Trust but Verify: Take the Time to Find the Best Doctor for You Personally

Trust Your Doctor?

Choosing a doctor to help you navigate the increasingly complex world of health care can be incredibly difficult and unfortunately can you trust your doctorsometimes hazardous to your health. We all imagine physicians in general to be like Marcus Welby and deserving of our trust, but are also increasingly faced with the knowledge that there is a wide gap in performance and ability among individual physicians (The Bell Curve: What happens when patients find out how good their doctors really are?). This dichotomy is confirmed by recent Gallup polling as outlined in the following article: Why We Trust Doctors (http://www.nationaljournal.com/features/restoration-calls/why-we-trust-doctors-20120419):

As we have become better-informed patients, we have grown more cynical about a health care system that is ever more corporate and reliant on technology. Nevertheless, our faith in physicians has proved incredibly durable. Gallup, which has polled on public trust in professionals every year since 1976, reports high and rising marks for doctors. In the latest survey, from 2011, 70 percent of respondents rated medical doctors as high or very high when asked about their “honesty and ethical standards,” a record. When the Kaiser Family Foundation asked Americans whom they trusted in 2009—the height of the debate over the health care law—78 percent said they believed that their doctors put patients’ interests ahead of their own. Amazingly, this trust persists even among people who have been harmed by their physicians, according to a growing body of research.

WHAT DOCTORS KNOW

At its core, medicine is a personal business. Even as health care has become more technological (surgical robots, electronic medical records) and physicians have become more squeezed for time, nearly every medical encounter involves a face-to-face interaction between a doctor and a patient. A machine may take your blood pressure, but a person still asks what ails you and then helps fix it. Pollsters and scholars of medical ethics say that this personal interaction is a key to doctor-patient trust.

When you ask patients if they trust doctors, they imagine their own doctors—specific people who have helped them when they were sick. A doctor is rarely seen as the agent of a big institution or, like a member of Congress, as a well-liked but distant individual. Your doctor is the person who sits in a room with you and helps to solve your problems. If you ask people how they feel about the medical system, they grade it much lower than they do physicians. “Trust in doctors is very much interpersonal trust,” says Mark Hall, a professor of law and public health at Wake Forest University, who has studied the dimensions of the doctor-patient relationship.

Doctors benefit from a reputation for altruism that has remained mostly unblemished. They still take the ancient Greek Hippocratic oath, and most patients still believe that a desire to help, and not to make a profit, motivates their doctor.

Unlike choosing a car (which has a crash-test rating) or retaining a lawyer (who has a win rate), picking a medical practitioner is not really a fact-based process. It’s hard to find a meaningful metric that shows whether a doctor is great or mediocre. Although advocates and policymakers are trying to improve measures of quality and patient access to ratings, most patients still make decisions blind. “How does a patient know anything about me?” asks Pellegrini, wondering how she would select a surgeon if she got sick. “Maybe I’m just a personable doctor, and my outcomes suck,” she says.

Click here to watch a video about How to Choose a Surgeon for Your Shoulder Replacement.

A recent article in USA Today highlights the broad range of physician quality and some of the factors involved in the problem of unnecessary surgeries: Doctors perform thousands of unnecessary surgeries (http://www.usatoday.com/story/news/nation/2013/06/18/unnecessary-surgery-usa-today-investigation/2435009/)

There are three broad categories of unnecessary surgery: the immoral, the incompetent and the indifferent. “There’s a health and safety aspect … and we take that very seriously,” says Joseph Campbell, the FBI’s deputy assistant director for criminal investigations. “I think there are a very small percent of doctors who are crooked, maybe 1 or 2%,” says John Santa, a physician and former health system administrator who became director of the Consumer Reports Health Ratings Center in 2008.

“I think there’s a higher percentage who are not well trained or not competent” to determine when surgery is necessary, Santa says. “Then you have a big group who are more businessmen than medical professionals — doctors who look at those gray cases and say, ‘Well, I have enough here to justify surgery, so I’m going to do it.'”

But many patients simply aren’t inclined to question their doctors.

“We expect the physician to know what’s best for a patient,” says William Root, chief compliance officer at Louisiana’s Department of Health and Hospitals. “We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage.”

USA Today also provides some tips to avoid unnecessary surgery (http://www.usatoday.com/story/news/nation/2013/06/19/unnecessary-surgery-tips-to-avoid/2438947/)

Why you should get a second opinion before getting surgery (http://www.usatoday.com/story/news/nation/2013/06/19/surgery-second-opinion-interactive/2439275/)

We see many patients each year that have had failed shoulder surgeries and many mention that they were told that they should have shoulder surgery so a potential shoulder problem does not become worse. Unfortunately, all too often, the wrong or unnecessary procedure starts a cascade of problems that takes a simple shoulder problem and turns it into a failed shoulder surgery. Many patients feel a simple surgery like a spur removal in the shoulder is benign and perhaps necessary to prevent future problems, but we are increasingly learning that many of these procedures are likely unnecessary. We have written about this topic previously, https://www.theshouldercenter.com/shoulderpain/2013/shoulder-surgery/spur-acromioplasty-impingement/ , encouraging patients to always consider getting a second opinion prior to considering shoulder surgery.

Arizona Center for Hand to Shoulder Surgery regularly offers a second opinion on the diagnosis or treatment of shoulder problems or shoulder surgery.

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