How To Choose Your Doctor

This blog gives insider’s tips on finding a specialist.

You just found out that you need a knee replacement. Or, your going to get that ‘mommy makeover’ that you promised yourself. Or, you are dreading it, but you may need back surgery. More and more the onus is on you to find the right physician to connect with. How do you do it? How do you find someone who will look after you, not rip you off and take care of you?  You’d think in 2020 where we can find reviews on just about anything, be it an Amazon product or a restaurant review, that finding a good specialist would be easy. It’s hard. I am going to give you my advice, show you the pitfalls of what patients do and hopefully  equip you better if you need to find a physician.

Reviews

Everything gets reviewed nowadays and there are a lot of different websites that do physician reviews. They keep changing every few years. Some companies acquire each other and some companies become irrelevant. It’s reasonable to look at reviews. Go look at my reviews if you like. It will give you an idea what is out there. Here’s the problem:

  1. It’s not systematic. If 100 patients see Dr. X, only a small proportion leave a review
  2. Patients with negative experiences are more likely to leave negative reviews. Happy patients move on with heir lives.
  3. Surgeon’s doing more complicated surgeries on sicker patients are more likely to have negative reviews
  4. Sometimes patients don’t like what a physician says. Eg. Saying you’re too fat or not giving that script for narcotic can lead to a negative review
  5. Some physicians only push their good patients for reviews
  6. Some patients like to complain, like they would if they had poor service in a restaurant.

Are you getting my drift? It’s like a scientific experiment where the methodology has holes all through it and the samples are varied between groups and analysis ad hoc. Garbage in gives garbage out. Coupled with this, reviews can be placed with a simple email address that a providers office can do (yes, I’ve seen it in my own community). There is not check to see if the patient actually saw the review. This can buff up a quack with fake posts.

What would I suggest with reviews? Get a flavor. If the physician rates poorly, read the reviews- was it the office staff or wait time? If they rate perfectly across everything, see how others in the same community rated. If it doesn’t look right, then it probably isn’t. Beware the ‘perfect profile’. Also, try sites like https://www.docinfo.org/ that log complaints or the local state medical board and see if there is information on complaints, discipline, lawsuits.

Experience

Most surgeons learn the basics in residency but we hone our trade in practice. Practice means exactly that- doing things many, many times. My first five years were very different to my last. I learned my limits in my first five years. I made stupid mistakes, technical errors. Most did not matter and patients did well. Experience is many things. Are they well trained? Are the board certified. I’m not board certified in the US but am in Australia, a similar system, so similar the American College of Surgeons grandfathered me in. Did they do a fellowship? A fellowship is finishing school. It’s extra training that a surgeon does on their own behest to learn from masters. It’s not needed to practice but it shows a level of commitment beyond what’s needed- like “Extra Credit”. I did two fellowships. Most surgeons by 10 years out are humming. At 30 years out they may not want to learn new things. 20 years of experience is the sweet spot.

Beware of the fresh surgeon marketing a gimmick. You don’t need gimmicks. You need a good outcome with low complications.

A long practice usually weeds out the hacks as we will discuss below.

 

Personal Recommendations

This is big. Talk to friends. Talk to family. Talk to your neighbor. Someone will tell you if they have know someone who saw that specialist and what they thought. A recommendation through friends and family beats an online review any day of the week.

 

GP Recommendations

This is gold.

Your GP is like an air traffic controller.

He/she doesn’t fly the plane but your GP knows where everything is and can direct air traffic. You are not the first person with the problem he/she has seen. Your GP usually have favorites they refer to you. Your GP knows who to avoid and who to see. Who the hacks are. Who does good work. Who is just a ‘cutter’. Who is thoughtful. This is really where you should start.

 

Initial Consult

Ok. So you picked out a specialist using some or all of the above techniques and you make you visit. There is a lot to take on board here. Check out the office. Are the staff rude? Is the waiting room dirty? Is it too slick? Is you doctor on time? A little late is ok but an hour or two is not good. That initial consultation is an option, that’s all. You can leave and go elsewhere We are physicians don’t “own” you. We are giving an opinion. Listen. Make sure are actually talking to the surgeon before you commit to surgery. Take it all on board. Take a family member. The doctor should listen to your story. He/she should examine you. They should give you time. If you spend 5 minutes with the surgeon and then are offered surgery think hard. If you never see the surgeon and are offered surgery, run away! At the end of the day your gut feeling will help.

There are so many patients I have seen who were offered big surgeries  elsewhere and things didn’t feel right and they left. Trust your instinct.

If you are expected to cashpay (beyond your deductible) but the procedure is covered by insurance, if you are out of network or if insurance is not accepted,  look elsewhere. Remember you are seeing the surgeon for an opinion. It’s not binding.

 

If you feel like you are being sold a used car- look elsewhere.

Seven Questions To Always Ask Before Committing To Surgery

  1. What are your options?
  2. what is the nature of the procedure?
  3. What are the risks?
  4. What is the likely chance of a successful outcome?
  5. What is the recovery like?
  6. Is this condition common?
  7. How many have you done?

Teaching Hospitals versus Private Practice

If you have something that is not rare then going to a private practice surgeon is ok. That way you’ll be guaranteed (or should be) of actually having that surgeon operate on you. Mayo Clinic, Cleveland Clinic, Stanford etc are amazing institutions but are teaching hospitals. That is where the next generation of specialist is taught and guess, what they learn on you! In a teaching hospital, the surgeon on you may be in charge but may not do the surgery. The more routine a case, the more likely a fellow or resident does it under supervision. Teaching hospitals are great places to go if you have something rare or complex. Otherwise, your community surgeons can probably look after you just as well.

 

Wrap Up

Talk to your GP. Talk to friends. Talk to relatives. Use google but don’t trust it. See what your gut tells you after your initial visit and that should guide you. At the end of the day no specialist is fallible. Bad things happen to good people but at least this way it won’t be quite like going to a shonky mechanic.

Do you agree or disagree? Any tips? I’m on this side of the door and sometimes I struggle! Leave any comments or questions below. If you liked the post, please share it or like it!

Lali Sekhon

Author:

Lali Sekhon, MD, PhD, MBA| Father | Husband | Neurosurgeon| Hockey Fan | Innovator | Inventor | Educator | ΒΓΣ | Health Care Leader | I'm a neurosurgeon (MD, PhD, MBA, FRACS, FACS) who has been a physician for over 30 years. I'm also a tech junkie and a cynical optimist. Having completed a medical degree, a PhD and an MBA, I can give you an honest opinion on anything related to medicine and health care with tips and reviews and commentaries. Some of the topics are related, others, somewhat related, but all for the layperson: honest, simple and practical. It's not brain surgery!

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