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

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mptfan
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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 » Sun Sep 24, 2017 10:20 pm

Erwin007 wrote:
Sun Sep 24, 2017 7:02 pm
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.
I think that response was meant to be a joke, it is a reference to a Seinfeld episode.

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ram
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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 ram » Sun Sep 24, 2017 10:26 pm

Cruise wrote:
Sun Sep 24, 2017 3:58 am
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.

You may have to exclude 99% of surgeons. The best way to avoid a physician who has not been sued is to be that physicians first patient.
http://www.nejm.org/doi/full/10.1056/NE ... #t=article

From the article: "By the age of 65 years, 75% of physicians in low-risk specialties and 99% of those in high-risk specialties were projected to face a claim. "
Ram

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ram
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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 ram » Sun Sep 24, 2017 10:36 pm

BogleFanGal wrote:
Sun Sep 24, 2017 7:20 am
Do PCPs who recommend a specific specialist ever receive financial incentives to do so?
It is illegal.
https://en.wikipedia.org/wiki/Stark_Law
Ram

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CULater
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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 CULater » Sun Sep 24, 2017 10:40 pm

With respect to a surgical procedure, several years ago I wound up at Memorial Sloan-Kettering for cancer surgery, lesions in both lobes of the liver a major surgery. I'll always remember one of my doctors who visited me in my hospital room the day before the surgery. He told me that the surgery that would be performed had a mortality rate of at least 5%, but that the mortality rate at MSK was much lower. The reason he gave me: because "we perform a lot of surgeries like this here." He didn't say because MSK was full of terrific surgeons who know more than anybody in the country about cancer surgery (which is probably true); it was because they do a lot of these surgeries and experience counts. So, I guess I'd look for a hospital that does a lot of whatever you are needing done, and I'd look for a doctor who does a lot of whatever that is. The more chances they've had to practice on other people before they get to you, the better.
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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 toofache32 » Sun Sep 24, 2017 11:45 pm

Cruise wrote:
Sun Sep 24, 2017 3:58 am
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.
While intuitive on the surface, you have to view this from the perspective of the willingness of surgeons to get involved with situations that are bound for complications from the beginning. Some patients present situations where they WILL have complications. Many surgeons recognize this and refer them to surgeons willing to take on the challenge. I am one of those surgeons who gets referrals from others in my specialty from a 300 mile radius. My complication rate might be higher because I take on the challenging cases nobody else is willing to do. When my schedule is full of train wrecks, it will show in the data. But I see more train wrecks than my colleagues and am theoretically better prepared for them.

Be careful with recommendations from OR nurses. Their opinions tend to be colored by their experience with the surgeon which is not related to patient care. Some in my hospital speak grandly of a surgeon who they like to work with while the rest of us surgeons know he's a butcher. There is a breast surgeon in my area who removed my wife's breast lump. I trained under her as a resident and she was miserable to work with. Yelled at everyone and nobody liked her. A bonafide B. But while training I saw her surgical skills and decision making. While she is the last person you want as your next door neighbor, she is exactly the person you want standing over you with a knife. So I took my wife to her and it went fine.

I recommend my patients to get multiple opinions if they want. I will forward their records to anyone free of charge. I'm surprised more don't do this. The astute patients ask me how often I do this surgery although I don't think they know what they answer should be, especially since I treat uncommon problems.

Don't bother with online ratings because we all know these come from 2 sources: one is that mainly disgruntled patients take the time to write something. The other is that many offices now request (by text or email) that patients with good outcomes leave a review. There are numerous 3rd party vendors who specialize in generating these good reviews to bury the bad reviews. The days of legitimate reviews are over.

For the magazine with "Top Doc" ratings... Most people don't know that the majority of these are paid advertisements. I was listed in one of these and the magazine hounded me for over a year to pay $250 for their plaque to hang on my wall.

Be careful with recommendations from a PCP. These PCPs are so busy that all they know is if the specialist took the problem off their hands, regardless of how well they did it.

Don't bother looking at their training unless you know what programs excel at the area you need. For example, Harvard is known to be very poor at training the areas of my specialty. But this is only known within my specialty. They still get by on the name.

I do like the idea someone mentioned of getting the opinion of a hospitalist. They, more than anesthesiologists and nurses, have a better feel for post-op complications and general outcomes.
White Coat Investor wrote:
Sun Sep 24, 2017 9:32 pm
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.
I like this.
Also, ask for patient recommendations directly from the surgeon. Not many surgeons do this, but for certain cancer removal procedures I do, I keep a list of patients who have agreed to allow me to share their phone number with other patients needing the same surgery. These patients are NOT slam dunks and some have had complications so new patients can understand it's not all rose petals. This list includes several other physicians I have operated on. I do screen out the unrealistic weirdos who had a great result but will never be happy. New patients love this because I tell them it's a chance to speak with another patient while I'm not in the room to hear what they say. They can ask anything...the good, bad, and ugly. New patients also love to hear from someone on the other side that has already been through this.

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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 qwertyjazz » Mon Sep 25, 2017 5:04 am

HIinvestor wrote:
Sun Sep 24, 2017 7:12 pm
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.
http://m.huffpost.com/us/entry/us_56fc1 ... f5c606742b

Seinfeld reference
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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 SGM » Mon Sep 25, 2017 7:33 am

As a retired family physician and gerontologists I referred my patients to specialists who were responsive and communicative to me and would see my patients quickly if I felt it was more urgent. The specialists knew that I would not abuse the privilege by exaggerating the need for an urgent referral.

It is important the primary to communicate the exact nature of the reason for a referral for best results. Look for a PMD who can communicate with patients, family and other physicians. As a PMD I often dragged patients back into the room who ended an exam with "oh by the way." What a patient most fears to discuss is usually the last thing they say as you are about to let them out the door.

Sometimes it is important not to make certain referrals to protect the patient from unnecessary procedures. Remember that to a "hammer everything looks like a nail".

As a retiree I continue to go to the local hospital for continuing medical education and find it very satisfying to have specialists tell me how much they miss working with me. One ENT who rarely comes to the hospital anymore to see patients, came in to do a diagnostic procedure on an elderly relative at my request. She enumerated all the likely diagnoses she could rule out with the procedure and after performing the procedure ruled them all out without awakening the patient from his slumber. It reminded me why I used this specialist in the past. She was business like, thorough, competent, knowledgeable and communicative.

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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 carolinaman » Mon Sep 25, 2017 7:56 am

My primary is in a large network of doctors. He and his predecessors like to recommend other doctors in their medical group. Their recommendations do not always seem satisfactory to me. I had a bad experience with a dermatologist recommended by my primary. Years later, when I had a need of a dermatologist again, he was still recommending this guy who was terrible. He never asked me about my experience with this and with I did not like him.

I usually try to research doctors online, although I recognize there are serious limitations in the credibility of online ratings. I will get recommendation from primary and if I know someone, like a nurse, I will get their recommendations. I try to make the best decision based upon the information I have. Some ratings, like Angie's List, are pretty useless with selecting doctors.

It is best to use a doctor that does lots of the procedures that you are to have. You do not want knee replacement surgery from a doctor who does this once or twice a year. I needed to have MOHS surgery a few years ago. Despite my primary's misgivings (because he did not know the doctor), I chose a doctor who had done 25,000 of these. It worked out well and there is no noticeable scar on my face.

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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 soccerdad12 » Mon Sep 25, 2017 8:12 am

Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?

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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 Mitchell777 » Mon Sep 25, 2017 8:18 am

I posted yesterday but do not think it went through. I would suggest getting two or three opinions. Ask doctors who they would have do their similar surgery if their partners could not do it. I've had interesting, and informative, responses. Just recently, before I could ask, the doctor told me he had the same procedure I needed. I quickly asked who he used and he shared it. Another time I was having trouble getting a doctor to give me an opinion on a particular surgeon, so I pressed on, and he finally responded that when he needed surgery similar, he used Dr X. When I saw Dr X, he told me the procedure the first Dr wanted to do was "almost never done anymore, but I did many of them 20 years ago". Then I found Dr X had performed surgery on many local doctors. Usually if you ask the right questions of three docs you have an answer you're more comfortable with. Incompetence exists. I've learned the hard way. I was once misdiagnosed with rather serious consequences. More than a decade later, I asked a Dr for a surgery recommendation and he told me a particular Dr was "behind the curve". It was the same Dr that misdiagnosed me. Still practicing and doing surgery and the local Dr's know he is not current with the technology.

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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 » Mon Sep 25, 2017 9:38 am

soccerdad12 wrote:
Mon Sep 25, 2017 8:12 am
Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?
No.

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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 » Mon Sep 25, 2017 9:56 am

Munir wrote:
Mon Sep 25, 2017 9:38 am
soccerdad12 wrote:
Mon Sep 25, 2017 8:12 am
Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?
No.
Would not premier hospitals weed out fake doctors with false credentials from diploma mills?

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

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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 » Mon Sep 25, 2017 10:02 am

My hope in humanity is restored in that at least a couple BH got my obvious Seinfeld reference. OP, maybe add that to your criteria. If the doc doesn’t have at least a rudimentary knowledge of Seinfeld episodes, then mark them off your list.

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 Pawpatrol » Mon Sep 25, 2017 10:22 am

VictoriaF wrote:
Mon Sep 25, 2017 9:56 am
Munir wrote:
Mon Sep 25, 2017 9:38 am
soccerdad12 wrote:
Mon Sep 25, 2017 8:12 am
Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?
No.
Would not premier hospitals weed out fake doctors with false credentials from diploma mills?

Victoria
I do not know of any diploma mills or false credentials assuming they have a medical degree and are board certified in the area they practice.

If you have a rare disease, deadly disease or complicated situation an academic institution would have its advantages.

Seeing doctors avtivates people's sense of trust/mistrust and can be very scary. For people who are prone to being mistrusting, and feel that if they don't research their health condition they will be mistreated know that seeing doctors and feeling safe will be hard for you. In that case, get second opinions, bring someone you trust to your appointments and find strategies listed above to help you. How hard was it for you to find and trust a caregiver/nanny for your parents/kids? If that was hard for you finding a doctor will likely be similar

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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 Rupert » Mon Sep 25, 2017 10:35 am

CULater wrote:
Sun Sep 24, 2017 10:40 pm
With respect to a surgical procedure, several years ago I wound up at Memorial Sloan-Kettering for cancer surgery, lesions in both lobes of the liver a major surgery. I'll always remember one of my doctors who visited me in my hospital room the day before the surgery. He told me that the surgery that would be performed had a mortality rate of at least 5%, but that the mortality rate at MSK was much lower. The reason he gave me: because "we perform a lot of surgeries like this here." He didn't say because MSK was full of terrific surgeons who know more than anybody in the country about cancer surgery (which is probably true); it was because they do a lot of these surgeries and experience counts. So, I guess I'd look for a hospital that does a lot of whatever you are needing done, and I'd look for a doctor who does a lot of whatever that is. The more chances they've had to practice on other people before they get to you, the better.
+1. For a complicated surgery (i.e., to borrow White Coat Investor's language, a not bread-and-butter surgery), I'd pick my hospital first, and narrow down doctors that way. Sometimes the post-surgical care provided by the hospital can be as important (or more important) than the surgery itself. Sometimes the best surgeon in the world can't save you from the post-surgical MRSA infection.

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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 » Mon Sep 25, 2017 10:37 am

Pawpatrol wrote:
Mon Sep 25, 2017 10:22 am
VictoriaF wrote:
Mon Sep 25, 2017 9:56 am
Munir wrote:
Mon Sep 25, 2017 9:38 am
soccerdad12 wrote:
Mon Sep 25, 2017 8:12 am
Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?
No.
Would not premier hospitals weed out fake doctors with false credentials from diploma mills?

Victoria
I do not know of any diploma mills or false credentials assuming they have a medical degree and are board certified in the area they practice.
The reason for my comment is that I am now re-listening to Freakonomics podcasts. Back in July 2012, they had a session "Freakonomics Goes to College, Part 1," http://freakonomics.com/2012/07/30/frea ... ranscript/ . Among other things they noted:

"EZELL: ...They sold degrees in anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, neurology, obstetrics, oncology, ophthalmology, pediatrics, psychiatry, radiology, surgery, urology, and I would ask you where do you think the people who are employed that bought degrees in those majors?"

"DUBNER: And that’s one firm. So I have two questions for you. One is where the hell are all these fake doctors, and how do I stay away from them? And two is, if there are two hundred thousand roughly from one firm, how many fakes are we talking about in toto?"

"EZELL: ...Only occasionally will a graduate flush up. He could be practicing in a hospital. He could have something go awry in a medical procedure and then they start looking at his credentials, and then find out that he’s a phony."

This is a 5-year old program and I hope that such degrees are no longer possible. But if they still exist, I expect that premier institutions do better screening.

Victoria
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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 » Mon Sep 25, 2017 10:41 am

VictoriaF wrote:
Mon Sep 25, 2017 9:56 am
Munir wrote:
Mon Sep 25, 2017 9:38 am
soccerdad12 wrote:
Mon Sep 25, 2017 8:12 am
Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?
No.
Would not premier hospitals weed out fake doctors with false credentials from diploma mills?

Victoria
Hi Victoria,

They mostly do- you are correct. However, there can be physicians at medical centers who care more for their "reputations" and have ego problems which would not make them caring physicians who look at patients as individuals. They may see patients as statistics for their next scientific paper. Moreover, many do not perform their own surgeries but have house staff do it. In summary, having medical center physicians give an opinion is worthwhile but unless the surgery is a rare and difficult operation, I would choose a private setting. Even then, I might go to the Mayo Clinic or Cleveland Clinic for such difficult operations. This may sound a harsh judgment and a generalization which is correct, but there always are exceptions to the rule.

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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 » Mon Sep 25, 2017 10:46 am

Munir wrote:
Mon Sep 25, 2017 10:41 am
Even then, I might go to the Mayo Clinic or Cleveland Clinic for such difficult operations. This may sound a harsh judgment and a generalization which is correct, but there always are exceptions to the rule.
Thank you, Munir. Our health is our most valued possession and we should minimize its risks wherever we can. Preferring Mayo Clinic or Cleveland Clinic does not sound harsh. Hearing your opinions, and those of other physicians, is a benefit of being a forum member.

Victoria
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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 » Mon Sep 25, 2017 11:08 am

VictoriaF wrote:
Mon Sep 25, 2017 10:37 am
Pawpatrol wrote:
Mon Sep 25, 2017 10:22 am
VictoriaF wrote:
Mon Sep 25, 2017 9:56 am
Munir wrote:
Mon Sep 25, 2017 9:38 am
soccerdad12 wrote:
Mon Sep 25, 2017 8:12 am
Does going to a doc in a highly ranked medical system help? I go to Duke for my docs and I would think that they would weed out any docs that are substandard. Would that be an accurate assumption?
No.
Would not premier hospitals weed out fake doctors with false credentials from diploma mills?

Victoria
I do not know of any diploma mills or false credentials assuming they have a medical degree and are board certified in the area they practice.
The reason for my comment is that I am now re-listening to Freakonomics podcasts. Back in July 2012, they had a session "Freakonomics Goes to College, Part 1," http://freakonomics.com/2012/07/30/frea ... ranscript/ . Among other things they noted:

"EZELL: ...They sold degrees in anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, neurology, obstetrics, oncology, ophthalmology, pediatrics, psychiatry, radiology, surgery, urology, and I would ask you where do you think the people who are employed that bought degrees in those majors?"

"DUBNER: And that’s one firm. So I have two questions for you. One is where the hell are all these fake doctors, and how do I stay away from them? And two is, if there are two hundred thousand roughly from one firm, how many fakes are we talking about in toto?"

"EZELL: ...Only occasionally will a graduate flush up. He could be practicing in a hospital. He could have something go awry in a medical procedure and then they start looking at his credentials, and then find out that he’s a phony."

This is a 5-year old program and I hope that such degrees are no longer possible. But if they still exist, I expect that premier institutions do better screening.

Victoria
There is no such thing as a degree in <medical speciality>. To get a state medical license (i do not know for certain this is true for all states but easily would assume so) one has to provide medical school diplomas, board certification documents, references,subject to background search, and a host of other questions about lawsuits/complaints/medical and mental health problems. Ok now to get privleges to work at a hospital, another process entails that takes way longer than it should.

I think the podcast is sensationalist journalism wrt medical degrees. Is it possible, sure, but seriously doubt even if possible happens at any scale that they suggest. There is simply too much red tape to be able to practice medicine. And even if this were possible, i they would get noticed rather quickly.
Last edited by Pawpatrol on Mon Sep 25, 2017 11:12 am, 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 VictoriaF » Mon Sep 25, 2017 11:12 am

Pawpatrol wrote:
Mon Sep 25, 2017 11:08 am
There is no such thing as a degree in <medical speciality>. To get a state medical license (i do not know for certain this is true for all states but easily would assume so) one has to provide medical school diplomas, board certification documents, references,subject to background search, and a host of other questions about lawsuits/complaints/medical and mental health problems. Ok now to get privleges to work at a hospital, another process entails that takes way longer than it should.

I think the podcast is sensationist journalism wrt medical degrees. Is it possible, sure, but seriously doubt even if possible happens at any scale that they suggest. There is simply too much red tape to be able to practice medicine. And even if this were possible, i they would get noticed rather quickly.
Thank you, Pawpatrol, this is comforting.

Note that the information source is not Dubner's sensationalism but a book "Degree Mills: The Billion-Dollar Industry That Has Sold Over a Million Fake Diplomas" https://www.amazon.com/gp/product/16161 ... 1616145072 . One of the authors Allen Ezell founded and was the head of the FBI’s DipScam diploma-mill task force.

Victoria
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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 dm200 » Mon Sep 25, 2017 11:29 am

In my (non-medical) opinion and experience, there are no sure thing answers.

You are (or may be) restricted by your insurance coverage.

I value the opinions of nurses.

I believe you want someone who does procedures or treats lots of such patients. I think you get a more accurate answer by asking: "Describe your typical patients and conditions" (then see if yours is one) vs. "Do you treat patients with xxx/"

I discount most patient ratings because physicians that tell patients just what they want to hear get rated highly. [Such as "Don't worry about being 50 pounds overweight!"]

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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 toofache32 » Mon Sep 25, 2017 11:54 am

dm200 wrote:
Mon Sep 25, 2017 11:29 am
You are (or may be) restricted by your insurance coverage.
Not necessarily. Out of network surgeons usually take their patients to in-network hospitals for elective surgery. The hospital is the expensive part.

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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 dm200 » Mon Sep 25, 2017 12:08 pm

toofache32 wrote:
Mon Sep 25, 2017 11:54 am
dm200 wrote:
Mon Sep 25, 2017 11:29 am
You are (or may be) restricted by your insurance coverage.
Not necessarily. Out of network surgeons usually take their patients to in-network hospitals for elective surgery. The hospital is the expensive part.
Sure - all depends on many details.

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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 Grt2bOutdoors » Mon Sep 25, 2017 12:24 pm

Pajamas wrote:
Sun Sep 24, 2017 1:53 am


For a procedure, you also want a doctor who does that procedure frequently, if that is possible.
+1. ^^^ That, or is the inventor of the technique to be used.
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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 CedarWaxWing » Mon Sep 25, 2017 12:51 pm

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.
1. As a retired anes doc I would agree... and I have called other anes docs I did not know for that exact purpose, and would do so again.

2. Someone asked if there is ever a financial incentive for a doc to recommend a doc... usually, no, but then again, it is common for a doc to refer to his own multi-specialty group. This can be good or not so good... but he/she knows those other folks and over years there is a solid knowledge base of who is very good or average. Frankly, where I have worked, most of the people in the hospital are very good imho.. and I have no financial relationship with anyone outside of the people in my one specialty group.

Unfortunately, sometimes a multi-specialty group that has a dominance in one thing.. such as internal medicine or gastroenterology or primary care... will tend to refer to only their group locally, and may or may not have a practice of referring unusual things to another local group, or not when someone locally happens to be better for certain problems. (If you never work with that other group, who can someone know how good or not one person in the group may be at during a laparoscopic esophagectomy for example?)

It is not always a clear cut choice, and yes, there can be subtle financial incentives to refer to only your group, but good docs will cross refer when it is medically sensible to do so, and will not if there is no clear advantage. You can however, ask to be referred to anyone you may feel is particularly good.

3. Most board certified mds are very good at what they commonly do, and will be happy to refer you to someone who is better at something unusual than they are, and will not be insulted if you simply ask them if how many of "xxx cases" they see or do in an average year, and if they feel there is anyone else who is noted to be especially skilled or more experienced in "xxx cases".

Best,

M
Last edited by CedarWaxWing on Mon Sep 25, 2017 12:57 pm, edited 1 time in total.

CedarWaxWing
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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 CedarWaxWing » Mon Sep 25, 2017 12:56 pm

toofache32 wrote:
Sun Sep 24, 2017 11:45 pm
Cruise wrote:
Sun Sep 24, 2017 3:58 am
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.
While intuitive on the surface, you have to view this from the perspective of the willingness of surgeons to get involved with situations that are bound for complications from the beginning. Some patients present situations where they WILL have complications. Many surgeons recognize this and refer them to surgeons willing to take on the challenge. I am one of those surgeons who gets referrals from others in my specialty from a 300 mile radius. My complication rate might be higher because I take on the challenging cases nobody else is willing to do. When my schedule is full of train wrecks, it will show in the data. But I see more train wrecks than my colleagues and am theoretically better prepared for them.

Be careful with recommendations from OR nurses. Their opinions tend to be colored by their experience with the surgeon which is not related to patient care. Some in my hospital speak grandly of a surgeon who they like to work with while the rest of us surgeons know he's a butcher. There is a breast surgeon in my area who removed my wife's breast lump. I trained under her as a resident and she was miserable to work with. Yelled at everyone and nobody liked her. A bonafide B. But while training I saw her surgical skills and decision making. While she is the last person you want as your next door neighbor, she is exactly the person you want standing over you with a knife. So I took my wife to her and it went fine.

I recommend my patients to get multiple opinions if they want. I will forward their records to anyone free of charge. I'm surprised more don't do this. The astute patients ask me how often I do this surgery although I don't think they know what they answer should be, especially since I treat uncommon problems.

Don't bother with online ratings because we all know these come from 2 sources: one is that mainly disgruntled patients take the time to write something. The other is that many offices now request (by text or email) that patients with good outcomes leave a review. There are numerous 3rd party vendors who specialize in generating these good reviews to bury the bad reviews. The days of legitimate reviews are over.

For the magazine with "Top Doc" ratings... Most people don't know that the majority of these are paid advertisements. I was listed in one of these and the magazine hounded me for over a year to pay $250 for their plaque to hang on my wall.

Be careful with recommendations from a PCP. These PCPs are so busy that all they know is if the specialist took the problem off their hands, regardless of how well they did it.

Don't bother looking at their training unless you know what programs excel at the area you need. For example, Harvard is known to be very poor at training the areas of my specialty. But this is only known within my specialty. They still get by on the name.

I do like the idea someone mentioned of getting the opinion of a hospitalist. They, more than anesthesiologists and nurses, have a better feel for post-op complications and general outcomes.
White Coat Investor wrote:
Sun Sep 24, 2017 9:32 pm
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.
I like this.
Also, ask for patient recommendations directly from the surgeon. Not many surgeons do this, but for certain cancer removal procedures I do, I keep a list of patients who have agreed to allow me to share their phone number with other patients needing the same surgery. These patients are NOT slam dunks and some have had complications so new patients can understand it's not all rose petals. This list includes several other physicians I have operated on. I do screen out the unrealistic weirdos who had a great result but will never be happy. New patients love this because I tell them it's a chance to speak with another patient while I'm not in the room to hear what they say. They can ask anything...the good, bad, and ugly. New patients also love to hear from someone on the other side that has already been through this.
1+ All excellent info.

M

testing321
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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 testing321 » Mon Sep 25, 2017 1:50 pm

I have had an older primary care doc for the last 14 years that has given me excellent referrals over the years.

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dm200
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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 dm200 » Tue Sep 26, 2017 8:14 am

Unfortunately, sometimes a multi-specialty group that has a dominance in one thing.. such as internal medicine or gastroenterology or primary care... will tend to refer to only their group locally, and may or may not have a practice of referring unusual things to another local group, or not when someone locally happens to be better for certain problems. (If you never work with that other group, who can someone know how good or not one person in the group may be at during a laparoscopic esophagectomy for example?)
Years ago, we had primary care physicians with such a group and the group included several specialists, such as Dermatology and Gastroenterology.

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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 bhough » Tue Sep 26, 2017 7:20 pm

It sounds like you are getting a vasectomy. Go to a person who does alot of them. This might blow in the face of all that you've heard so far, but in my state, that is the guy who advertises on the billboards of the highway. He has done hundreds of thousands. I chose to go to the guy at the academic center who does kidney transplants and might have done one of these every other month and wished I went to the guy with high volume, but who maybe wasn't so "impressive". I'm assuming if the family practice guy also does this procedure, you don't need a kidney transplant,....Agree that nurses are only going to tell you who is the nicest (which has absolutely nothing to do with their surgical acumen, may in fact be inversely related). The nice thing about medical boards is that generally (yes, I know there are rare exceptions), if you pass your boards and do years of training, you are usually not a nutcase. Most reputable specialists will refer you on to the subspecialists if you need something they are not comfortable doing. So, your local Urologist at the best hospital in the city that works 5 days/week and has been practicing in the area for 10 years and is between the ages of 40-55 is probably your best bet.
b

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Wildebeest
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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 Wildebeest » Tue Sep 26, 2017 7:37 pm

There was an interesting study of whom cardiologists would refer to for cardiac bypass surgery and it turns out that they had no idea about complications rates and success rates.

Jack Bogle was so right: "What was the best financial lesson you’ve ever learned?

I guess the best financial lesson I’ve ever learned was about investing, as distinct from finance. I was a runner in a brokerage firm in 1947, 1951, and an old runner with me said, “Bogle, the only thing you need to know is that nobody knows nothing.”.

Translates very well to medicine.

Good luck.
The Golden Rule: One should treat others as one would like others to treat oneself.

hmw
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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 hmw » Tue Sep 26, 2017 8:21 pm

Erwin007 wrote:
Sun Sep 24, 2017 7:02 pm
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.
I think it was a reference to a Seinfeld episode.

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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 » Tue Sep 26, 2017 8:35 pm

Wildebeest wrote:
Tue Sep 26, 2017 7:37 pm
There was an interesting study of whom cardiologists would refer to for cardiac bypass surgery and it turns out that they had no idea about complications rates and success rates.

Jack Bogle was so right: "What was the best financial lesson you’ve ever learned?

I guess the best financial lesson I’ve ever learned was about investing, as distinct from finance. I was a runner in a brokerage firm in 1947, 1951, and an old runner with me said, “Bogle, the only thing you need to know is that nobody knows nothing.”.

Translates very well to medicine.

Good luck.
These statistics usually aren't published and may not be tracked. If they were tracked, they would have to be adjusted for difficulty (some patients have higher risks than others), but such adjustments are imperfect.

These statistics (when available) are very useful, but they aren't the only way to evaluate the competency of a colleague; far from it.

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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 user5027 » Tue Sep 26, 2017 8:42 pm

Not sure this would work for your specific procedure, but when my fiance needed a doctor in a new location, her father walked into the local pharmacy and asked the pharmacist. It worked. The physician was excellent and we stuck with him until he unfortunately went concierge.

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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 hmw » Tue Sep 26, 2017 8:50 pm

I am a surgeon.

I like the answer WCI given previously. If you are having a rare, or highly complex surgery done, I would go to a center or surgeon who has high volume in this type of surgery. e.g. Whipple procedure, major liver resection. Some these type major surgeries are clearly better with a high volume surgeon. If you have something minor, and routine like hernia repair or vasectomy, I think a community surgeon will be fine.

Not sure how easy it is for a lay person to find the best surgeon.

OR nurses and anesthesiologists can probably tell you who to avoid. But they may not be able to tell you who is the best. I see surgeons from other specialities every day and honestly I have no idea who is great, and who is average.

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VictoriaF
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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 » Tue Sep 26, 2017 8:54 pm

hmw wrote:
Tue Sep 26, 2017 8:50 pm
OR nurses and anesthesiologists can probably tell you who to avoid. But they may not be able to tell you who is the best. I see surgeons from other specialities every day and honestly I have no idea who is great, and who is average.
Nurses and anesthesiologists may know whom to avoid, but I doubt they would tell that to a stranger. It's not easy to comment negatively about your colleagues and it may have negative consequences for you.

Victoria
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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 bostondan » Tue Sep 26, 2017 9:30 pm

I am a cardiology fellow currently at a highly-ranked academic hospital. I practiced as a hospitalist briefly before that at a different Crimson-themed Boston hospital. I have a complete non-evidence-based method for who I select as a physician. It probably isn't particularly helpful for most people, and may not actually be a valid method, but I am sharing it nonetheless. I break it down by medical and surgical specialties:

Medical specialties:

1. I like if my doctor was selected as a chief resident during Internal Medicine residency. It means that a substantial number of people who were observing this person closely in training felt that he or she was of the highest caliber. The doctor might still be bad and just fooling people, but it is one more way to reduce my risk of choosing incorrectly. I was a chief resident, so am familiar with the selection process.

2. I prefer someone who is kind and patient. Medical specialties rely heavily on taking a good history from a patient. Yes, we have labs and imaging studies that can answer questions, but ultimately the history is critical. I do not want a PCP or medical sub-specialist that rushes me. I don't intend to ramble on forever, but I don't want to be rushed. I want the doctor to think intensely about my ailment, analyze the data thoughtfully, and then come to the right conclusion.

3. I prefer medical specialists who are prominent clinician-educators rather than doctors who do primarily research. Clinican-educators tend to have a higher percentage of time doing actual clinical work with higher patient volume, which is possibly associated with better outcomes, and they also are forced to stay up-to-date on the literature due to being teachers.

4. I'm not sure any of the above things are easy for a layperson to figure out, so it might not be helpful.

Surgical specialties:

1. On the rare occasion that I have needed a surgeon, I try to go to "the guy" who is know for that. I needed a ethymoidectomy a few years ago, so I went to the guy at Mass Eye & Ear who is probably the most prominent nationally with respect to minimally invasive sinus surgery. A couple years later, at a wedding in California, I met a surgical rep who worked who sold endoscopic tools for sinus surgeries. I told him who I went to and he mentioned that the surgeon was well known for his incredible surgical skills based on reps who had been in the OR with him previously.

2. Unlike with medical specialists, I like my surgeon to be a little cocky and to give me the impression that he likes the operating room more than his family (sorry to any surgeons reading this). I have this fear that my surgeon will be mid-operation and get a call that his family member needs him to come urgently, leading to the surgeon rushing through the surgery (even if he doesn't think he is doing so). However, if he is obsessed with his work and good outcomes, perhaps he won't lose focus. I have absolutely no idea if this is true or not. It probably isn't. It makes me feel better though.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

toofache32
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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 toofache32 » Tue Sep 26, 2017 10:31 pm

Bostondan gives great insight. As a surgeon, I would like to clarify the concept of "chief resident" as it is very different in surgical specialties compared to medical specialties. In some medical specialties, the chief resident is an administrative position where a resident who has otherwise finished his training stays for an additional year for a mixture of clinical and administrative duties. This is indeed an honor because there may only be 1 chief resident from a field of 20-40 internal medicine residents. Bostondan or other medical physicians please correct me if I am wrong.

In the surgical specialties, "chief resident" simply means a resident in their final/senior year of training. My surgical residency accepted 4 residents each year for a 6-year residency. So we had 4 "chief residents" each year who were those 4 residents in their 6th and final year of residency. All of them were chief residents. In other words, "chief resident" for a surgeon simply means you lasted until the end.

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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 me2164 » Tue Sep 26, 2017 10:59 pm

Answering as a board certified emergency physician.
1. Ask people in your community--get a recommendation, preferably from someone who has seen the physician
2. Ask your primary care doctor for recommendations
3. Don't pay attention to medical school or residency program. It say nothing about how good of a doctor you will become.
4. Bed side manner can be a consideration, but does not mean the person is a better doctor because he/she is nicer and communicates well. I'll take the rude doctor with better skills over the nice guy that is mediocre.
5. Interview at least two doctors before doing going to surgery or deciding on a PCP--find someone you are comfortable with.
6. Ignore the online ratings

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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 Kidneydoc » Wed Sep 27, 2017 6:30 am

As a physician, I would not trust Castle Connolly or any Top Docs listing. It’s based on popularity amongst a community physician survey and not on clinical outcomes or evidence. Eventually Medicare will release 5 Star physician ratings in the future, like they currently do for hospitals, nursing homes and dialysis centers based on quality data (but personally I would dispute what “quality” is, as much of it is data submission).

To evaluate surgeons, I would get info from anesthesia/other surgeons, ICU nurses/critical care specialists and hospitalists. I hate to say this but superb bedside manner is ideal but not essential: you need to have a surgeon who know how to cut and when not to cut. I would hear of prolonged OR time for routine procedures, unexpected postoperative complications and ICU stays, and repeat morbidity/mortality conferences on same physicians (been in one myself as a witness). All surgeons will have complications, but the worst ones will stand out.

For non surgical specialities, sometimes the doctor who always gives a antibiotic or narcotic medication and has great customer service skills is not what you want. Your PCP should be your coach, tell you what you don’t want to hear ( exercise, lose weight, address end of life decision making) and tell you info straight up. What I find is that physician practices are like a factory, valuing volume (more patients per hour) but not effectiveness as a physician. The real art of medicine is making a 10-15 min visit feel like 1/2 hour, and communicate effectively.

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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 Seasonal » Wed Sep 27, 2017 7:27 am

I've read that the best choice is a surgeon who does a lot of the procedure and that procedure is a large percentage of the surgeon's practice. This is a better predictor than just doing the procedure frequently. Ask both questions.

Atul Gawande (surgeon, New Yorker writer and best-selling author) wrote that statistically you're better off with an average surgeon who works with a consistent team than a very talented surgeon who has no set team. A team that works well together is very important.

There may not be direct payments to doctors for recommendations, but there are other incentives, such as I'll recommend you and you'll recommend me.

A high success rate may have more to do with the surgeon's choice of patients than the surgeon's skill. Same for hospitals. Beware of ratings that don't take this into account.

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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 Ninnie » Wed Sep 27, 2017 11:47 am

I consider the ability to provide good referrals to be a key skill set of my PCP. My current PCP has done a good job with this.

Giving me a few terrible referrals is one of the main reasons I switched from my last PCP.

Having a PCP who is part of a large hospital network 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 dm200 » Wed Sep 27, 2017 11:51 am

Seasonal wrote:
Wed Sep 27, 2017 7:27 am
I've read that the best choice is a surgeon who does a lot of the procedure and that procedure is a large percentage of the surgeon's practice. This is a better predictor than just doing the procedure frequently. Ask both questions.
Atul Gawande (surgeon, New Yorker writer and best-selling author) wrote that statistically you're better off with an average surgeon who works with a consistent team than a very talented surgeon who has no set team. A team that works well together is very important.
There may not be direct payments to doctors for recommendations, but there are other incentives, such as I'll recommend you and you'll recommend me.
A high success rate may have more to do with the surgeon's choice of patients than the surgeon's skill. Same for hospitals. Beware of ratings that don't take this into account.
From a patient's point of view, this makes a lot of sense.

While it may be nice to have a surgeon who is nice, communicative, etc. - for surgery, I don't really care much if the surgeon is an ornery, cantankerous SOB - as long as they get the job done.

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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 bostondan » Wed Sep 27, 2017 9:18 pm

toofache32 wrote:
Tue Sep 26, 2017 10:31 pm
Bostondan gives great insight. As a surgeon, I would like to clarify the concept of "chief resident" as it is very different in surgical specialties compared to medical specialties. In some medical specialties, the chief resident is an administrative position where a resident who has otherwise finished his training stays for an additional year for a mixture of clinical and administrative duties. This is indeed an honor because there may only be 1 chief resident from a field of 20-40 internal medicine residents. Bostondan or other medical physicians please correct me if I am wrong.

In the surgical specialties, "chief resident" simply means a resident in their final/senior year of training. My surgical residency accepted 4 residents each year for a 6-year residency. So we had 4 "chief residents" each year who were those 4 residents in their 6th and final year of residency. All of them were chief residents. In other words, "chief resident" for a surgeon simply means you lasted until the end.
You are absolutely correct. I had meant to point this out in my post, but forgot to.

For internal medicine, a chief resident is actually an attending, not a resident at all. It is a misnomer. I stayed for an extra year to do a mix of teaching, clinical work as an attending, and administrative work. I was selected to do this. I did not apply for this position (most do not), but was asked by the Chair of the Department of Medicine to take it after committees met and made the selection. I believe some places refer to this position as "chief of the residents" to avoid that confusion.

For surgical specialties, as you mentioned, often times every person in the final year is a chief resident. That is obviously very different.

For Family Medicine, it is also usually someone in the final year of training, not an extra year and not an attending.

We like to make things as confusing as possible in the medical world!
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

toofache32
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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 toofache32 » Wed Sep 27, 2017 10:50 pm

Duplicate
Last edited by toofache32 on Thu Sep 28, 2017 6:58 am, 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 PhysicianOnFIRE » Wed Sep 27, 2017 11:23 pm

Erwin007 wrote:
Sat Sep 23, 2017 11:53 pm
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.
What do anesthesiologists know? They're in the lounge with their feet up watching TV while the CRNAs are in the OR.

Seriously, the amount of time that an actual anesthesiologist is in the OR vs a CRNA is minuscule.

If it's a fairly common procedure, your PCP probably has some patients who have had that operation and know what their patients' experiences were like (were they happy, did they have a good outcome, etc.).

Better people to ask would be circulating nurses or scrub techs. They see lots of different surgeons doing the same procedures and know who is good and who they would go to (unlike the Gyn doc at my hospital Who routinely asks the staff questions like "Is that bowel?" Or "is that the ureter?" during his surgeries).
As an anesthesiologist, I know the capabilities or our surgeons extremely well. I am responsible for the patients in up to four rooms at a time and I'm there for any significant incidents that occur in our operating rooms.

I agree that O.R. personnel will have the inside scoop on the surgeons, but most people aren't going to know any of them well enough to coax a good opinion out of them. As an outsider, I would be sure I was in a facility that has done many of the procedure that you're about to undergo and ask a lot of questions. If you happen to be close to someone who works there, you'll obviously want to get their opinion.

:beer
-PoF

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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 » Wed Sep 27, 2017 11:34 pm

PhysicianOnFIRE wrote:
Wed Sep 27, 2017 11:23 pm
Erwin007 wrote:
Sat Sep 23, 2017 11:53 pm
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.
What do anesthesiologists know? They're in the lounge with their feet up watching TV while the CRNAs are in the OR.

Seriously, the amount of time that an actual anesthesiologist is in the OR vs a CRNA is minuscule.

If it's a fairly common procedure, your PCP probably has some patients who have had that operation and know what their patients' experiences were like (were they happy, did they have a good outcome, etc.).

Better people to ask would be circulating nurses or scrub techs. They see lots of different surgeons doing the same procedures and know who is good and who they would go to (unlike the Gyn doc at my hospital Who routinely asks the staff questions like "Is that bowel?" Or "is that the ureter?" during his surgeries).
As an anesthesiologist, I know the capabilities or our surgeons extremely well. I am responsible for the patients in up to four rooms at a time and I'm there for any significant incidents that occur in our operating rooms.

I agree that O.R. personnel will have the inside scoop on the surgeons, but most people aren't going to know any of them well enough to coax a good opinion out of them. As an outsider, I would be sure I was in a facility that has done many of the procedure that you're about to undergo and ask a lot of questions. If you happen to be close to someone who works there, you'll obviously want to get their opinion.

:beer
-PoF
I'm a hand surgeon and I would argue that for the majority of my surgeries the anesthesiologist never steps foot in my room and has no idea about my capabilities as a surgeon. All they know is that the patient didn't die during my case, but since they didn't see a second of the operation they have zero idea how good or not good I am. For some cases where lengthy hospital stays are the norm, then yeah an anesthesiologist probably has some idea because they're dealing with issues in the PACU due to massive blood loss, or spending 8 hours in a case that should take 4, etc.

Since the OP didn't specify what kind of procedure they were having, I have my opinion on how I would find a good hand surgeon.

Lots of people have criticized my suggestion to ask OR nurses or scrub techs, but if you asked any of the nurses I work with who does a good gallbladder, or spinal fusion, or hysterectomy, they wouldn't have any qualms about telling you who is a butcher and who is good, and in my experience their recommendation doesn't have anything to do with whether they like working with them or not.

As in all things, YMMV.

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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 CWhea1775 » Thu Sep 28, 2017 7:42 am

You could also ask a nurse who works with patients recovering from your procedure who they would use.

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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 fasteddie911 » Thu Sep 28, 2017 8:28 am

bostondan wrote:
Tue Sep 26, 2017 9:30 pm

1. I like if my doctor was selected as a chief resident during Internal Medicine residency. It means that a substantial number of people who were observing this person closely in training felt that he or she was of the highest caliber. The doctor might still be bad and just fooling people, but it is one more way to reduce my risk of choosing incorrectly. I was a chief resident, so am familiar with the selection process.
I would somewhat disagree in regards to using "chief resident" as criteria for physician quality. Every program probably chooses a chief differently, but I've had a few colleagues that were chiefs who weren't necessarily people I would choose to be my doctor. Considering that chief year is more admin-heavy, at least where I was, it seemed clinical acumen wasn't at the forefront in the selection process all the time.

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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 dm200 » Thu Sep 28, 2017 9:01 am

fasteddie911 wrote:
Thu Sep 28, 2017 8:28 am
bostondan wrote:
Tue Sep 26, 2017 9:30 pm
1. I like if my doctor was selected as a chief resident during Internal Medicine residency. It means that a substantial number of people who were observing this person closely in training felt that he or she was of the highest caliber. The doctor might still be bad and just fooling people, but it is one more way to reduce my risk of choosing incorrectly. I was a chief resident, so am familiar with the selection process.
I would somewhat disagree in regards to using "chief resident" as criteria for physician quality. Every program probably chooses a chief differently, but I've had a few colleagues that were chiefs who weren't necessarily people I would choose to be my doctor. Considering that chief year is more admin-heavy, at least where I was, it seemed clinical acumen wasn't at the forefront in the selection process all the time.
I used to think/believe that a Physician who had some kind of part time relationship/affiliation with a Medical School would be a real plus. A few years ago, though, I was discussing this with someone (not a medical person) who worked in his specialty (statistical analysis) with the medical industry and he told me that there are a lot of very "mediocre" physicians who take these jobs. Thoughts?

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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 CULater » Thu Sep 28, 2017 9:20 am

When having a procedure done at a teaching hospital, such as a university hospital, I'm not sure you know who is doing the procedure while you are unconscious anyway. An inexperienced resident or other might be your actual surgeon. At the University hospital near me, I was recently told that the rules were changed so that the staff surgeon actually had to be present during the procedure instead of flitting around between several operating rooms. Geez, until I heard that I had no idea that the staff physician might have actually not even been present except occasionally during a procedure. I think that a patient is able to request that the staff physician be the actual person doing the procedure, but I'm not really sure about that. How can I be sure that the person I think is performing the procedure in a teaching hospital is actually the one doing it?
On the internet, nobody knows you're a dog.

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