Most doctors are well trained, ethical, and caring. However, a small minority are not, and it is up to you to make certain you don’t end up in the care of one of them.
Almost every state has a medical board that posts physician information on line. The AMA maintains a list of state boards on their website. You can find it here:
You can usually find information about your doctor’s education and training, board certifications (a good thing) and in what specialties. Some states also include records of a doctor’s disciplinary and medical malpractice payments histories. All of this is valuable information. A few medical malpractice claims should not be alarming; a long list should be.
Just because a doctor says something doesn’t make it true. Under our “fee for service” model, doctors don’t get paid unless they are doing something to or for you. Surgeons occasionally see surgical problems in cases where surgery might not be the best option. Put another way, “When the only tool you have is a hammer, everything looks like a nail.” Even when surgery is appropriate, surgeons may disagree on the procedure to be performed.
There is subtle, and sometimes not so subtle, pressure to recommend treatment a patient does not need. Google “doctor fraud” and watch how many hits you get. An oncologist in the Detroit area was recently sentenced to prison for telling healthy patients they had cancer so he could give them expensive chemotherapy. It is crucial that for serious diagnoses and surgical procedures you get a second, and perhaps even a third, opinion.
Don’t rely on the recommendations of friends who got a good result with a doctor. Bad doctors don’t kill or maim everyone. Similarly, physician referrals don’t always mean that the doctor to whom you are being sent is qualified and capable. I am amazed at the number of doctors here in Phoenix who are frequently sued but still get referrals from their colleagues. On the other hand, a negative recommendation from someone you trust should be reason enough to avoid a particular doctor.
Doctors only have privileges at certain hospitals, and not all hospitals are created equal. A good surgical result doesn’t mean much if you get killed by the nurses in the hospital. If hospitalization is necessary, find out the hospitals where your doctor has privileges. Don’t agree to a hospital just because it is close to your home. The federal government has a website that enables you to compare hospitals. Go here. You can compare infection rates, readmissions (not a good sign), patient satisfaction surveys, hospital deficiencies, and a number of other categories information.
In selecting a surgeon, practice makes perfect. The best results are achieved by the surgeons who do the procedures over and over and over. Get someone who does lots of the specific surgery you need.
Complication rates and associated problems are statistically related to the day of the week the surgery is performed. If possible, have your surgery on a Tuesday morning when the surgeon is not just returning from vacation. If possible, avoid the hospital on a holiday weekend—the least qualified, most junior staff is on duty then. Try to avoid weekend hospitalization in general. At teaching hospitals where they have residents, July is a dangerous time because the new residents begin on July 1 every year.
Have a patient advocate with you 24/7, if you can. Thirty or forty years ago, nearly every nurse at a hospital was a Registered Nurse. Now they are few and far between. Hospitals use nurses with less training to save money.
If an operation is to be done, make sure they are going to operate on the correct site. “Wrong patient, wrong site” surgeries occur multiple times a day. Also, make sure the medications you are offered are really prescribed for you and not some random patient. Make sure you get the medications you are supposed to be taking and in the proper doses. Make sure you get the tests the doctor planned for you. If in doubt, insist that the staff call the doctor. Don’t let them mix you up with another patient. Tell everyone your full name and date of birth at every possible opportunity.
Medicine is a big business, and we are its customers. Be an informed consumer and you give yourself the best chance of a good result.
So just to summarize:
1. Check a prospective physician’s record on your state medical board’s website
2. Listen to trusted sources who tell you to avoid a particular provider
3. Check records on the hospital where a procedure is to be performed by going to the Medicare website
4. Make sure you have a patient advocate at the hospital
5. Insure that any procedure is done on the correct site, e.g., the left knee, not the right.
6. Check medications given to you in the hospital—make sure they have been ordered for you and are the correct dose. Make sure you get all the medication your doctor has ordered.
7. Get all the tests the doctor has ordered for you
8. Tell everyone in the hospital your name and date-of-birth at every opportunity
9. Be an informed healthcare consumer
