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

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Erwin007
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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 » Thu Sep 28, 2017 12:36 pm

CULater wrote:
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?
You know who the surgeon of record is because their name is on the consent form you sign before surgery. Hopefully no one really thinks that a surgeon, especially at a teaching hospital, is going to stake their reputation on letting an inexperienced resident do their surgery without supervision. The lingo I remember from training was that the attending had to be "readily available" (open for interpretation) and "present for the key portions of the procedure" (also open for interpretation--what is the "key" portion?).

In my experience the attendings hovered until they had confidence in you and then they'd let you do stuff directly supervised, then they'd let you do stuff while they were in the corner doing computer charting or catching up on dictations, and then they were present for the surgical timeout before going to sleep in the lounge in the middle of the night while the senior resident and junior resident were nailing the femur fracture in the middle of the night and would come back in for the final X-rays.

Where I did med school the chief of ENT would run two rooms simultaneously with huge head and neck cancer surgeries and would bounce back and forth between rooms to be present for the critical parts of the cases, while teams of 2 residents would be doing lots of the exposure or more mundane parts of the cases.

It's a dilemma, right? No one wants to be operated on by an inexperienced surgeon but then everyone expects expert care.

We always found it hilarious and stupid when patients would request to not have residents present for their surgery. So instead of an almost expertly trained assistant who cares and wants to be there and knows the preferences of their attending surgeon and can really help out (getting and keeping retractors in the right place so the surgeon can see, requesting to have the correct instruments so the surgeon doesn't have to interrupt their train of thought, etc.) you're now forcing the attending surgeon to use a team of scrub techs who are paid by the hour and don't give two sh^*s about what's going on.

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PhysicianOnFIRE
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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 » Thu Sep 28, 2017 1:40 pm

Erwin007 wrote:
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.
There are plenty of practices that have anesthesiologists in the room the entire time. I've sat thousands of cases myself. Currently, I happen to work in a care team setting that I'm guessing is somewhat similar to yours, where the anesthesiologists manage multiple rooms staffed by CRNAs. I'll admit that I spend much less time in the hand cases where critical events are extraordinarily rare.

If you never see the anesthesiologists, you probably shouldn't make disparaging remarks about what you imagine they're doing. If they're not busy interviewing, examining, and filling out the preop evals on 30 other patients that day, or dealing with emergent situations in other rooms, they just might be busy performing the peripheral nerve block for your next patient.

Of course, YMMV as you say, and towards the end of a long day, you just might find me in the lounge with my feet up. But I contend that I am more than familiar enough with our surgeons to know who to trust with my family's surgical needs.

:beer
-PoF
Last edited by PhysicianOnFIRE on Thu Sep 28, 2017 4:07 pm, edited 1 time in total.

fasteddie911
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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 2:55 pm

dm200 wrote:
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?
I think it depends. Someone heavily involved with med students, resident training, etc. it may be a perk as that person is under a microscope being surrounded by colleagues and such, and thus may practice better. However, someone could only be very loosely affiliated with a med school, but still advertise their affiliation as a marketing ploy, in which case they are probably no different than any other private doc. However, those in academics may sometimes be limited in their clinical exposure as they spend more time doing research, teaching, admin, etc., so they may not be as sharp as a private doc. Likewise, training at big-name academic places, while it sounds impressive, won't necessarily lead to the most skilled surgeons or operators, as they may spend more time doing research or not get much autonomy for whatever reason. It's tough to figure out and I'd go along with most suggestions here and just ask around, but I just don't think there's a foolproof method or rule-of-thumb that could be applied universally.

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 » Thu Sep 28, 2017 6:20 pm

CULater wrote:
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?
I think the situation has improved over the years for the patients. It was not uncommon in the past that the senior resident/chief resident did the entire cases with the attending somewhere in the hospital doing paperwork/writing grant proposal etc when I was a surgical resident. Regulatory body has cracked down on this practice, and the attending is usually in the OR now. If one looked the surgical list of someone like Dr. DeBakey, a very famous CV surgeon, there is no way that he would have been personally present for all the surgeries. He probably had a team of residents/fellows that did most of the work.

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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 » Thu Sep 28, 2017 6:26 pm

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?
That is like asking would a great English Professor at Harvard be who you would want to teach you composition. The Harvard Professir is picked for their fame and their research. So, alas, a big name physician may be a test of a certain level of intelligence but not particular medical skill in their field. If you know enough to only pick a sub sub sub specialist, then yes. Otherwise you may just be subsidizing their research or a colleagues on something unrelated to your care.
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daveydoo
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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 daveydoo » Thu Sep 28, 2017 7:33 pm

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

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?"
I do think that this is a good test. I've been very impressed by docs who are forthcoming about their limitations and even their oversights and errors. My month-old son was seeing a well-regarded specialist who was about to do an invasive procedure. We were chatting as he was about to start and I off-handedly mentioned that my son had this done on the first day of his life. He stopped dead in his tracks, whirled around, and asked me the details. He was candid that he had not been aware, and that the present test was therefore unnecessary. It was a low-risk procedure and this guy cared not one iota about a humiliating admission -- he wouldn't let my kid assume needless risk no matter how inconsequential. I really admired that.

For a non-procedural interaction, any bright, honest, and conscientious physician will suffice. He/she will either know the answer or will track it down. Imo, 99% of medicine is diligence (well, and pattern-recognition :happy) ; there is very little brilliance required day-to-day. Most of you will never need a brilliant diagnostician. What distinguishes physicians, though, from "mid-levels" is the ability to recognize that 1% of the time when things are not as they appear. I would only want a really bright physician, even if he/she doesn't need that "A" game every time I'm in the office. Medicine is quickly moving away from this model -- schools are selecting for a more customer-service-oriented model, choosing glib charmers over smart introverts.

For procedures, it's different. I would go to a doc with a lousy bedside manner if he/she were technically the best. For a major procedure, I'd choose a center that does a high volume, as others have said. Many major metro areas have a city magazine (Boston, Philadelphia) that annually surveys area docs and publishes a list of the "best specialists" (I think all of the major east coast cities have this). Of course, many of the best docs never appear on these lists (too small a referral base, not at a major center, etc.), but the ones on the list are pretty uniformly excellent. I do not mean the bought-and-paid-for lists that fill the in-flight magazines and all the self-paid "Who's Who" garbage.

A good PCP can only get you so far, in terms of referrals. In most integrated health systems (the way everything is moving), you will be referred to a service and not an individual. When the specialist I was just referred to knew little about my condition (well-trained in other areas, I'm sure, but knew less than I did about this actual reason for my referral), I had to insist on a second opinion from one of the sub-specialists in this area. In contrast, when I had a similar issue (same health system) over a decade ago, they set me up initially with one of their true experts. So I agree with others (Nisiprius, maybe?) about snooping online to see what folks self-identify as their interests and expertise. Also, US News ranks departments and this can be a decent starting point, with the caveat above (i.e., that getting to a well-regarded department isn't the whole battle). Again, there are excellent bastions of care that never show up on these lists, and institutional reputations lag reality by a decade or so, but stand-outs on these lists should be excellent choices. As academic medical centers, they may not be particularly well run or well funded or well staffed or have impressive physical plants -- but the docs in these top departments should be top-notch.

Looking at a doc's pedigree/training can be helpful but it's a mixed bag. Plenty of Harvard-trained docs do research-intensive fellowships and spend 90% of their time not seeing patients (meaning they are very sharp but may have relatively limited clinical exposure); others are superb, busy clinicians. A US undergrad who goes to an overseas medical school is a bit of a red flag -- although some have a blinding passion for medicine that can overcome other deficiencies. Many (native) foreign grads receive inferior training and re-train here in the US in low-demand specialties and/or uncompetitive training programs. Others, as has been pointed out above, are superstars who just really want to be in the US.

Age-wise, I do think there is a sweetspot -- recent enough training to be a go-getter and be comfortable with the latest, but also seasoned enough to have seen your particular condition -- not just the textbook examples but the weird ones, too -- a hundred times at least. Like any "trade," there is a lot of medicine that isn't written down and doesn't get taught and has to be acquired through experience. There are very aggressive new docs and very conservative new docs but the more seasoned ones seem to converge around more middle-of-the-road styles -- inaction and unwarranted action can both get you into trouble.
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nedsaid
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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 nedsaid » Thu Sep 28, 2017 7:42 pm

One mark of a good physician is curiosity. The willingness to dig deeper, ask questions, maybe order a test. Not just rush me out the door.
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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 » Thu Sep 28, 2017 7:45 pm

Glad to see we can get together and 3 pages later not come to a consensus. Feels like a thread about international vs. domestic only investing. :D

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 staythecourse » Thu Sep 28, 2017 7:55 pm

nedsaid wrote:
Thu Sep 28, 2017 7:42 pm
One mark of a good physician is curiosity. The willingness to dig deeper, ask questions, maybe order a test. Not just rush me out the door.
I would not say curiosity, but being thorough. When I teach residents I tell them the same thing it does not matter how smart or well read they are in their field. The BEST doctors are thorough. Great care does not come from what you see in shows like ER or House. It is not the diagnosis of a zebra that makes a great physician (that just makes great bragging rights to other colleagues). It is the ability to not miss something and feel you can give a explanation of each of the patient's medical complaints. Seems easy enough, but with the production pressure that has now invaded medical care it is not as easy anymore to give appropriate level of time to each patient. Sadly, I only see that getting worst.

Good luck.
Last edited by staythecourse on Fri Sep 29, 2017 10:28 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 daveydoo » Thu Sep 28, 2017 9:37 pm

staythecourse wrote:
Thu Sep 28, 2017 7:45 pm
Glad to see we can get together and 3 pages later not come to a consensus.
What, you wanted a name and address? :D

There must be two dozen excellent suggestions up there. Feel free to use them!

If everyone could instantly find the region's "best" doctor -- whatever that means -- he or she would be way too busy to see you.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"

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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 » Fri Sep 29, 2017 6:30 am

dm200 wrote:
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?
Both of these responses to my comment are accurate, at least part of the time. That is why I said I wasn't really sure this helped the general layperson. You really have to know how a person is selected for the job. At my institution, admin skills were not really a priority when selecting chiefs. I know this because I was heavily involved in the selection process the following year. We focused on teaching and clinical skill, with high scores on testing being another secondary trait that was preferred (not a primary factor, because some high scorers aren't good doctors). I know the general selection process for the hospitals in the Boston area, so can use that as a factor when choosing my own physician or recommending one for others. I don't exclusively choose chief residents, since that would be a little bit absurd. It's just a nice additional way to know the person is at least felt to be competent by another large group of people.

Regarding academic physicians being mediocre, certainly that can be true. You will find mediocre people in every field in all situations. It really depends on the specialty though. For example, for jobs that are highly available, such as being a hospitalist, it is relatively easy to get hired at an academic hospital, therefore making it more likely to find a mediocre hospitalist working there. That being said, I found the community hospitalists to be much more likely to be of low quality (I did a lot of community moonlighting), though many of the community hospitalists were also great. Overall, the appeal of an academic hospital to me is the vast resources that most have. If an emergency happens when you are admitted to the hospital, a tertiary care center is likely to have every kind of specialist ready to come see you with short notice. That isn't always a good thing, but it is preferable to me as an informed consumer.
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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 bcowan12 » Sat Sep 30, 2017 12:53 am

A few months ago, I heard about a new website called amino.com on a financial podcast. If you have a specific procedure you want to research, it analyzes millions of insurance claims to see what doctors in your area have done the most, and with the least chance of requiring follow up work. It provides this info without asking any identifying personal information. It will even filter for doctors covered by your insurance.

I've never had the need to use it, but have mentally filed it away in case I do. It seems like a good resource for the "expert's dilemma".

Regards,
Bruce

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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 Oct 02, 2017 8:48 am

staythecourse wrote:
Thu Sep 28, 2017 7:55 pm
I would not say curiosity, but being thorough. When I teach residents I tell them the same thing it does not matter how smart or well read they are in their field. The BEST doctors are thorough.
If a medical office is not thorough in processing insurance information is that a reflection on the physician?

I asked my doctor to submit a referral for my annual blood tests as a preventative measure. I explicitly wrote preventative in the PM to my doctor. The doctor responded that the referral has been submitted. Some weeks after I did the blood tests, which were perfect as usual, I received a bill from the lab, because the doctor's office has coded the tests as for a condition. I talked to the Lab, I talked to my insurance company, and I had several exchanges with my doctor's office. They still can't get it right, even though I sent them follow-up PMs with detailed instruction for how they have to re-submit the referral to the lab.

I realize that it is not my doctor who is handling the insurance claims. However, I am dismayed how much time is wasted on their side, as well as mine, which could've been prevented if the initial referral was submitted according to my initial request spelled out in my initial PM.

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 staythecourse » Mon Oct 02, 2017 9:11 am

VictoriaF wrote:
Mon Oct 02, 2017 8:48 am
staythecourse wrote:
Thu Sep 28, 2017 7:55 pm
I would not say curiosity, but being thorough. When I teach residents I tell them the same thing it does not matter how smart or well read they are in their field. The BEST doctors are thorough.
If a medical office is not thorough in processing insurance information is that a reflection on the physician?

I asked my doctor to submit a referral for my annual blood tests as a preventative measure. I explicitly wrote preventative in the PM to my doctor. The doctor responded that the referral has been submitted. Some weeks after I did the blood tests, which were perfect as usual, I received a bill from the lab, because the doctor's office has coded the tests as for a condition. I talked to the Lab, I talked to my insurance company, and I had several exchanges with my doctor's office. They still can't get it right, even though I sent them follow-up PMs with detailed instruction for how they have to re-submit the referral to the lab.

I realize that it is not my doctor who is handling the insurance claims. However, I am dismayed how much time is wasted on their side, as well as mine, which could've been prevented if the initial referral was submitted according to my initial request spelled out in my initial PM.

Victoria
All I can say is I run my own practice and take 100% responsibility for EVERYTHING that happens (good and bad). Mistakes happen especially clerical ones considering so many people are involved (like a bad game of telephone). However, after trying to figure it out with hopefully the one running the show, i.e. practice manager or the doctor himself it should have been resolved. Like any business I look to see how the business is run. If they can't get to fixing what seems to be a pretty simple problem then it concerns me. Have you talked to the practice manager or doc direct? If so, this is pathetic. As I say often on here "vote with your feet" if you are not getting the quality of care you want (clinical or nonclinical).

Good luck.

p.s. It is true that most doctors are pretty far removed from billing and much more now that they are often employed by a larger employer, i.e. hospitals so they are likely not the best at addressing this specific issue.

p.s.s. Are you sure the billing charges would be different for "preventive" vs. "condition"? A quick call to your insurer will tell you that.
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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 F150HD » Mon Oct 02, 2017 9:14 am

good or otherwise, how do you choose a 'primary care doctor' when you don't go to one that often?

I am always asked this when filling out emergency forms here or there, how do you choose one? do most people just do this randomly by whatever is convenient by their home and in their insurance network?

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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 Oct 02, 2017 9:28 am

F150HD wrote:
Mon Oct 02, 2017 9:14 am
good or otherwise, how do you choose a 'primary care doctor' when you don't go to one that often?

I am always asked this when filling out emergency forms here or there, how do you choose one? do most people just do this randomly by whatever is convenient by their home and in their insurance network?
Get referrals from your friends, family, colleagues. Then pick one in a large (or large-ish) practice who is in your insurance network and who is accepting new patients. I like a practice large enough to have its own in-house lab and several specialties. My GP's office, for example, has a couple of neurologists, several gastroenterologists, a rheumatologist, and an endocrinologist on staff. That makes getting into to see a specialist a little bit easier, and it's also helpful that they can all see my entire medical record and each other's notes. And if my GP leaves or retires, they'll just switch me to another one in the practice; so I won't have to scramble to find a new GP who is accepting new 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 VictoriaF » Mon Oct 02, 2017 9:40 am

staythecourse wrote:
Mon Oct 02, 2017 9:11 am
VictoriaF wrote:
Mon Oct 02, 2017 8:48 am
staythecourse wrote:
Thu Sep 28, 2017 7:55 pm
I would not say curiosity, but being thorough. When I teach residents I tell them the same thing it does not matter how smart or well read they are in their field. The BEST doctors are thorough.
If a medical office is not thorough in processing insurance information is that a reflection on the physician?

I asked my doctor to submit a referral for my annual blood tests as a preventative measure. I explicitly wrote preventative in the PM to my doctor. The doctor responded that the referral has been submitted. Some weeks after I did the blood tests, which were perfect as usual, I received a bill from the lab, because the doctor's office has coded the tests as for a condition. I talked to the Lab, I talked to my insurance company, and I had several exchanges with my doctor's office. They still can't get it right, even though I sent them follow-up PMs with detailed instruction for how they have to re-submit the referral to the lab.

I realize that it is not my doctor who is handling the insurance claims. However, I am dismayed how much time is wasted on their side, as well as mine, which could've been prevented if the initial referral was submitted according to my initial request spelled out in my initial PM.

Victoria
All I can say is I run my own practice and take 100% responsibility for EVERYTHING that happens (good and bad). Mistakes happen especially clerical ones considering so many people are involved (like a bad game of telephone). However, after trying to figure it out with hopefully the one running the show, i.e. practice manager or the doctor himself it should have been resolved. Like any business I look to see how the business is run. If they can't get to fixing what seems to be a pretty simple problem then it concerns me. Have you talked to the practice manager or doc direct? If so, this is pathetic. As I say often on here "vote with your feet" if you are not getting the quality of care you want (clinical or nonclinical).

Good luck.

p.s. It is true that most doctors are pretty far removed from billing and much more now that they are often employed by a larger employer, i.e. hospitals so they are likely not the best at addressing this specific issue.

p.s.s. Are you sure the billing charges would be different for "preventive" vs. "condition"? A quick call to your insurer will tell you that.
Thank you for a prompt response. To answer your questions:
1. My doctor is at a medical office affiliated with the George Washington University Hospital.
2. I have not spoke with the staff. I exchange PMs with my doctor, and she passes information to her staff.
3. The coding makes a significant difference, because I have a High Deductible Health Plan (HDHP) with which preventative care is free for me. However, I have to pay a (large) deductible for condition-related treatments.
4. I already had a situation where the office has coded a test as a "condition" instead of "preventative." I tried to resolve it, gave up, and paid for it myself. This time, I want to have it resolved. If I don't persist, I will end up paying unnecessary charges every year.

My take-aways from your response:
1. In the future, make telephone calls instead of using PM. (However, PMs provide me with a paper trail of the communications.)
2. Consider changing a doctor, because lack of thoroughness in mundane issues could be a symptom of larger problems.

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 travellight » Mon Oct 02, 2017 9:45 am

White Coat Investor wrote:
Sun Sep 24, 2017 9:32 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?
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.
+1, great advice.
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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 Oct 02, 2017 10:53 am

VictoriaF wrote:
Mon Oct 02, 2017 9:40 am
staythecourse wrote:
Mon Oct 02, 2017 9:11 am
VictoriaF wrote:
Mon Oct 02, 2017 8:48 am
staythecourse wrote:
Thu Sep 28, 2017 7:55 pm
I would not say curiosity, but being thorough. When I teach residents I tell them the same thing it does not matter how smart or well read they are in their field. The BEST doctors are thorough.
If a medical office is not thorough in processing insurance information is that a reflection on the physician?

I asked my doctor to submit a referral for my annual blood tests as a preventative measure. I explicitly wrote preventative in the PM to my doctor. The doctor responded that the referral has been submitted. Some weeks after I did the blood tests, which were perfect as usual, I received a bill from the lab, because the doctor's office has coded the tests as for a condition. I talked to the Lab, I talked to my insurance company, and I had several exchanges with my doctor's office. They still can't get it right, even though I sent them follow-up PMs with detailed instruction for how they have to re-submit the referral to the lab.

I realize that it is not my doctor who is handling the insurance claims. However, I am dismayed how much time is wasted on their side, as well as mine, which could've been prevented if the initial referral was submitted according to my initial request spelled out in my initial PM.

Victoria
All I can say is I run my own practice and take 100% responsibility for EVERYTHING that happens (good and bad). Mistakes happen especially clerical ones considering so many people are involved (like a bad game of telephone). However, after trying to figure it out with hopefully the one running the show, i.e. practice manager or the doctor himself it should have been resolved. Like any business I look to see how the business is run. If they can't get to fixing what seems to be a pretty simple problem then it concerns me. Have you talked to the practice manager or doc direct? If so, this is pathetic. As I say often on here "vote with your feet" if you are not getting the quality of care you want (clinical or nonclinical).

Good luck.

p.s. It is true that most doctors are pretty far removed from billing and much more now that they are often employed by a larger employer, i.e. hospitals so they are likely not the best at addressing this specific issue.

p.s.s. Are you sure the billing charges would be different for "preventive" vs. "condition"? A quick call to your insurer will tell you that.
3. The coding makes a significant difference, because I have a High Deductible Health Plan (HDHP) with which preventative care is free for me. However, I have to pay a (large) deductible for condition-related treatments.
4. I already had a situation where the office has coded a test as a "condition" instead of "preventative." I tried to resolve it, gave up, and paid for it myself. This time, I want to have it resolved. If I don't persist, I will end up paying unnecessary charges every year.
There are very few and very specific preventive tests that are "free" by most insurance plans. Did your insurance company or someone else tell you that the specific blood tests you had could be free if they were preventive? And more importantly, what were the CPT and ICD-10 codes you requested to be used for those tests? There are many people out there who ask the office to "code it so I don't have to pay for it" which sounds similar to what you said when you asked them to code it as preventive vs. condition. Lastly, what were the criteria for you to qualify for having these tests coded as preventive instead of diagnostic?

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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 Oct 02, 2017 11:07 am

toofache32 wrote:
Mon Oct 02, 2017 10:53 am
There are very few and very specific preventive tests that are "free" by most insurance plans. Did your insurance company or someone else tell you that the specific blood tests you had could be free if they were preventive? And more importantly, what were the CPT and ICD-10 codes you requested to be used for those tests? There are many people out there who ask the office to "code it so I don't have to pay for it" which sounds similar to what you said when you asked them to code it as preventive vs. condition. Lastly, what were the criteria for you to qualify for having these tests coded as preventive instead of diagnostic?
My insurance company GEHA, under HDHP, has a list of free preventative tests, exams and procedures. This is quite common for high-deductible plans, and since I had GEHA-HDHP, I did not have to pay for these services. Last year, my doctor's office has put a wrong code on a preventative test and I ended up paying for it.

This year, I did not start by asking for a specific code. I asked for a referral for an annual preventative test in conjunction with my annual physical exam. To prevent last-year's situation I explicitly requested the referral to be coded as a preventative test.

I talked with my insurance company GEHA-HDPD. GEHA told me that the code was wrong, and gave me the code that would be considered preventative and thus would be paid by them instead of me. Only then I contacted the doctor's office with a specific code I wanted them to use.

You are welcome to challenge my actions. However, I am usually quite thorough and value thoroughness in others. That's why I picked up on staythecourse's comment. Until today, I dismissed my doctor's office's sloppiness as that of the staff. After reflecting on staythecourse's comment, I am thinking that if the office is sloppy with coding, they can be sloppy with diagnosis and other issues.

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 Oct 02, 2017 11:14 am

Observation/question:

1. From my patient experience, etc. , I tend to believe that some expert Physicians/surgeons who might be the "best" for difficult or complicated situations may not be "the best" for more normal or routine situations. I reached that conclusion when consulting a hand surgeon about a ganglion cyct on my wrist - and never went back to him.

2. I wonder (don't know) how the comptency/stability/etc. of a Physician's office staff makes a difference? My previous Endocrinologist (Thyroid and Parathyroid issues) seemed excellent and thorough. However, in her individual practice, her staff was a revolving door - near 100% turnover sometimes in a few months.

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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 » Mon Oct 02, 2017 12:05 pm

VictoriaF wrote:
Mon Oct 02, 2017 9:40 am
staythecourse wrote:
Mon Oct 02, 2017 9:11 am
VictoriaF wrote:
Mon Oct 02, 2017 8:48 am
staythecourse wrote:
Thu Sep 28, 2017 7:55 pm
I would not say curiosity, but being thorough. When I teach residents I tell them the same thing it does not matter how smart or well read they are in their field. The BEST doctors are thorough.
If a medical office is not thorough in processing insurance information is that a reflection on the physician?

I asked my doctor to submit a referral for my annual blood tests as a preventative measure. I explicitly wrote preventative in the PM to my doctor. The doctor responded that the referral has been submitted. Some weeks after I did the blood tests, which were perfect as usual, I received a bill from the lab, because the doctor's office has coded the tests as for a condition. I talked to the Lab, I talked to my insurance company, and I had several exchanges with my doctor's office. They still can't get it right, even though I sent them follow-up PMs with detailed instruction for how they have to re-submit the referral to the lab.

I realize that it is not my doctor who is handling the insurance claims. However, I am dismayed how much time is wasted on their side, as well as mine, which could've been prevented if the initial referral was submitted according to my initial request spelled out in my initial PM.

Victoria
All I can say is I run my own practice and take 100% responsibility for EVERYTHING that happens (good and bad). Mistakes happen especially clerical ones considering so many people are involved (like a bad game of telephone). However, after trying to figure it out with hopefully the one running the show, i.e. practice manager or the doctor himself it should have been resolved. Like any business I look to see how the business is run. If they can't get to fixing what seems to be a pretty simple problem then it concerns me. Have you talked to the practice manager or doc direct? If so, this is pathetic. As I say often on here "vote with your feet" if you are not getting the quality of care you want (clinical or nonclinical).

Good luck.

p.s. It is true that most doctors are pretty far removed from billing and much more now that they are often employed by a larger employer, i.e. hospitals so they are likely not the best at addressing this specific issue.

p.s.s. Are you sure the billing charges would be different for "preventive" vs. "condition"? A quick call to your insurer will tell you that.
Thank you for a prompt response. To answer your questions:
1. My doctor is at a medical office affiliated with the George Washington University Hospital.
2. I have not spoke with the staff. I exchange PMs with my doctor, and she passes information to her staff.
3. The coding makes a significant difference, because I have a High Deductible Health Plan (HDHP) with which preventative care is free for me. However, I have to pay a (large) deductible for condition-related treatments.
4. I already had a situation where the office has coded a test as a "condition" instead of "preventative." I tried to resolve it, gave up, and paid for it myself. This time, I want to have it resolved. If I don't persist, I will end up paying unnecessary charges every year.

My take-aways from your response:
1. In the future, make telephone calls instead of using PM. (However, PMs provide me with a paper trail of the communications.)
2. Consider changing a doctor, because lack of thoroughness in mundane issues could be a symptom of larger problems.

Victoria
Thanks for the info. for a more complete picture. I would meet with the practice manager or whoever is in charge of running the office. A face to face is worth everything. Just explain you completely legitimate situation and ask them to make the proper changes. It is not fair that you should have to pay for something that was done incorrect on their part. It is all about documentation on your records and proper billing.

The doctor in this situation will likely know nothing about billing and unfortunately becomes a game of telephone at this point where the message is blurry at best and missed completely at worst. In these situations the physician is intentionally kept at arms length from the billing/ business side. He/ she should have said as much and given you the contact info. of the go to person to answer your question who can help.

In your situation, one would hope going somewhere else will get you a better result, but maybe not. However, if the institution does not value giving good customer service when needed then that just can not be tolerated. My bet is if you can find the point person and explain the situation where they understand the problem it should get resolved.

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 travellight » Mon Oct 02, 2017 12:57 pm

One small way to assess your primary care physician: next time you see that person and have a cold, tell them about your symptoms and ask for antibiotics. If they try to educate you on viral causes and why antibiotics are not likely to help but to keep them informed if it doesn't clear up, that is a good sign.

Likewise with narcotic pain meds, cigarette smoking, and obesity.
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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 travellight » Mon Oct 02, 2017 1:02 pm

"Patients in the study who demonstrated the highest level of satisfaction were more likely to have an inpatient admission (adjusted odds ratio 1.12) than those with the lowest levels of satisfaction. They also accounted for 8.8% more health care expenditures, including greater prescription drug expenditures. Worst of all, they demonstrated a higher mortality, with an odds ratio of 1.26, which means they had a 26% higher chance of dying."

.... quote above is from this article:

http://scienceblogs.com/insolence/2012/ ... lity-of-c/
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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 Oct 02, 2017 1:29 pm

travellight wrote:
Mon Oct 02, 2017 12:57 pm
One small way to assess your primary care physician: next time you see that person and have a cold, tell them about your symptoms and ask for antibiotics. If they try to educate you on viral causes and why antibiotics are not likely to help but to keep them informed if it doesn't clear up, that is a good sign.
Likewise with narcotic pain meds, cigarette smoking, and obesity.
I agree. However, I would bet that patient satisfaction surveys would tend to rate physicians who just prescribe the antibiotics right away higher than those who do it right. In my opinion, many of these patient surverys published by various entities (such as Checkbook) rate Physicians higher if such physicians just tell patients what they want to hear, such as "everything in moderation" (smoking, eating junk, etc.) or, "don't worry if you are 50 pounds overweight - as long as you are happy"

A longtime friend of ours has the same Kaiser primary care physician as I do. The friend is very unhappy with the Physician because the Physician told the friend that she is very overweight/obese and needs to lose weight.

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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 travellight » Mon Oct 02, 2017 3:00 pm

dm200 wrote:
Mon Oct 02, 2017 1:29 pm
travellight wrote:
Mon Oct 02, 2017 12:57 pm
One small way to assess your primary care physician: next time you see that person and have a cold, tell them about your symptoms and ask for antibiotics. If they try to educate you on viral causes and why antibiotics are not likely to help but to keep them informed if it doesn't clear up, that is a good sign.
Likewise with narcotic pain meds, cigarette smoking, and obesity.
I agree. However, I would bet that patient satisfaction surveys would tend to rate physicians who just prescribe the antibiotics right away higher than those who do it right. In my opinion, many of these patient surverys published by various entities (such as Checkbook) rate Physicians higher if such physicians just tell patients what they want to hear, such as "everything in moderation" (smoking, eating junk, etc.) or, "don't worry if you are 50 pounds overweight - as long as you are happy"

A longtime friend of ours has the same Kaiser primary care physician as I do. The friend is very unhappy with the Physician because the Physician told the friend that she is very overweight/obese and needs to lose weight.
haha, no good deed goes unpunished!
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Physician Credentials: Offshore vs. American Medical Schools

Post by stargazer » Wed Nov 21, 2018 11:03 am

[Thread merged into here, see below (next page) --admin LadyGeek]

At the risk of broaching a controversial topic (in the subforum of personal consumer issues)...

In searching for a new physician, I take into account several factors: recommendations from other physicians, word-of-mouth from friends, office location, types of insurance accepted, hospital affiliations, malpractice claims, and medical education. I have generally discounted online physician reviews because of the small sample size, and because of the the possibility that those reviews can be influenced by one or two disgruntled patients.

As regards medical education, I have favored doctors who completed their education at an American medical school vs. those who completed their education at an offshore medical school. My wife has told me that this consideration is irrelevant since all doctors wishing to practice in the US must take the same board exams and must complete a residency in a US medical center. She maintains that the rigor of the residency program is a better measure of a doctor's educational credentials than the reputation of the medical school he/she attended.

As regards these two factors (the rigor of the residency program vs. the reputation of the medical school attended), which deserves greater weighting?

Please note: As I stated at the outset, this is one consideration among many.
Last edited by stargazer on Wed Nov 21, 2018 11:10 am, edited 1 time in total.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by GAAP » Wed Nov 21, 2018 11:08 am

My wife and I both chose doctors with foreign degrees. To practice, they had to pass the boards, just like anyone else. Their education could have been first rate, or not -- the same as someone with a domestic degree.

My preference is to get someone that has practiced for a while, so they have some experience -- but not too long, so that they are more likely to be current with the latest medical knowledge, and less likely to be burned out.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by climber2020 » Wed Nov 21, 2018 11:21 am

The most important thing to look for is where they did their residency. Medical school is a series of hoops to jump through, and you don't learn much about actual doctoring during that time. Having said that, a person from the US who goes to a foreign medical school generally does so because his grades and test scores weren't good enough to get into a US medical school. You can interpret that however you see fit.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by carolinaman » Wed Nov 21, 2018 11:34 am

Choosing new physicians is difficult without referrals from physicians or friends knowledgeable of the health industry (i.e. nurses can be good for this). I have had to change primary physicians twice in last 4 years due to their leaving practice. It was a difficult task because of the lack of objective information. I agree with a lot of what you say. I would not totally discount physicians educated and trained overseas. Someone trained in the developed world would have a lot more credibility than one trained in third world nation. I am sure that residency is challenging and weeds out a lot of marginal students, but I have seen too many doctors (most US educated) whose competency is questionable to think that residency is foolproof.

My wife is going to an ENT who was trained in India. He is excellent and very highly regarded. I would not hesitate to use him for his specialty. My mother had an Asian doctor as her primary and he also was very good.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by somekevinguy » Wed Nov 21, 2018 11:50 am

I'm a physician who is heavily involved in training new physicians (and my wife is also a physician)

Residencies definitely matter more than medical schools. Neither guarantees that a physician will be outstanding or even competent necessarily but in general, residencies are where physicians learn their specialty and the practice of medicine- residencies (via the faculty, the hospital/patient population, etc) provide for varying opportunities to learn this practice. That being said, everyone passes the same boards and residencies are all accredited by the same governing body (ACGME) to meet some minimum standards. I think medical schools/residencies are a factor but certainly not the only factor and maybe not even that important of a factor (the data isn't conclusive as people have studied this).

That being said, all else being equal, would I rather have an internist who graduated from UCSF and trained at Harvard/MGH or one that went to school in the Carribean and went to a small rural community hospital for residency? Doesn't mean the former will always be a better physician than the latter but I think most would choose the former.

Unfortunately, I feel for the general public as there really isn't a great way to distinguish quality of physicians. I feel better about choosing a restaurant to eat at or a general contractor than I do a physician (based on the information available to the general public). If you have any physician friends, it is worth asking them for recommendations.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by dalbright » Wed Nov 21, 2018 11:57 am

stargazer wrote:
Wed Nov 21, 2018 11:03 am
At the risk of broaching a controversial topic (in the subforum of personal consumer issues)...

In searching for a new physician, I take into account several factors: recommendations from other physicians, word-of-mouth from friends, office location, types of insurance accepted, hospital affiliations, malpractice claims, and medical education. I have generally discounted online physician reviews because of the small sample size, and because of the the possibility that those reviews can be influenced by one or two disgruntled patients.

As regards medical education, I have favored doctors who completed their education at an American medical school vs. those who completed their education at an offshore medical school. My wife has told me that this consideration is irrelevant since all doctors wishing to practice in the US must take the same board exams and must complete a residency in a US medical center. She maintains that the rigor of the residency program is a better measure of a doctor's educational credentials than the reputation of the medical school he/she attended.

As regards these two factors (the rigor of the residency program vs. the reputation of the medical school attended), which deserves greater weighting?

Please note: As I stated at the outset, this is one consideration among many.
Unless this is for some unique condition that you need treated, your best bet if you or your spouse is active in a local facebook group, Mom's group, etc is to ask for a recommendation and let them narrow the search down for you. Then if you want you can make a final decision based off the above criteria and I think you will be in good shape.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by Watty » Wed Nov 21, 2018 11:58 am

One thing to watch out for is how good their English is. I have run into at least one that had a very strong accent that made him hard to understand.

Some practices will have a short video by the doctor on their website where you can hear the doctors talk.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by jayk238 » Wed Nov 21, 2018 1:03 pm

I am one of those no name doctors who trained at a small community hospital in a rural town. Lol.

I dont know too many UCSF internists in my area or any for that matter. Most are probably at ucsf or some major city too busy teaching residents and students instead of day to day practice.

Id rather you seek someone who cares about you takes time to listen and can send you to the appropriate place.

Ive heard bad things about ‘well trained’ doctors who went to Harvard but are jerks. Is that what you want?

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by HueyLD » Wed Nov 21, 2018 1:17 pm

You are right, Dr. JAyK.

A relative moved to a new city and was looking for a urologist. The first one he found looked good on paper with Ivy League credentials for both undergraduate and med. schools. However, the doctor had no people skills and he refused to listen to any idea that was not his. He even told my relative to take it or find someone else.

So, my relative found someone else and that was the happy ending.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by dm200 » Wed Nov 21, 2018 1:19 pm

No medical credentials, but speaking as a patient

To me the medical school is largely irrelevant. My PCP went to Medical school in the UK and my endocrinologist went to medical school in Iran. I am very happy with both.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by ResearchMed » Wed Nov 21, 2018 1:20 pm

jayk238 wrote:
Wed Nov 21, 2018 1:03 pm
I am one of those no name doctors who trained at a small community hospital in a rural town. Lol.

I dont know too many UCSF internists in my area or any for that matter. Most are probably at ucsf or some major city too busy teaching residents and students instead of day to day practice.

Id rather you seek someone who cares about you takes time to listen and can send you to the appropriate place.

Ive heard bad things about ‘well trained’ doctors who went to Harvard but are jerks. Is that what you want?
I agree with almost all of the above (previous comments) about how to "judge" credentials.

But... if you don't LIKE/RESPECT your doctor, or don't feel your doctor LIKES/RESPECTS *you*, then consider looking for another.
"Chemistry" can be very important, in terms of "does the doctor LISTEN to what you say"; sometimes a symptom could be missed if the physician isn't really listening.

We are at a very major medical school/teaching hospital, and there are some absolutely phenomenal physicians here. And some did not train in the USA. Yes, the bar is high to "get here", but that doesn't guarantee "only the best".

Use your own good judgement and common sense, too.

This is a difficult time in "medical care history", given all of the pressures on physicians, such that things can feel or be rushed.
But some physicians handle this better than others, in a variety of ways.
If you don't "feel right" about one physician, then try another, odd as that might seem to some.

We've had some of the very best during the decades we've lived in the area, and - for one "memorable" visit when the prior PCP left - what was absolutely the worst.
(It was so bad that we went to the VP for "quality/patient care" and filed a complaint. We had the "advantage" of having compelling - and damning - strings of electronic messages. We were so glad of that, b/c if we had needed to claim the same exchanges but verbal, we understand that it probably wouldn't have been believed.)

And one of the best physicians ever, in the past, was not at a major teaching hospital.

Point is, there can be the good, the bad, and the ugly anywhere.
Consider the choice to be one of the most important "due diligence" efforts you might ever have.
But it's not all/only on paper.

RM
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by dm200 » Wed Nov 21, 2018 1:24 pm

HueyLD wrote:
Wed Nov 21, 2018 1:17 pm
You are right, Dr. JAyK.
A relative moved to a new city and was looking for a urologist. The first one he found looked good on paper with Ivy League credentials for both undergraduate and med. schools. However, the doctor had no people skills and he refused to listen to any idea that was not his. He even told my relative to take it or find someone else.
So, my relative found someone else and that was the happy ending.
Yes - I have encountered such physicians over the years.

Then again, some physicians that have no people skills may be the best at doing things like invasive procedures and surgery.

I also place very low credibility on patient reviews of physicians. In my opinion, patients tend to rate Physicians high when the Physician tells the patient just what the patient wants to hear. "Don't worry, Mrs. Jones -- being 75 pounds overweight is just fine."

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by galeno » Wed Nov 21, 2018 1:32 pm

Best 2 quotes I've ever heard.

"Graduating medical school gets you a "union card". This "union card" gets you into residency (a specialty training program) where you REALLY learn how to be a doctor."

"Recently graduated medical students know just enough to be dangerous."
AA = 40/55/5. Expected CAGR = 3.8%. GSD (5y) = 6.2%. USD inflation (10 y) = 1.8%. AWR = 4.0%. TER = 0.4%. Port Yield = 2.82%. Term = 33 yr. FI Duration = 6.0 yr. Portfolio survival probability = 95%.

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dm200
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by dm200 » Wed Nov 21, 2018 1:47 pm

Others may disagree, but I regard a DO degree as reasonably equivalent to an MD degree when choosing a Physician.

somekevinguy
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by somekevinguy » Wed Nov 21, 2018 1:58 pm

jayk238 wrote:
Wed Nov 21, 2018 1:03 pm
I am one of those no name doctors who trained at a small community hospital in a rural town. Lol.

I dont know too many UCSF internists in my area or any for that matter. Most are probably at ucsf or some major city too busy teaching residents and students instead of day to day practice.

Id rather you seek someone who cares about you takes time to listen and can send you to the appropriate place.

Ive heard bad things about ‘well trained’ doctors who went to Harvard but are jerks. Is that what you want?
jayk: hopefully you didn't take my comment as disparaging- my main point was that while it might matter all else being equal, it is unclear if it matters that much and there are many other factors that matter more. So yes, bedside manner matters, and someone who takes the time with you and cares about you matter- but none of those attributes is exclusive to graduates of one type of medical school/residency or another. And of course, your available options in your local geographic area make a big difference (although people with rarer/more complicated cases may choose to travel to a larger center for different expertise)

Here's an example of some of the data saying medical school ranking doesn't seem to have a lot of effect on patient outcomes: https://www.ncbi.nlm.nih.gov/pubmed/30257919

Here's an example of some of the data saying that residencies might matter (higher complication rates for patients treated by someone from the bottom 20% of OB residencies vs the top 20% of OB residencies): https://www.ncbi.nlm.nih.gov/pubmed/19773562

And some info that prestige of medical school or residencies may not matter much:https://www.ncbi.nlm.nih.gov/pubmed/?te ... g+programs
Last edited by somekevinguy on Wed Nov 21, 2018 2:17 pm, edited 1 time in total.

BionicBillWalsh
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by BionicBillWalsh » Wed Nov 21, 2018 2:17 pm

Not to beat this horse to death...

I’m a physician. I find that patients/consumers are so well educated and have so many sources to weed out bad docs that this topic is almost irrelevant. The age old argument of allopathic vs osteopathic vs US medical school grad vs Foreign medical school grad has been going on for a very long time.

Ultimately, find a physician that you trust. Typically within minutes of your visit, you’ll get a pretty good feel for them and their ability to solve your problem. If they don’t feel right to you, and you’re lucky enough to live somewhere with other options, check out those options. If you only have one option where you live, and you feel like you’re not being taken care of like you want to be taken care of, speak up. As long as this is done respectfully, it is always welcome.

staythecourse
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by staythecourse » Wed Nov 21, 2018 2:20 pm

All I can say is I did my residency and fellowship at Harvard (BWH) and have trained with: American grads, Foreign grads, Md's, DO's, traditional, nontraditional, straight up clinical, and MD/ PHD's and can say I have not noticed a difference between american grads and foreign grads. The only thing above I have seen is he MD/ PhD guys don't seem to have the same intuitive clinical sense as guys who are just straight up MDs. Likley not because they can't but they are splitting their time between thinking clinical and lab work.

I would without a doubt agree WHERE you train is more important then the med. school. It is a selection bias in itself. To get into Harvard, Hopkins, Stanford, UCSF, etc... you have to be pretty darn intelligent so that checks off that box so to speak. Medicine is no different then being an apprentice in any other occupation, i.e. plumber. You will likely ONLY be as good as those who trained you since you are learning the clinical acumen from seeing and interacting with your superiors and fellow residents/ fellows.

I have seen plenty of docs I would not trust with my dog (I don't even have one) and some I have NO problem taking care of my loved ones.

BTW, the ability of a physician to LISTEN to your issues and work WITH you in coming up with a good treatment plan that you are on board with should be HIGH up on that list. That does not mean someone with good bedside manner though which outside of touch feely points doesn't always equate to good care. Also, if you are looking for a PCP the biggest thing to look for is one who is intelligent and well respected as he/ she will only use the consultants that give good care as to keep their reputation at the top of the list. The last is the big issue with corporate medicine. Since everyone in that situation is employed the referrals they send you may not be the person they would send their loved ones as there is indirect (expectations) or direct (bonus structure is based on it) keeping revenue within the corporate structure.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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Munir
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by Munir » Wed Nov 21, 2018 2:34 pm

I am a retired physician who is considered a foreign medical graduate but really graduated from an "American" medical school located abroad and accredited by the State of New York. I did my residency at a university medical center in the US and then obtained my US specialty Boards.

I don't see a mention of the importance of having your specialty boards in the above discussion. Putting aside the "patient-friendly" description which is very important but which could be in the eyes of the beholdeth, the qualities I would look for are in this order of importance:

1. Having Specialty Boards with renewable certification every few years.
2. Residency training and the location/reputation of the program, and whether it was a university center or not.
3. What kind of coverage and/or affiliation does the physician have with other physicians. Being in solo practice is a negative.
4. Age of the physician- not too young and not too old.
5. Medical school location including foreign or US.

All the above is what can be checked ahead of time but may still not tell the whole story until you have your own actual experience with a specific physician. You need to trust the chemistry otherwise your doctor-patient relationship might fail. This last qualification may not be needed with a super-specialist that you will see only for a short time and limited purpose.

Starfish
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by Starfish » Wed Nov 21, 2018 2:34 pm

I assume offshore means outside US. If it means those Caribbean "american" schools, then I don't know.

Foreign doctors are IMHO better on average because is a lot harder for to become a doctor in US. So it's only the good ones can do it. All foreign doctors I know and at the top (but then they went to very selective residency programs so maybe is that).
Of course a top medical school in US is also hard to get into.
My main criteria is the residency they went at. A good program makes it irrelevant where the degree is from.
I have seen plenty of docs I would not trust with my dog (I don't even have one) and some I have NO problem taking care of my loved ones.

It is very strange for me how people come with strong opinions about qualifications of doctors when they have no qualifications to judge.
It's worse than trying to predict the market 2 years in advance. Excepting reading their credentials there is no way to judge a doctor.

LE: now i see, you DO have the qualifications...

hmw
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by hmw » Wed Nov 21, 2018 2:41 pm

I am a subspecialty surgeon.

I would put more weight on the residency/fellowship training program over the name of the medical school.

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climber2020
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by climber2020 » Wed Nov 21, 2018 3:02 pm

Munir wrote:
Wed Nov 21, 2018 2:34 pm

I don't see a mention of the importance of having your specialty boards in the above discussion. Putting aside the "patient-friendly" description which is very important but which could be in the eyes of the beholdeth, the qualities I would look for are in this order of importance:

1. Having Specialty Boards with renewable certification every few years.
Sorry, but I don't agree with this. Every competent doctor should be board certified. All you have to do is pay your money and take a test once in a while. It's a pretty low bar. The main usefulness of board certification is its absence; if someone couldn't pass the exam on multiple attempts, that should be a red flag. Other than that, being board certified says very little about a person's clinical skills.

money_bunny
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by money_bunny » Wed Nov 21, 2018 3:07 pm

dm200 wrote:
Wed Nov 21, 2018 1:24 pm


I also place very low credibility on patient reviews of physicians. In my opinion, patients tend to rate Physicians high when the Physician tells the patient just what the patient wants to hear. "Don't worry, Mrs. Jones -- being 75 pounds overweight is just fine."
Pretty sure a few of the damming ones I have are:

"I asked for large amounts of Xanax and they said no." Or "Previous doctor at practice had me on an excessive amount of Xanax and he is on a "Leave of Absence*" and why do you think you need to reduce it when I am doing so well on it. "He had several patients on dangerous amounts of medications. He is no longer licensed to practice medicine due to these prescribing patterns and some other issues.

Same doctor was also a "Speaker" for a name brand drug. Many of his patients were on this medication.

Ok now the actionable part of this is to advocate for yourself and do your own homework. Especially for anything with harm potential, or high cost. Do you really need the latest and greatest BP medication or can you just start with Lisinopril.

You can also see what your doctor or NP/PA prescribes frequently on Propublica.

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Munir
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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by Munir » Wed Nov 21, 2018 3:49 pm

climber2020 wrote:
Wed Nov 21, 2018 3:02 pm
Munir wrote:
Wed Nov 21, 2018 2:34 pm

I don't see a mention of the importance of having your specialty boards in the above discussion. Putting aside the "patient-friendly" description which is very important but which could be in the eyes of the beholdeth, the qualities I would look for are in this order of importance:

1. Having Specialty Boards with renewable certification every few years.
Sorry, but I don't agree with this. Every competent doctor should be board certified. All you have to do is pay your money and take a test once in a while. It's a pretty low bar. The main usefulness of board certification is its absence; if someone couldn't pass the exam on multiple attempts, that should be a red flag. Other than that, being board certified says very little about a person's clinical skills.
I don't think we disagree on this. You do want to know if someone IS Board-certified or not- right? That's all I'm saying- make sure the doctor IS board -certified. You'd be surprised how many are not.

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Re: Physician Credentials: Offshore vs. American Medical Schools

Post by stoptothink » Wed Nov 21, 2018 3:51 pm

dm200 wrote:
Wed Nov 21, 2018 1:47 pm
Others may disagree, but I regard a DO degree as reasonably equivalent to an MD degree when choosing a Physician.
Today, the training at MD and DO programs are very similar. Furthermore they all are licensed by the same state boards and held to the same requirements for practicing medicine. I work very closely with my employer's DPC medical facility, without a doubt the best physician we have on staff is a DO and two of the staff MDs did their residency at UCSF and Mayo. Based on my experience, where a physician completed their education and training is generally a minute factor in how good they are at their job.

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