How To Find A Good Doctor: An Unconventional Approach.

In my last post, I talked about the value of a second (or even third) opinion. But how do you know the medical advice you are getting is coming from a good doctor? You can get as much medical advice as you want, but if the sources aren’t good, you are unlikely to end up in a better situation. In this article I cover how to find a quality physician. This article assumes you are trying to find a specialist to address a specific disease. However, many of these principles can be applied to a general practitioner. But things like looking for a physician by their research (see below) will be less applicable for finding a GP.

While most people start with Google, start with Pubmed instead to find a list of candidates. Search for research articles about the condition you have that were published in the last 3 or so years. Then find the authors of these papers that are MDs for your initial list of candidates. The reason to take this approach is that Pubmed is a good proxy for physicians active in research. This means a physician is more likely to be Uptodate on the latest in treatments for your condition. You should prioritize articles that are most applicable to you. For example, if you are a biological male, research done on how your conditions impact pregnancy is probably not the most applicable. If you need help navigating the Pubmed search features, feel me to message me.

Note: I can feel the haters now. They would say “there are many great physicians that are not active in research”. And this is true. So if you get a referral by other means, a physician not having articles in Pubmed doesn’t mean they are a bad physician. They could just have a more clinical focus. But, if you are starting from zero, Pubmed is a good starting point (even though it is research focused, as opposed to physician focused).?

Next, check the reputation of the physician with a site like Health Grades, Vitals, or a similar site. Once again, before the haters cue up their keyboard about these sites, I have outlined the drawbacks of these sites below. That said, I do think you should go ahead and search your doctor in these systems. What to keep in mind when searching for physician reviews on these sites:

1.)??The ratings are far more about patients’ opinion of the doctor rather than a doctor’s technical abilities. So what you can get from these sites is an insight into a doctor’s bedside manner. Which, despite what shows like House would have you believe, is important. So much of being able to diagnose and treat a patient is a patient feeling comfortable sharing necessary information with the doctor. So bedside manner does serve a practical purpose; it is not just a nice to have. Now before people get up in arms about these sites not being the end-all, be-all of bedside manner: let me say I agree with you. But generally, if a physician has a really high (or low) rating on these sites, it is a reasonable proxy for how they communicate and relate to patients.

2.)??Beware of the Yelp effect. When was the last time you took the time to write a glowing positive review of a restaurant you liked? Maybe you do this regularly, and if you do, bless you. But chances are, if you are like most people, you have only written a few positive reviews at most. Yet people can’t wait to fire up their keyboard to share a negative experience. The same is true in the realm of healthcare rating sites. Negative experiences are far more likely to be shared than positive ones. So ratings are biased toward the negative for most providers.?

3.)??Understand that patients rate physicians based on the overall experience patients have when interacting with a doctor’s practice. So if the doctor is great, but their front desk person is horrible, that can translate into a bad review. Billing issue? That can translate into a bad review. So it is important to actually look at the individual reviews carefully and not just the aggregate score.

4.)??Check more than one of these doctor rating sites. You would be surprised at how much a doctor’s rating can vary across these sites.

Overall, I would say checking your physician against these sites is valuable information, but these sites should be used to exclude a doctor rather than find a doctor. If a doctor that you found on Pubmed has a low rating on these sites, that is a potential red flag. However, if a doctor has solid ratings on these sites, proceed with booking an appointment.

Before your appointment, look up your disease on the Uptodate patient information section of your disease. I touched on Uptodate and how to use it in a previous post (See references section, first reference, for URL to that post). That way you can compare your proposed treatment plan from your doctor against the information on Uptodate. If your proposed treatment plan differs, ask your doctor why. If they don’t have a good reason, this should be a red flag.

You should also ask the following questions during your appointment (note these questions are modified questions from Peter Attia’s article on how to find a good doctor [2]. If it feels awkward asking these questions, feel free to blame me.

1.????How much time, on average, do you spend per month staying informed of the latest research from journals like?JAMA, New England Journal of Medicine, and other journals specific to your specialty?

2.????Which conferences do you try to attend each year?

3.????Which lab tests and biomarkers do you consider essential for patient management?

4.????How much time, on average, do you spend with each patient per year (i.e., in-person visits, video meetings, reviewing labs and records, phone calls, emails)?

After your appointment, take time to check in with your gut feeling. Regardless of your gut feeling, if you are facing a serious medical condition, you should consider getting multiple medical opinions (see my previous post) [3]. However, ultimately even though you may not be a medical professional, your gut is good for assessing whether the doctor is a good fit for you. If you walk away from your appointment trusting your doctor, that is a good sign. Otherwise, keep looking. Don’t be afraid to go through multiple physician appointments until you find the right one.

As usual, I am available via messenger for any questions you may have.

Joshua Engle, MD?

References:

1.)??“Researching Your Disease: How to Make Sure The Medical Article You Are Reading Is A Quality Journal Article (And Where To Find Medical Articles)”. URL: https://www.dhirubhai.net/pulse/researching-your-disease-how-make-sure-medical-article-joshua-engle/?trackingId=0eaUPcUESNSllfb1Rf%2Fb3g%3D%3D

2.)??“How to find a good doctor”. Peter Attia, MD. URL: https://peterattiamd.com/how-to-find-a-good-doctor/

“Questioning Your Diagnosis or Treatment: The Art of Getting a 2nd (or 3rd) Opinion”. URL: https://www.dhirubhai.net/pulse/questioning-your-diagnosis-treatment-art-getting-2nd-3rd-joshua-engle/?trackingId=B0NYEXFeQF%2B9wytENsKvNA%