Doctors Who Hear You
Today, doctors base treatment options on “evidence-based medicine.” It means that doctors rely on research—clinical trials—to provide the best treatment for their patients. But the question here is how to find the right physician to provide the best treatment for you. Critically important is bedside manners, better known as social skills. To me, it’s the doctor who has the patience to listen to my history of aches and pains and helps me get back to exercising or spending a week in the courtroom without pain. Whether it’s a doctor, nurse practitioner, or physician assistant, finding the health care provider that listens to you is an absolute imperative.
Patient Participation
The best medical outcomes are dependent on patient participation. I’m a medical malpractice lawyer, and I have seen a pattern of patient noncompliance that leads to delays in diagnosis. The failure to take medications as prescribed may lead to a premature visit to the morgue. The failure to give your doctor a complete and accurate medical history in an urgent care setting may lead to misdiagnosis and the failure to seek a second opinion outside of the recommended physician or surgeon’s network of referrals may lead to unnecessary surgery. When it comes to procedures, keep in mind that unlike in Canada and Europe, health care in America is a profit-based system. So, it’s wise to get a second look at a non-emergent medical issue before going to surgery.
How do you find the best doctor for you? In my research for this article, I talked to lawyers, non-lawyers, and friends in the health industry. Most of them said they relied on their friends’ recommendations, and they made sure the doctor accepted their insurance. This approach focuses on results, which is a tried-and-true method of finding a good physician, but with one caveat. Some medical problems have a high risk of complications, and the results from surgery are far from perfect. For example, back surgery may be successful, but the patient may end up with minimal pain relief. A bad result does not mean a bad surgeon.
Avoid Internet Doctor Reviews
Should you look up reviews of physicians on the internet? Probably not a useful practice, but we all do it. This past year, I needed repeat surgery on my lower back. Redo surgery is more complicated and is associated with a higher risk of failure. My contacts in the medical profession span the entire country, but I set up appointments with two surgeons east of the Mississippi who were highly recommended by specialists in unrelated fields of medicine. If I had relied on internet reviews, I would not have chosen either of them. One surgeon had a sergeant major for a nurse practitioner, and the other had been sued numerous times. Both had received negative comments about rude and callous remarks. My decision came down to logistics, the doctor closest to me. But I trusted my sources, who raved about their skills, not patient reviews.
On occasion I see unanimous 5-star internet reviews of doctors. Like the advertisements of the best doctors listed in airplane magazines, many stellar reviews are paid for.
When it comes to information on a doctor’s skill, nurses are a reliable source. If you can keep the confidence of a friendly nurse, they may whisper the name of a doctor to avoid. Nurses spend their days and nights in the trenches, at the bedside, or in the operating room, participating in minute-by-minute care of a patient. They know which doctors check on their patients timely, and they know which patients don’t do as well after surgery compared to the patients of the more skilled surgeons.
Osteopathic Physicians Versus Medical Doctor
I’m often asked about the difference between osteopathic doctors (DO) and medical doctors (MD).
Traditionally, DOs’ medical school training is similar to MDs. One difference often mentioned is the Dos’ holistic approach to caring for their patients, meaning they use the same conventional methods practiced by MDs, but they tend to focus on the physical, mental, and emotional aspects of illness and treatment of the entire person. In the past, osteopathic manipulation was part of their arsenal of treatment. Today, not so much. One major difference is the opportunity for residency programs. Fifty years ago, most MD residency programs were not open to DOs. Today, qualified osteopathic students are accepted in some of the most prestigious MD residency training programs. Admission to MD medical schools requires a tad higher GPA and MCAT scores. In terms of grade points, though, the difference averages out to a 3.6 versus a 3.7. In the 4th year of medical school, students must take the United States Medical Licensing Examination (USMLE). A good score on the USMLE Step 2 exam improves the medical students’ chances of acceptance to the more sought-after residency programs such as neurosurgery and plastic surgery. Statistically, 98% of MD students passed the step 2 exam. 97% of the DOs passed the same exam. My primary care doctor is a DO, and I would recommend him to my friends.
Has My Doctor Been Board Certified?
Board certification means the doctor has undergone additional training in a specialty area of medicine. Doctors become board-eligible once they have successfully completed their residency. A board-certified vascular surgeon, for example, would be more qualified to perform surgery on a blocked vessel in the neck than a general surgeon. A high percentage of doctors completing a residency program become board-certified in their specialty. On occasion, a doctor may fail the oral part of the examination but pass on their second try. Doctors who are not board-certified in the specialty area where they have had training may still practice, but according to some studies, their complication rates may be a little higher.
If you have a choice, I recommend finding a fellowship-trained doctor who specializes in treating a specific medical problem. Fellowships offer specialized training after the doctors complete their residency. For example, let’s say you fell on your outstretched arm while biking. Now your shoulder hurts so bad you can’t lift it over your head. A board-certified orthopedic surgeon could perform shoulder surgery, but a better choice is a fellowship-trained shoulder surgeon who routinely repairs complicated rotator cuff injuries.
On occasion, you may see PhD next to MD. These doctors not only practice medicine, but they are involved in medical research, and yes, they are the brainiest of the smart people who practice medicine. In 2023, Drew Weissman, MD PhD, was one of two researchers awarded the Nobel Prize for the development of the mRNA technology used to make the vaccine to fight COVID-19.
TV Ads of Patients Dancing and Frolicking
Again, it’s important to remember that medical care in America is based on profit margins. If you watch any of the evening news channels, you will see drug companies advertising prescription drugs that suggest viewers ask their doctor about them after a rapid-fire announcement of the drug’s potential complications. Only the United States and New Zealand permit drug companies to market prescription drugs directly to consumers. Critics of the practice say it leads to overdiagnosis and unnecessary treatment. A few years ago, I was defending a radiologist - the most important doctor you’ve never met - in a delay in diagnosis in a lung cancer case. A week before the trial, the New England Journal of Medicine reported a clinical trial of a lung cancer drug that improved survival. Life expectancy is always an issue in personal injury cases and this article was useful on the issue of damages. The television advertisement showed elderly people smiling and hopeful of living longer. The results of the clinical trial of chemotherapy showed a median survival improvement of 2.8 months over the existing chemotherapy. True, this drug was an improvement over existing treatment, and it’s also true that the manufacturer has hundreds of thousands of dollars improving the drug’s effectiveness, but when it was first marketed, it provided a sliver of hope. Critics of the drug rightfully claimed it was misleading.
Despite profit motive, drug companies have advanced the quality of life on two fronts: prevention and cure. However, let’s consider Bob, a hypothetical physically active male in his 70s, who has gained 20 pounds in 18 months after bilateral knee surgery has prevented him from his daily workouts. He has seen the Wegovy TV commercials, and a few of his friends who have struggled with their weight swear it’s the real deal. Bob makes an appointment with his family doctor because he needs a prescription to get the drug. Bob learns that the drug really works but patients not only lose unwanted fat but almost half of their muscle mass. His family doctor explains that the loss of muscle mass affects strength and stability, and at his age, this medication raises the risk of falling. A fractured hip or worse is an invitation to new digs at the nearby assisted living facility. Wisely, Bob entered a dietician managed weight loss program.
Growing Old with Your Doctor
Growing older means dealing with the inevitable breakdown of the mind and body. In the 21st century, primary care (PCP) physicians have taken an active role in the prevention of diseases. Knowing their patient’s family history, they can suggest screening tests, such as prostate testing, mammograms, and colon cancer screening, to name a few. PCPs can manage chronic medical conditions, such as osteoarthritic pain, which often improves the quality of life. I recall reading an article in a medical journal about longevity. The author concluded, “Stay close to your doctor.”
A Small Step Towards Improving Access to Healthcare
One more thing, if you are reading this, you probably have access to good health care and can choose the doctor you want. There are millions of people in this country who do not have access to necessary health care. Seasoned lawyers, regardless of politics, should lend a hand to the less fortunate where we can. One option is the ABA’s Medical Legal Partnership Interest Group. I looked at the ABA directory of Medical-Legal Partnership Programs. The mission statement says, “To improve the health and well-being of vulnerable populations in partnership with the medical community through the work of volunteer lawyers.” There are Pro Bono programs in many cities throughout the country. Ohio has many opportunities. Although I would prefer to volunteer in the Tuscany region outside of Florence, Italy, I plan to check out the Child and Youth Law program at Nationwide Children’s Hospital here in Columbus, Ohio.