How to choose a Doctor and Hospital
The life you save may be the life of someone you love!
by Steve Van Nattan
DISCLAIMER: For legal purposes, you
should not rely on the following as if I am the ultimate source. You must take
responsibility for your own life. YOU are the one who answers for YOUR health.
IT'S UP TO YOU
Whether you are buying a cabbage, signing a mortgage, or looking for a doctor, YOU are the buyer, and the old adage applies as much as ever. "Caveat Emptor-- Let the buyer beware." The primary care doctor you choose can help you recover and live happily, or he may mess up your life, bankrupt you, or even kill you. Who performs your surgery, and the hospital you choose, can also be a life and death matter.
Usually, it is not life or death, but getting the best care can make a real difference in your recovery and return to normal life. So here are some guidelines which YOU can follow to learn, AHEAD OF TIME, the best doctor and hospital for you.
To any doctor reading this, we are not trying to paint you as a villain, but there are some real duds in the medical field. If you are one of them, we couldn't care less how you feel about this article. We hope you get caught and run off as soon as possible. Responsible doctors will simply shine brighter when scrutinized.
1. CHOOSE EXPERIENCE- A doctor who is just starting his practice may be a good doctor, but chances are, he will make far more blunders than an experienced doctor. A new doctor may have some recent high tech knowledge, but experience is far more valuable. A practice with both an older and younger doctor, who communicate faithfully, is the most desirable. The new doctor will bring the older doctor up to date, while the older doctor will keep the new doctor from misdiagnosing. Beware of feeling sorry for a new doctor. Why should you risk life and health to let him "practice" on you?
2. ASK QUESTIONS- A doctor who resents questions is incompetent and fears he will get caught. You are the one who is sick, not him, so he should be happy to respond to your concerns. If your doctor seems to need to keep you in the dark, you can bet he has a reason-- he is also in the dark!
3. BEWARE OF JULY- In July recent graduates from medical schools go to their new internship assignments. The experienced hospital staff move on. These new doctors are going to make far more mistakes than the experienced ones. If your surgery is not an emergency, try to wait a few months while these internists practice on someone else.
If you can have your surgery in April or May, you will get the best treatment. Your chances of staying out of the mortuary are much better.
4. CHECK THE RECORDS- Ask the hospital to show you their mortality rates. They HAVE to show this to you. If they are reluctant, be very suspicious. Also, you may get the records by contacting: Health Standards and Quality Bureau (HCFA), Room 2-D-2 Meadows East, 6325 Security Blvd., Baltimore, MD 21207. They have regional offices- check to see if one is in your community.
If your hospital is a real hazard, you might want to take the report to the local newspaper and see if you can stir up an investigation. It is a real service to your friends and neighbors.
5. ASK AROUND- Ask your dentist, school nurse, a nurse at church, and your pastor which doctor they use. Ask what they think of your primary care doctor and any surgeons or specialists to whom you are referred. Ask about the hospital. How is the patient care? After reading the following suggestions, you will have more questions to ask.
6 EMPIRICAL QUESTION- You like your primary care doctor, but you don't know if he will experiment a bit to find out what is wrong with you. ASK. "Doctor, do you run dozens of tests, then refer, or are there times when you will treat me empirically to see if we can get over the problem?"
Doctors who test heavily are often trying to protect themselves from law suit, so form a personal friendship with your doctor if you can. He needs to feel he can trust you if you expect him to treat you empirically. If you CRAVE tests, you have another problem-- I can't help you. Try Ward B.
7. IS YOUR DOCTOR SUSPICIOUS OF OTHER DOCTORS?- "Doctors are guessing fully 30% of the time." (Dr. G______, Barstow, CA) If your doctor is never suspicious of another doctor's diagnosis, beware. He is a club man and will gamble your health to protect his golf buddies. You don't want the local cops protecting criminals, so why would you want your doctor protecting quacks at your expense?
If your doctor DOES show suspicion of another doctor, keep your big mouth shut. Do not go around bragging on how your doctor caught some other doctor misdiagnosing. Your doctor will never trust you again. Get your gossip somewhere else and not at your doctor's expense.
8. BE WILLING TO TRAVEL- This is true of primary care doctors, specialists, surgeons, and hospitals. Small towns often have good primary care doctors, but that is where it usually ends. The best surgeons end up in the big city medical centers where their skills are in higher demand and they are paid better. You don't get that many brain surgeries in a city of 20,000. If you need surgery, pass up your local hospital, and go to the big city.
With primary care doctors, beware of the "home town boy" attitude. If your doctor is messing up, or he has misdiagnosed you, get out of town-- at least for your medical care. If you do, make ambulance arrangements before you have to dial 911!
9. DOES YOUR DOCTOR CALL FOR HELP?- A doctor who will not consult with other doctors, to be certain of a diagnoses, is arrogant or lazy. Some doctors have a political ego trip going, and they refuse to talk to certain people-- lab technicians, doctors, administrators, etc. Let them play their little games. Take your health needs to a man who has your interests first.
10. FRIDAY NIGHT- Where is your doctor Friday night? If you are a party animal, well then you might think it is cute for a doctor to be one also. Wrong. Party animals are adulterers and fornicators, and those are the people who primarily spread AIDS. You CAN get AIDS from an infected doctor.
Is your doctor seen at the country club drinking? A doctor should never drink alcohol. Alcohol destroys brain cells, and the first thing to go is the intuitive skills-- the skills a doctor uses to save your life. Personally, I like a doctor who is at home with his family Friday night and teaching Sunday School Sunday morning. Help yourself, it's your life you're gambling.
11. WHO IS YOUR FAMILY DOCTOR'S SPECIALIST? If you know where YOUR doctor takes HIS family to see a specialist, that must be a better than average MD. Use him when your doctor is out of town or when he retires.
12. CAN YOU GET TO YOUR DOCTOR IN A CRISIS?- Dr. Beachnau in Revenna, MI has his phone number on a sign in the waiting room-- his home phone! Now there is a man who is in it to serve. Reward such doctors with respect and restraint-- don't call them at home unless you are in real trouble.
Ask former patients and your doctor-- will the surgeon you are referred to drop you after the surgery. Can you get to him later? Will he tell you, or your family, what he did and how the operation went?
13. BEDSIDE MANNER- Does this whiz bang super-surgeon look like a baboon? You ought to be a bit suspicious friend. Ask around town if he is gentle with kids. Does he explain what is going on in person, or does he leave you in the dark and send a flunky intern, who looks like a high school rapper, to do his rounds?
14. WILL HE DEFEND YOU- Ask former patients. If the nurses in post operative care are rough or rude, will the surgeon take the time to defend you. If he defends the establishment first, he is to be avoided at all costs. He would rather cover up for your death than protect you. This is as important as any other consideration.
15. EXAMINING MANNER- Does your primary care doctor or surgeon treat you like just another cipher in a long line of accounts receivable? Or is your doctor a real friend who treats you like he really cares? Does he give you his full attention? Does he ask you what you think is wrong with you? A good doctor knows that people often have a pretty good idea what is wrong, they just don't know what to call it or how to get rid of it. An arrogant doctor thinks all patients are ignorant hypochondriacs. How does your doctor size up?
16. IS HIS OFFICE CLEAN- Does the latest magazine on the waiting room reading rack have the date, August 24, 1972? Does the headline on Time magazine read, "Lindburg crosses the Atlantic solo"? Is the waiting area clean and the furniture fresh looking? You want a doctor who gives attention to detail. Is the doctor personally clean, and how about his home? If it is a trash pile with an old Chevy rusting in the back yard- well, shall we say, "Beware"?
17. LADIES IN WAITING- While you are waiting, watch the office staff and nurses. Are they personally neat and clean? Do they make sexually explicit talk with each other or good old boys who come in? Are they carrying on a perpetual feud? Are they rude to older folks? Do they eat while they work?
18. A FAVOR'S A FAVOR- Once you find a good doctor, visit him when you are well. If he has a hobby, take him articles or leads on bargains. Take him to your favorite fishing hole, or loan him the cottage at the lake for a weekend. Ladies, send his wife a good recipe you found. Don't do this as a bribe-- do it as an act of appreciation for his kindness and good work. DO NOT talk about your ailments when you are fishing or socializing with your doctor-- he needs a break-- even from your rare disease!
19. POLITICS- Good doctors get into hot water with the establishment. Hospital administrators are forever intruding into the professional world of the hospital's doctors. You may hear rumors about your doctor from nurses, or you may find your doctor unusually distracted on a visit. This may well be a temporary thing which results from his stand for good ethics or sound medical practice.
If your doctor is a Chief of Staff he will have frequent battles with nurses and hospital officials over everything from billing policy to whether the nurses should have another bathroom. Stay out of it, and assume that he is a good doctor. A doctor who never gets into scraps with those around him is a milk toast. However; if he takes it out on his patients, then he is in over his head. Start shopping.
20. THANK YOU- Send greeting cards, or a note after you are well, thanking him for his care. "Dear Doctor: The spare part you put in a year ago has 20,000 miles on it now and doing great. Thanks!"
Doctors are NOT overpaid, and they can use encouragement. The next time you think your doctor or surgeon is getting too much money, consider the big dumb galoot who stuffs a plug of tobacco into his cheek, stumbles up to the plate, slugs a ball into right field, and collects $4 million. Doctors save lives and repair nerve endings for much less. Also, their expenses would terrify you-- especially insurance.
21. IS HE KEEPING UP?- Is your doctor keeping up with new medical practice? Is he taking in seminars and training sessions? If he is never missing from his office, beware. He may be too lazy to go back to the classroom. This is a bad sign.
Also; if nearly all of his "seminars" are in Las Vegas, he may be studying anatomy at Caesar's Palace. Change doctors.
22. CONFIDENT OR KNIFE HAPPY- Check around town. Is the surgeon or doctor prone to cut when a less intrusive technique would do? Does he do cesareans and mastectomies to pad the local hospital's budget? Does he yell "rotor rooter" when you tell him your prostate is enlarged? I knew a surgeon in the High Desert who carried a scalpel in his shirt pocket. He WAS the best knifeman in the area, but you sure wanted to be sure another doctor agreed that the knife was essential.
23. LAB- Visit the lab your doctor uses, especially your primary care physician in a smaller town or city. Sit down in it and watch what is happening without being a customer. Is it clean? Do the employees look alert and neat, or is the whole place a bit of a dump? Are the staff fighting? Ask around the neighborhood, and ask your doctor for official performance records of the lab.
24. AIDS- Ask your doctor what AIDS precautions he takes. Does he use latex gloves and a mask to examine patients? Ask if he takes AIDS patients. If he says he doesn't, that is your best choice. AIDS is being spread by casual transmission, and doctors CAN get it from treating patients and conceivably give it to you. Research has shown that AIDS can go airborne. If he takes a lofty attitude with you and belittles the risk of AIDS-- flee! He is not safe, especially if he quotes the Center of Disease Control, which is systematically covering up the AIDS plague.
25. SANITY- Does your doctor ever have to get away from the office to keep his sanity? Does he have a hobby? This came up previously, but I want to stress it again. A doctor who never takes a break is driven beyond the limits of his abilities, and he WILL make mistakes. His problem may be that he is greedy for bucks or is over his head in debt, and he puts filthy lucre above your health. Beware. Find a more relaxed MD.
One sign a doctor is in over his head is that his front office overbooks and you have to wait two hours in the waiting room at every appointment.
26. THE DOCTOR'S WIFE- Is she supportive of him? The ideal is to find the doctor's wife working with him. That means he is not hustling nurses and office help. She will also help with examinations of ladies which is a comfort. If the doctor's wife is a nag, and he is clearly hen-pecked, this is a sign he is distracted, and he may be a womanizer on the side.
27. POTTY MOUTH- If your doctor has a filthy mouth, he has a filthy mind. A man with a filthy mind is a man with lousy ethics, and he is a hazard to your health. If he profanes God freely, he has no fear of judgment or retribution. He will cheat you and do tests that are not needed, and he will lie to you to get your money. Caveat emptor! People with filthy minds get all cleaned up verbally when they hear one word-- "AIDS".
28. ONE TRACK PROGRAM-
If your doctor has a procedure that he claims is one of a kind, and if no other doctor in the area seems very impressed with the procedure-- run. Doctors are always looking for legitimate advances in medicine that will improve health care. If something a bit unconventional comes up, but if it really makes a difference, it will get around. It will be proven by the interest it generates in hospital coffee rooms where the medical staff hang out.
29. WILL HE MEDDLE?- If you want a wimpy sniveling little MD who will tell you only what you want to hear, well then, you had better go make a down payment on a coffin right away. A good doctor will tell you you are a big fatty, and he will demand that you cooperate or find another doctor. It is very discouraging to a doctor with a good ethic and a clean conscience to have to pick up after a self-destructive patient. You have pre-cancer conditions, your parents both died of cancer, and you won't quit smoking. You are really dumb. Why should your doctor pamper you? I'm saying it like a lot of doctors would like to say it. Shape up, fatty!
30. MERCY BABY- Does your doctor have mercy on the poor? Does your doctor have an unofficial sliding scale of payments? He just doesn't hit the poorer patients quite as hard as the upper middle-class folks. If you are well fixed, rather than bellyaching about this, you should see this as a sign that your doctor is a compassionate and decent man. Pay up and shut up. You have found a rare bird indeed. If you are the poor patient, DO NOT go around town advertising the good deal you got at the doctor's office. Thank God for him and keep quiet. OK?
31. THE OFFICE- Can the office staff always find your records? Are they polite to you. There is no reason why you should put up with snot nosed office help. You are paying their paycheck, and when you come to their waiting room, chances are, you are already feeling lousy enough, right?
Also, do they know where the doctor is when you call? If they say that he will call you later, does he? If it gets too bad, you have to assume that a sloppy office is a sign of a sloppy mind. Clear out.
32. ULTERIOR MOTIVES- Once in a while you find a doctor who is a "pusher". He is pushing one drug company's products all of the time because he is getting a kickback. Then there are the doctors pushing AMWAY. Ugh! Some space cadet mystic MDs, who go to Esalan on vacation, push anything from spring water to vegetarian diets and yoga. Leave those doctors to bandage Guru Mahootna Hallywally. Find another Doc please.
33. ECCENTRIC- Some doctors are very eccentric. Does your doctor have a wad of hair that looks like exploding shredded wheat, or does he charge up and down the corridor mumbling to himself? Does he tap, tap, tap with his pencil? If he has high marks in everything else, forget it. This is his way of keeping his sanity. But if he falls down in other areas, you need to start looking for a doctor who acts a bit more conventional. Our family doctor road his bike to work-- good man too.
34. MEDIA- Sometimes doctors get into the news. They may be attacked for alleged malpractice, or they may be drawn into hospital and city politics. They may be faulted for alcohol or drug abuse. Remember, the media never has to answer for their actions. They destroy men with false stories and they suffer no consequences.
However; you must look into it. What if it is true? The best source in these questions is your pastor. Pastors have a way of getting in on the professional gossip, and they can quietly learn the facts pretty well. Often, the problem is some other doctor who is jealous or mad because your doctor has taken a stand on ethics or standards. The jealous slob will "set up" and accuse a good doctor to destroy him. Do not reward this by changing doctors. But if the story is true, do not stay with the faulted doctor to "give him another chance". It is dumb to risk your health to rehabilitate an offender.
35. CASE OUT THE JOINT- Now, I don't want to encourage you to be obnoxiously snoopy, but it is good practice to drive by your doctor's home from time to time. Is he letting it run down? How do his kids act on Saturday afternoon? Is he at church on Sunday morning? If so, that's a good sign of decent living. If you know any of his neighbors, what do they think of him? Is he helpful and well liked in the neighborhood?
If he is a member of any civic or business groups, is he liked there for his boozing or his good conversation? If you can LEGALLY get his credit references, it will tell somewhat about him. Just remember, he probably had to go over his ears in debt to get through medical school. Be fair, OK.
36. REFER- Does your doctor, specialist, or surgeon refer you almost all of the time? Yes? So, why are you paying that first bill dummy? Go open an account with the specialist he refers you TO. You do not HAVE to go to a primary care physician who knows nothing. You can find one who can actually cure a few things without referring ALL of the time. Why pay $50 a visit just for loyalty?
37. PREJUDICE- Does your doctor clearly show racial or other prejudice? Do his office and nursing help despise older folks? If so, he is the type who will show no loyalty to you in a tough situation. Think about it. Does he show signs of bitterness at conservative causes and Christians who are narrow? Tell me, what do you think he will do if your child falls down the stairs? If you are a conservative Christian or a Republican, he will turn you in to social services. Doctors can be just as mindlessly bigoted as anyone else. You liberals can relax. Conservative doctors do very little harm to liberals.
Find a doctor who has a steady view of the world-- a man who has had some tough times in the past. Some of these foreign doctors who have immigrated to the USA are very well seasoned by human suffering, and they are very slow to judge people unjustly. Most of them have been well trained and checked out by the AMA, and they can be very good doctors.
My four kids were brought into the world by an American, Filipino, Argentinean, and Indian doctor from India. Though all were good doctors, the MD from India was the most gentle and efficient, and he gave us the most time during prenatal visits.
38. NEW TECH- Does your doctor make the investment needed to add new high-tech instruments and devices to his office, examining, and operating procedures? Are other doctors always ahead of him in getting new things? If he is slow in this area it may be simply out of greed and laziness rather than wise caution. If it is a pattern, find another doctor.
39. HMO AND VETERAN'S HOSPITALS- Choose HMOs carefully. You will be given a short list of doctors whom you HAVE to use when you sign up with an HMO. Check out the doctors-- every one of them. Check out the hospital-- visit it for a walk-through (See no. 40). You will not have second choices once you sign up with most HMOs. The same applies to Veteran's hospitals. They will lose your records every time you go to them. I promise you that! The care is free, but the rub comes eventually.
There are HMOs and veteran's hospitals which do a better job than others. As much as any item in this booklet, the warning applies-- caveat emptor, let the buyer beware.
40. TAKE A WALK- This time we mean the hospital your doctors use. Most doctors use two or three hospitals. Which one is best? The doctors will be slow to fink on the place that pays them, so YOU check.
WALK THE FLOORS. Visit every area you can get into. Sit in the waiting room to see what the atmosphere is like. Is the cafeteria clean? Are the halls clean, and is there someone cleaning somewhere in the hospital at any given time of the day? Does trash accumulate before it is hauled out? Are the visitor's restrooms clean? When you visit a friend in the hospital you can ask them what they think while they are there. Are the nurses helpful? Do they send in trainees who hurt your friend? Are there young men walking around with stethoscopes around their necks with apparently nothing to do?
If you have several bad impressions, discuss it with your doctor. Ask him bluntly why he is not affiliated with a better hospital. If he tells you he is agitating for change, give the hospital three months. Then do the walk-through again. If it is better, you have a good hospital.
Remember, during your stay in the hospital, your host will not be your good doctor-- it will be the gang who takes care of you night and day. If the health care workers all have long hair, ear rings, and talk with a lisp, you better be sure they are the folks you want to visit BEFORE you call 911.
41. PRESCRIPTIONS- Will your doctor give you samples from his shelf? Does he suggest generic or alternative drugs at lower prices? Does he encourage you to look for bargains in Mexico? Does he add drug to drug to drug until you are swallowing 35 pills a day? Do you want to be a junky?
You may be the type who gets real comfort out of being sick-- you LOVE to hear the mystical voice of Dr. Chicken Little, "The sky is falling." If so, I can almost promise you that you will eventually find a doctor who will dope you into Nirvana. Just shop long enough, but I feel sorry for you. You need to get outside, take a long walk every day, make some friends of folks who talk about good things happening, and find a church where they sing a long time on Sunday morning. Also, get another doctor!
Last question-- Can you read the prescription? A doctor who writes so badly, that you don't know what he prescribed, is a jerk. I hear, "All doctors write terribly". That is a lie. Dr. Van W______ in Michigan writes very carefully so that you can read it before you pay the $5 per pill at the pharmacy. Hand it back to him and say, "Write it in English, Doc. I like to read." If he won't, don't pay him.
42. PREVENTION- Does your doctor give you diet and exercise methods you can use to PREVENT sickness? Doctors get exactly 8 hours on nutrition in medical school. They are conditioned to cure sick people, not prevent sickness. Furthermore, that plan is far more profitable. Prescribing broccoli to a cancer-prone patient is not going to get the bucks into the cash drawer nearly as well as letting the patient eat grease and prescribe chemotherapy later.
I know doctors who have nutritionists on hand to sit down with their patients and give them mini- seminars and / or scoldings in eating their way to better health. Find one of these doctors who is a REAL MD, (not a chiroquacktor) and you will be well served. Beware of the New Age doctors who discourage you from eating sugar and red meat as good food. Diabetics, etc, are the exception, but sugar is ESSENTIAL to the function of the brain, and red meat builds the brain. A doctor who attacks these good foods is a guru, not a doctor. Flee from him.
Does your doctor allow you to help yourself? Does he tell you how to do rehab therapy and get your health back after an operation? Some of this expensive therapy is simply a way to pad the books with cash. Does he tell you how to make a homemade device to exercise your wrist or leg?
The medical profession is trying to score or grade everything these days on a scale of 1 to 100. So why not score your health prospects?
Below is a record keeping area. Keep it simple with this rating scale:
(1) Barely tolerable;
Score each of the above areas (1 through 42) according to your observations. Then follow the scoring method if you want a percentage. You will NOT find a doctor with a 100% score. Don't even imagine that. Doctors are human. Once you see the weak areas, ask yourself if you can live with it. If so, just rejoice that you have a good doctor. If not, go shopping.
Remember, no doctor and hospital will give you 100%, but a low score should send you shopping for better health care. In all fairness, you might want to show your doctor this booklet and the results of your scoring. He may have an observation which is reasonable in some areas that look bad. Listen and be considerate, but remember-- caveat emptor-- let the buyer beware!
Also, I am very eager to hear from doctors. Is there an area I missed or should change in the next edition? Would anyone be interested in a national rating scale based on this system?