posted
I was just reading about a woman talking with her doctor, saying he was a good doc and both of them talking about second rate doctors.
How does she know her doc is good, and how does anyone know their doctor is second rate? How does one find a "best" in their field?
edit: And just how bad are second rate doctors? We know that there will certainly be doctors who had the best scores on tests, and then those who had the worst scores. How much does that really mean, though?
posted
You find good doctors by talking to other people. Nurses are good contacts.
Make sure they're board certified and don't have any disciplinary action pending against them - most states have a state medical licensure board website where you can put in the name and see if the doctor has had license suspensions in the past or something like that. Since some states don't report to other states, some doctors who lose their license in one state can simply set up shop in another.
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posted
I did, for my OB. I asked for female docs. The nurse got kind of an irritated look on her face as she rattled off the list of three I knew were attached to the hospital. Then she said, "You know what, why don't you try Dr. N" This was a male doctor, but with her reaction and upon her suggesting someone outside my parameters, I figured he was pretty good. And he has been a great doctor.
But still, this question is also spawned by my mom's experience. She had felt her doctor was caring. She had thought he had been listening to her, and upon recieving her medical records from him, found he hadn't been. It was very frustrating to her.
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"Second rate" is so subjective. It seems like an easy concept, but it really is hard to pin down. It was commonly known in medschool that the students who did the best on written tests and booklearning often did very poorly in tests focused on dealing with actual patients. In fact, the guy with the highest GPA after the first two years almost flunked out. He had to repeat several months of work in order to graduate.
Now I'm sure that poor guy has improved, but still. If he knows so much, but can't translate it into patient care, that could be second-rate doctoring. Or the guy that really seems so caring and has the best bedside manner may be totally incompetent when it comes to managing diabetes. Then there are the ones that only work to make money, and don't really care about patients, and don't care about asking the questions that can get to the root of their problems. Is that second rate?
Oh, then there are the ones that do everything the patient asks. They'll order obscure labs, unnecessary medications, diet pills, work statements, whatever. Is that second rate? Only in other doctors's eyes.
I don't think there is any way to test for the best doctor. Nurses do tend to know better than anyone, that is certainly one of the best resources.
And your observations brought up some of my curiousities about how the doctors interact within their community of colleagues. Is there a pecking order, and what are the factors that affect it? How do patients affect and fit into it?
Edit: In the words of my husband: "Is this an illegal question?"
First of all, many patients definitely feel that specialists are better, just by definition. They often go straight to specialists, even when they don't have a clear idea of what specialists do, how they are trained, or which specialist would be even indicated for their problem! I've seen fairly healthy patients who regularly see specialists at Mayo Clinic, University of Michigan, AND Indiana University all at the same time. I find it sad that our society and the medical society almost encourages this trend.
OTOH, I know many patients who blindly trust their family doctor, never ask questions, never seek outside help, and that can be even more damaging. Tragic consequences can occur when patients don't take some control of their own health.
Specialists often DO have a big ego. Many don't. But they make so much more money, so easily! They can focus in on one field and Know it so much better than us generalists can. They can afford bigger offices, more staff, and, sadly, can easily grow to expect to be waited on hand and foot. Can easily grow to see that their greater knowledge in one field is better than the generalists who know less but in many fields.
I'm afraid tha I am so low on the scale that I don't even See many of the social interactions between the other doctors. As a single, unmarried young doctor in a primary care field I feel very much at the bottom and I'm not very good at understanding social cues or motives. I have trouble making eye contact with doctors other than my own partners and I never, ever see myself as an equal peer. I'd say the surgeons are at the top, the more specialized the better, then the medical specialists, then primary care. Physicians at teaching hospitals are considered better than doctors at smaller institutions.
quote: Then there are the ones that only work to make money, and don't really care about patients, and don't care about asking the questions that can get to the root of their problems. Is that second rate?
Actually, I think that is the ultimate in second rate. I would think that the doctor that truly does care, but is weak in some areas would be likely to refer the patient to someone more capable. Then there are the ones, I think, that get off on simply making patients feel better without really addressing their own limitations and making up for them. I think this was the case with my mom's doctor.
How can you tell when a patient isn't being proactive enough with their health? How do doctors feel when medical records are requested by the patient?
I guess these are wierd questions, but with my mom's situation and my sudden immersion into interaction with medical doctors, I've just been wondering. With all my other kids, we lived in a rural area and had a family doctor. Because of a minor complication with my pregnancy from the get-go, I started out with an OB this time. When we had the baby, I began with a family doctor, but she turned me off with her lack of knowledge about breastfeeding and then when I went for the 3 day checkup, saw that I was not going into a small waiting room as I had with our well-missed family doctor, but into a large clinic with lots of other people who I didn't know the health status of. So I went to the pediatrician that I'd been concidering. I felt kind of bad for the family doctor I took the baby's care out of and worried that I might have hurt her feelings, especially after meeting her at a school function (her kids go to the same school).
Posts: 3495 | Registered: Feb 2000
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Have you ever done a landmark telling us why you decided to become at doctor, Theca? If so, can you point me to it? (btw - I think you're great -- as a person -- I've never had you as a doctor). Posts: 9538 | Registered: Aug 2003
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quote:How can you tell when a patient isn't being proactive enough with their health? How do doctors feel when medical records are requested by the patient?
Doctors feel VERY threatened when patients want the medical records themselves, just to read. I feel that if a patient wants the doctor's records themselves to read, then there is a huge problem with trust and it usually means the doctor/patient relationship needs to end. And I do feel threatened by it. It usually happens more with family members, though. Husbands, parents, or kids often demand records so they can go through them page by page and then sue when they find something questionable. However, if a big workup was just done and they just want to know the facts, all the test results, etc, that's a different story.
Being proactive "enough" is hard to tell. I've got patients that do hours of internet research on every aspect of health and want hour long appointments to discuss little tiny obscure details of normal lab results. I've got patients who are on oxygen 24 hours a day and they don't even know why. They don't know the first thing about why they take medications every day but they always know what color the medications are. I got paged last night by a lady with nausea who informed me she had a heart condition. What sort of heart condition? Well, she didn't know, but it was probably pretty bad. It was a HEART CONDITION. Turns out she has a benign heart murmur, I checked the chart.
I'd say proactive enough usually means a patient asks for explanations on the plan at the end of each visit and tries to be a part of the decision-making process. Someone who makes sure all their labs and tests are explained, and the reasons for all their medications are understood by both doctor and patient.
Many times doctors and patients have totally different views on what the visit was for or what was accomplished. Talking about it out loud helps. Also, taking along someone else is often good if serious issues are being addressed. Most patients only remember like 10-20% of what the doctor told them. A second person can really help keep things straight. Some doctors don't like it when another person is present but I like it. No matter how clear I am on the plan, even if I write it down, patients will often interpret the visit entirely different later on. It is scary.
posted
I second Farmgirl. You are a wonderful person, and I would love to have you as a doctor. I'm glad I got to meet you at EnderCon. Hopefully they'll have something like that again around here.
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In my opinion, the best doctors are those that can effectively communicate with their patients - they listen to and explain things to their patients. I've seen what I would consider "great doctors" and "awful doctors". Those "awful doctors" may have been really skilled individuals, but they were awful in my interactions with them. My great doctors can communicate with me - they certainly know more about how a body works (in general) than I, but I tend to know more about how my body works, so when we can listen to each other great things happen. The doctors I have disliked most are those that have dismissed my concerns or just plain not listened to me (what I describe seems unusual to them so they dismiss it), so I haven't stuck around long. I also really respect doctors that can admit that they don't know everything, that they have to do research, or that someone else may be better suited to help me.
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