jobs meaning one is ONLY as good as they have been trained. If they trained at Harvard or Hopkins vs. the community program next door, for example.

One aspect, I can vouch for is the most popular in the hospital in x field is USUALLY not the best at x field. The most popular and the most financially successful has more to do with being great at building a practice, i.e. making referrals happy, making patients happy, etc...

Good luck.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by dbr »

My physician recently retired. I switched to my wife's physician. She was recommended by a neighbor who is a physician but whom we know well enough to trust for both judgement and ethics.

One test of both my previous and present physicians is that they take seriously any discussion we bring up with them, bring facts and expertise to the table, and are willing to consult or research when they are not sure themselves.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by KlangFool »

https://blog.intercom.com/the-orange-juice-test/

OP,

I use "The Orange Juice Test" for the expert in any field. This works even in an area that I am not familiar in.

KlangFool
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by dbr »

KlangFool wrote: Sun Sep 24, 2017 9:52 am https://blog.intercom.com/the-orange-juice-test/

OP,

I use "The Orange Juice Test" for the expert in any field. This works even in an area that I am not familiar in.

KlangFool
I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.

As an aside, I am not so sure picking a physician is really exactly about finding an "expert." While medical care involves expertise I think there might be more to it that just getting an "expert."
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by InMyDreams »

Ask the employees who are taking care of that type of patient. Nurses from the OR. Nurses from the post-op area. Physical Therapists in the rehab. You get my drift.

Try to ask more than one person. If you can't find people actually working that area, ask those who work in the same facility, and ask them what they know - and would they ask people in the area where that care is provided.

I was with a friend in the ER one time. The doctor was referring her to an orthopedic surgeon. I looked at the doctor and asked if he had had knee surgery - yes. Who did his surgery? Pause, and then he told us. My friend did go with the suggested surgeon, however, and it worked out fine.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by KlangFool »

dbr wrote: Sun Sep 24, 2017 9:57 am
KlangFool wrote: Sun Sep 24, 2017 9:52 am https://blog.intercom.com/the-orange-juice-test/

OP,

I use "The Orange Juice Test" for the expert in any field. This works even in an area that I am not familiar in.

KlangFool
I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.

As an aside, I am not so sure picking a physician is really exactly about finding an "expert." While medical care involves expertise I think there might be more to it that just getting an "expert."
dbr,

I do not see a difference. It still comes down to can you trust the person.

<<I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.>>

This is part of my "General System Theory" learning over the past 30+ years.

This applies to any non-trivial area of expertise.

There are multiple levels of capability in each area.

-1) You do not know you know nothing.

0) You know that you know nothing.

1) You know what you know but you do not know what you do not know. Aka, you do not know your blind sport and the limit of your knowledge

2) You know what you know and what you do not know.

For any non-trivial procedure, the physician is either level 1 or 2. If the patient asks enough detail question, the physician will reach a point when he/she can no longer answer the question with any confidence. At that point, this is when "The Orange Juice Test" started.

A) Will the physician brush of the question as trivia in order to hide he/she lack confidence in answering the question?

Or,

B) Will the physician admit that he/she cannot answer the question with a degree of confidence at this moment and he/she will do the research and come back with a good answer?

That is the test. Are the right and good answer more important to this person than his/her ego? Can you trust the person to tell you when he/she does not know the answer?

KlangFool
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by dbr »

KlangFool wrote: Sun Sep 24, 2017 10:35 am
dbr wrote: Sun Sep 24, 2017 9:57 am
KlangFool wrote: Sun Sep 24, 2017 9:52 am https://blog.intercom.com/the-orange-juice-test/

OP,

I use "The Orange Juice Test" for the expert in any field. This works even in an area that I am not familiar in.

KlangFool
I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.

As an aside, I am not so sure picking a physician is really exactly about finding an "expert." While medical care involves expertise I think there might be more to it that just getting an "expert."
dbr,

I do not see a difference. It still comes down to can you trust the person.

<<I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.>>

This is part of my "General System Theory" learning over the past 30+ years.

This applies to any non-trivial area of expertise.

There are multiple levels of capability in each area.

-1) You do not know you know nothing.

0) You know that you know nothing.

1) You know what you know but you do not know what you do not know. Aka, you do not know your blind sport and the limit of your knowledge

2) You know what you know and what you do not know.

For any non-trivial procedure, the physician is either level 1 or 2. If the patient asks enough detail question, the physician will reach a point when he/she can no longer answer the question with any confidence. At that point, this is when "The Orange Juice Test" started.

A) Will the physician brush of the question as trivia in order to hide he/she lack confidence in answering the question?

Or,

B) Will the physician admit that he/she cannot answer the question with a degree of confidence at this moment and he/she will do the research and come back with a good answer?

That is the test. Are the right and good answer more important to this person than his/her ego? Can you trust the person to tell you when he/she does not know the answer?

KlangFool
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by nisiprius »

I don't have any answers.

One thing I do myself--it's dumb, it's obvious, but it's something to do--is to look for the doctor's profile and look carefully at what he or she lists as his "clinical interests." Thus, if my PCP says I need a hernia repair, and surgeon X lists "oncology; colorectal; endocrine" and surgeon Y lists "general surgery; laparoscopic surgery; abdominal surgery; hernia surgery," then it would seem as if, on the face of it, surgeon Y would be a more appropriate choice.

One of the few things experts seem to agree on is that "high volume" and experience with a procedure is very important.

Like everyone else I look up whatever ratings I can find, and I do look up the website of the licensing board to find out whether the doctor has had any disciplinary actions or malpractice suits against him or her, but the search for numbers seems to me like McNamara trying to quantify the progress of the Vietnam War--it's an exercise in futility. Nobody knows how to measure the right numbers, the instant they start being measured they start being gamed, and you always have the terrible problem about the best doctors getting the difficult cases and thus bad outcomes.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Cruise »

@klangfool:

"A) Will the physician brush of the question as trivia in order to hide he/she lack confidence in answering the question?

Or,

B) Will the physician admit that he/she cannot answer the question with a degree of confidence at this moment and he/she will do the research and come back with a good answer?"

This is a good test, but the reality of everyday practice is that 99.9% of expert consultants in any field will not "do the research and come back with a good answer" unless the compensation system rewards that behavior. Physician compensation systems are not set up to give MDs the time to research every (sometimes quacky) question that patients ask.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by VictoriaF »

mouses wrote: Sun Sep 24, 2017 12:10 am Before I had a good internist, I looked at where the person was educated, if they had gone to a top ranked school as opposed to the University of the Philippines or the like. I also looked at web reviews; sure those have to be taken with a grain of salt, but there is likely some worthwhile information in there.
I am listening to old Freakonomics Radio podcasts and one of them discussed fake degrees, including many MDs from U.S. institutions. The podcast is a few years old, and hopefully the most egregious diploma mills have been disbanded. But someone with a fake diploma obtained 5-10 years ago would now be in a recommended age/experience band.
mouses wrote: Sun Sep 24, 2017 12:10 amOne thing I found completely useless is a state magazine that has an annual issue of "top docs" in the state. They have awful doctors in that list, and did not include ones I knew were good. How those lists are made up I have no idea. The magazine claims it polls doctors to make up the list.
I consult Consumer Checkbook, Washington DC edition. I realize that it's far from perfect, but hope to avoid the worst.

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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by HueyLD »

I like the idea of asking one's PCP for referrals provided that you are satisfied with your PCP.

If you have a teaching hospital near where you live, you may be able to find someone who is an expert in the field with a good reputation.

But in most instances, finding a good health care provider is a crap shoot and you need a lot of luck.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by VictoriaF »

Georgetown University Medical Center (GUMC) every semester runs the Mini-Medical School. It's an 8-session program covering a variety of topics related to the biomedical sciences and health. For example, in the fall of 2017, they will be covering hormonal effects of metals, drug interactions, understanding stress-related disorders, hypertension, neuroscience, and current and emerging risks of blood transfusion. These sessions are intended as continuing education for medical professionals and information for the public.

My hope is that if I ever need a complex procedure or treatment, I will contact one of the organizers or presenters, use my credential as a Mini-Medical School graduate, and ask for their recommendations.

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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Allixi »

If availability at all hours, quick response to questions/concerns, or having long chitchatty conversations are important to you, then look for a direct primary care or concierge/boutique practice.

That matters much more than a PCP's level of training or expertise.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by VictoriaF »

Allixi wrote: Sun Sep 24, 2017 12:54 pm If availability at all hours, quick response to questions/concerns, or having long chitchatty conversations are important to you, then look for a direct primary care or concierge/boutique practice.
But should these be important?
Allixi wrote: Sun Sep 24, 2017 12:54 pm That matters much more than a PCP's level of training or expertise.
Are you being sarcastic?

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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Munir »

I am a retired surgical specialist.

1. If possible, find out who physicians themselves go to in that specialty- find a "doctor's doctor".

2. Obtain a recommendation from a local physician(s) such as your PCP.

3. Check credentials of the physicians and see if they are board-certified and whether they received their training in a university center.

4. Check the hospital they use - preferrably a hospital with a depth in specialists and equipment.

5 Do NOT rely only on the opinion of anesthesiologists and OR nurses since they have only a narrow perspective of a physician's qualifications and can be influenced by "sweet-talking" physicians.
Last edited by Munir on Sun Sep 24, 2017 2:35 pm, edited 1 time in total.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by cjking »

On another forum I was on a helpful contribution was made by a lawyer. (It wasn't a legal forum.) Someone asked him his success rate in court. He said that for any specialist like him it would be about 50:50, because they took the most difficult cases where the outcome was uncertain. (He would be the last stop in a chain of referrals from other lawyers.)

So I don't necessarily think patient outcome statistics are always meaningful. The best guy may be treating the most desperate cases.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by KlangFool »

Cruise wrote: Sun Sep 24, 2017 12:07 pm @klangfool:

"A) Will the physician brush of the question as trivia in order to hide he/she lack confidence in answering the question?

Or,

B) Will the physician admit that he/she cannot answer the question with a degree of confidence at this moment and he/she will do the research and come back with a good answer?"

This is a good test, but the reality of everyday practice is that 99.9% of expert consultants in any field will not "do the research and come back with a good answer" unless the compensation system rewards that behavior. Physician compensation systems are not set up to give MDs the time to research every (sometimes quacky) question that patients ask.
Cruise,

So, this tells you that you should verify any answer from this person. It is still useful.

KlangFool
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by KlangFool »

dbr wrote: Sun Sep 24, 2017 11:03 am
KlangFool wrote: Sun Sep 24, 2017 10:35 am
dbr wrote: Sun Sep 24, 2017 9:57 am
KlangFool wrote: Sun Sep 24, 2017 9:52 am https://blog.intercom.com/the-orange-juice-test/

OP,

I use "The Orange Juice Test" for the expert in any field. This works even in an area that I am not familiar in.

KlangFool
I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.

As an aside, I am not so sure picking a physician is really exactly about finding an "expert." While medical care involves expertise I think there might be more to it that just getting an "expert."
dbr,

I do not see a difference. It still comes down to can you trust the person.

<<I get the test. I am a little in the dark about how that applies to finding and choosing a good physician.>>

This is part of my "General System Theory" learning over the past 30+ years.

This applies to any non-trivial area of expertise.

There are multiple levels of capability in each area.

-1) You do not know you know nothing.

0) You know that you know nothing.

1) You know what you know but you do not know what you do not know. Aka, you do not know your blind sport and the limit of your knowledge

2) You know what you know and what you do not know.

For any non-trivial procedure, the physician is either level 1 or 2. If the patient asks enough detail question, the physician will reach a point when he/she can no longer answer the question with any confidence. At that point, this is when "The Orange Juice Test" started.

A) Will the physician brush of the question as trivia in order to hide he/she lack confidence in answering the question?

Or,

B) Will the physician admit that he/she cannot answer the question with a degree of confidence at this moment and he/she will do the research and come back with a good answer?

That is the test. Are the right and good answer more important to this person than his/her ego? Can you trust the person to tell you when he/she does not know the answer?

KlangFool
You have gotten far beyond me.
dbr,

It is very simple.

Can you trust a person's answer when he/she would not tell you the limit of his/her knowledge/ignorance?

KlangFool
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by HIinvestor »

The best specialist I ever had was by going to one of the top hospitals in the country (by US News & World Reports) and being fortunate enough to have been given an appointment with him because he was participating and preferred with my BCBS insurance. My internist urged me to go to that med center 1000s of miles from our state, and it was life-changing for me. He was my specialist for the next 17 years until referring me to another excellent specialist at another top medical center. (I did ask a family friend who is an allergist at that med center what he thought of that MD before I made the trip and he was very enthusiastic.)

My allergist was the person who found me a top specialist in my home state, after we were both disappointed that my specialist at the time would throw his hands up and say I was complicated when I needed him most (when I was ill). The new specialist inspires confidence and I think I will be asking him for a referral to a new internist (since mine and H's is 68 years old and mine can't find an internist for his wife).

For my surgeon, I asked around and interviewed the top two candidates. My sister's male surgeon was very arrogant and refused to look at the medical summary and answer questions I brought to the appointment. I refused to see him again. The surgeon who was recommended by the woman who has sat beside us for a decade of seasons when we attend the opera was a delight--gratefully read the medical summary and answered all my questions. She performed the procedure flawlessly and had such tiny fine stitches there was NO scarring! (She happens to be a kidney transplant surgeon but also does other surgeries.)

In all, luck plays a role but so does recommendations and especially from people you trust and whose opinion you value. Six degrees of separation can indeed be helpful in our close knit world.
Last edited by HIinvestor on Sun Sep 24, 2017 1:27 pm, edited 1 time in total.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by mptfan »

mouses wrote: Sun Sep 24, 2017 12:10 am
One thing I found completely useless is a state magazine that has an annual issue of "top docs" in the state. They have awful doctors in that list, and did not include ones I knew were good. How those lists are made up I have no idea. The magazine claims it polls doctors to make up the list.
Some publications charge for the privilege of being ranked.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by dbr »

KlangFool wrote: Sun Sep 24, 2017 1:09 pm
dbr,

It is very simple.

Can you trust a person's answer when he/she would not tell you the limit of his/her knowledge/ignorance?

KlangFool

Thanks.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by cashmoney »

motorcyclesarecool wrote: Sat Sep 23, 2017 10:38 pm In accordance with the forum guidelines, I am not seeking medical advice. Rather, I am seeking actionable ideas for how I can choose which practice/practitioner to perform an upcoming procedure.

Does anyone, especially any MDs on the board, know how I can go about finding out who to use for a given procedure and who I should avoid?
Call or stop by the physicians office to check to get an idea on how the office is ran.If you are om medicare you can search participating physicians by medical and part d drug utilization metrics:

https://www.cms.gov/Research-Statistics ... r2015.html


https://projects.propublica.org/checkup/
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by LadyGeek »

Please stay focused on helping the OP without specifying the details of your situation. As a reminder, see: Medical Issues
Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes a list of their top recommended sites.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by John Laurens »

If it’s a surgical procedure, ask if you can go in and watch the surgeon perform the operation on someone else first...just don’t take any Junior Mints in the operating theater.

Regards,
John
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by fsrph »

There is no one surefire answer. One thing to consider if you ask your family physician for a recommendation is are they a member of a large physician group practice.?They tend to refer within their group. A good, but not foolproof way, is to ask an employee of a hospital. For surgeons ask an or nurse. Granted you may not personally know these workers but maybe a friend of a friend does. I work in a hospital for decades and have a good idea who I'd recommend. They would not necessarily be the friendliness doctors but those who have proven themselves over time.

Francis
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dbr
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by dbr »

fsrph wrote: Sun Sep 24, 2017 4:41 pm There is no one surefire answer. One thing to consider if you ask your family physician for a recommendation is are they a member of a large physician group practice.?They tend to refer within their group. A good, but not foolproof way, is to ask an employee of a hospital. For surgeons ask an or nurse. Granted you may not personally know these workers but maybe a friend of a friend does. I work in a hospital for decades and have a good idea who I'd recommend. They would not necessarily be the friendliness doctors but those who have proven themselves over time.

Francis
Of course there is also the dilemma of finding the family physician in the first place. I guess one possibility is to ask whoever did your last procedure, if it came out well.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Calli114 »

mptfan wrote: Sun Sep 24, 2017 1:22 pm
mouses wrote: Sun Sep 24, 2017 12:10 am
One thing I found completely useless is a state magazine that has an annual issue of "top docs" in the state. They have awful doctors in that list, and did not include ones I knew were good. How those lists are made up I have no idea. The magazine claims it polls doctors to make up the list.
Some publications charge for the privilege of being ranked.
I agree about avoiding these types of "Top Doc" lists. In our region, it's basically a popularity contest, with the opportunity for the magazine to sell lots of glossy medical ads.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Pawpatrol »

I am glad you asked this question and grateful to be helpful in this topic as I have learned so much from all of you as a longtime lurker.

Background: I am a physician,have worked in a wide variety of health care systems ( hmo, academic setting, etc) and have been involved in educating medical students and physicians throughout my career in some capacity. I have served as an advocate for many friends, family members, students etc who have had similar questions as OP.

As others have pointed out, having a PCP who you feel is your advocate, listens to you, helps guide you through uncertainity, and geniunly cares about your well being is vital. I will add here, similar to the "orange juice test above" also says "no" to you at times and is willing not to be liked by you as a result. Hopefully they can explain it in a caring manner. Most people have this fallacy that more care is better care when usually it is the opposite. As a patient I fear getting a test (mri/ct being the scariest) of any kind not indicated. These tests all have false positives and are common. This leads to more tests and more tests and lots of worry and sometimes this drags on a long time. Hence, having a doctor not ordering tests or medications that you are asking for and willing to tolerate your dissapointment is an ideal trait to look for. If they can do this in a way that you still feel listened to and respected that is even more ideal.

So how do you find a good PCP? Others have provided some ideas as word of mouth is always a good first start. If you are with an HMO, talk to the member services if they are local and ask them. They are the ones that field a lot of the complaints and doctor change requests and will obviously not give you any name of someone they are getting complaints from.

All things being equal, sure, pick someone with better medical schools/residency programs but as someone that went to elite training programs then trained other doctors and students at these programs i think this is really not that important. Many of the best PCP's i have known didn't go to top programs and this is because absolute medical knowledge is really not that important (yes i said that!) compared to other skills like communication/professionalism. As Klangfool correctly pointed out, finding someone that knows what they know and knows when to ask for help is way more important than how much they know absolutely. Medicine is team based and you don't need to know everything and knowing who has the knowledge needed is the most important. Some of the most dangerous doctors i have trained were the smartest ones but didn't know their blind spots and were overconfident.

Also, each of you have different relational styles and respond better to different types of doctor personalities, so I would trust your gut on whether you feel your PCP is a good fit. There are lots of good PCP's out there so any of you can find one that feels right to you. Obviously, if you find yourself switching doctors a lot then that is a different matter but no need to stay with someone you don't trust.


Hope this helps
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by Erwin007 »

John Laurens wrote: Sun Sep 24, 2017 4:32 pm If it’s a surgical procedure, ask if you can go in and watch the surgeon perform the operation on someone else first...just don’t take any Junior Mints in the operating theater.

Regards,
John
How would this help? Never mind that due to HIPAA and other privacy laws and policies this kind of thing is never done, but how would this be any better? You have zero idea about the outcome.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by HIinvestor »

I have never heard of any patient being allowed to observe another's surgery or procedure and don't see how that would help anyway. I have permitted Med students to observe at teaching hospitals when I or a family member is the patient but not random patients.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by NoleBlooded »

I am a hospitalist. My experience with different specialists (including surgeons) is based on the outcomes post op, as well as their overall reputation within the hospital and patients readmission for surgical complications. I feel that I could be offer a recommendation on the best surgeon at my hospital.

If you know a local hospitalist I would discuss with them. An experienced rn could also provide good insight
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by BolderBoy »

climber2020 wrote: Sun Sep 24, 2017 6:18 am Ask a nurse. If you're looking for a surgeon especially, the nurses who work in the operating room will know which surgeons have a cool head and which ones freak out and panic.
Agree with this. I worked in Surgery for 40 years and the OR nurses who've worked at the chosen facility for longer periods of time will know who'd they want for themselves or their family.

Don't ask them, "Who's the best?" Ask them, "Who would you go to?" Be prepared, the answer could be, "No one here."
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by White Coat Investor »

motorcyclesarecool wrote: Sat Sep 23, 2017 10:38 pm In accordance with the forum guidelines, I am not seeking medical advice. Rather, I am seeking actionable ideas for how I can choose which practice/practitioner to perform an upcoming procedure.

Does anyone, especially any MDs on the board, know how I can go about finding out who to use for a given procedure and who I should avoid?
My thoughts:

# 1 If it's an emergency, take the guy on call and know at a minimum that he graduated from med school, completed residency, passed his boards, passed a credentialing committee at the hospital, and hasn't been thrown off staff. That weeds out an awful lot of people.

# 2 If it's a bread and butter procedure, don't get your panties in a wad. General surgery PGY2s do appendectomies in their sleep. Any emergency doc can do a lumbar puncture or a laceration where all the pieces are there. Any intensivist can do a central line. Any ENT is fine for ear tubes.

# 3 If it's not bread and butter, and it's not emergent, then it might be worth your time and money to undergo the same procedure I would recommend for finding a good attorney or accountant.

Go see a doc in that specialty, and ask her to name 3 docs, besides her, who she would trust to do that procedure on her or her family. Then ask the other three docs the same question when you go see them. Go with the one who gets named most often.
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Re: The Expert's Dilemma - How can I know I'm getting a good physician without being one myself?

Post by staythecourse »

Munir wrote: Sun Sep 24, 2017 1:02 pm
5 Do NOT rely only on the opinion of anesthesiologists and OR nurses since they have only a narrow perspective of a physician's qualifications and can be influenced by "sweet-talking" physicians.
I agree 100%. It may be a hot topic, but the usual, "ask a nurse" is not good advice. Most of the nurses I know LOVE me and still refer patients to me since I went private 4 years ago and no longer in the hospital and it has NOTHING to do with if I am good or not. They are influenced by who they like and have good working relationship with them as a person. That has NOTHING to do with if someone makes a good specialist. They don't see enough of the whole process to judge if person X taking care for procedure Y is good or not. They may see the operation (OR nurse) or the immediate postsurgical course (floor nurse), but there is no nurse who sees the whole situation play out from beginning to end to judge if a clinician is good or not.

That is not a slight against the nursing field. If someone asked me a referral for a nurse to take care of them postprocedure I would say the same thing about me. How would I be qualified since I only see a small sliver of the total care provided by person X and try to generalize it as a whole as a reflection of their total ability?

Good luck.
Last edited by staythecourse on Sun Sep 24, 2017 10:56 pm, edited 1 time in total.
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