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| The Doctor Dilemma |
| New York City has more M.D.'s than anyplace
else on the planet. So why is the right one harder to find than a
rent-controlled six on Central Park West? It needn't be -- you just have to
know WHERE to look. |
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BY JOANNE KAUFMAN
When I moved to new york from michigan after college, I was baffled to
discover that finding a job (in three days) and an apartment (in four) was a
lot easier than finding a doctor, perhaps because there was no medical
equivalent of a real-estate broker to whom I could articulate my most basic
needs: reasonable fees, in the neighborhood, warm, accessible, infallible.
For a while, I even kept my suburban-Detroit medical team in place,
scheduling visits home to coincide with checkups. As you can imagine, this
health hajj quickly became impractical. But without a network of friends and
colleagues to steer me to the right lab coat, I was reduced to finding
referrals by eavesdropping on conversations in the women's locker room at
the 92nd Street Y and on buses; the results were discouraging, to say the
least.
After a few years of trial and error, I found my internist through my best
friend's second husband's first wife. I found my dermatologist through my
college roommate's brother, my radiologist through my husband's cousin, and
my ob/gyn, a fertility specialist, through a former boss who provided the
ultimate recommendation: She'd just gotten pregnant. Finally, I'm set. And
you?
New York is a city of doctors, thousands of doctors -- nearly 60,000 at last
count, the largest concentration in the country. Paradoxically, it's also a
city of people searching for first-rate care that meets all their
needs -- medical, emotional, geographical and, of course, financial. So what's
the problem?
First, it sometimes seems easier to live with a nagging stomachache or
backache than to deal with the headache of trying to pick from that big pool
of docs -- particularly as medicine becomes increasingly sophisticated and
presents more treatment options. You know you need a urologist. Do you go to
the guy who does minimally invasive laparoscopic surgery or the one with the
more conservative technique? If you're facing cancer, how do you hook up
with someone with access to treatment protocols for new chemotherapy? How do
you even find out that such protocols exist?
"It's much more difficult now than it once was," says Mark Reiner, a general
surgeon. "In the old days, the doctor would say, 'You should see Dr. Smith.
He operated on my family members.' Today, people are bombarded with ads and
news reports; they're going on the Internet . . . " (This last a thorny
prospect, offering reams of unfiltered information but also hospital and
physicians' Websites that can arm you with plenty of useful information.)
Patients whose choices are limited by their insurance plans have a whole
other set of issues. Because of anorexic reimbursements from insurance
companies and the government, doctors have to see seven or eight or twelve
patients an hour to eke out a reasonable income these days -- which means
hurried, harried care. And just when you've found a physician who's a good
match, your employer switches health plans, or your doctor of choice drops
out.
What complicates matters is that the doctor you just have to see is -- as often
as not -- no longer taking new patients. "I think Manhattan people are obsessed
with the idea of the best and whether a certain practitioner is a chic
doctor," says an internist-cardiologist at New York-Presbyterian. "There's a
lot of he's the only one syndrome, a desire to know the patient profile of
the doctor and to know whether there are important people in a given
doctor's practice. And of course, there are some doctors who cultivate that
patient group."
But if your mother was right when she told you there was more than one Mr.
Right (or Ms. Right), there's also more than one Dr. Right. "The question
is, why do you need that one doctor?" asks Zeev Neuwirth, an internist at
Lenox Hill. "Chances are, in New York City, thank God, there is someone else
who can do that specialized procedure." And if the doctor you desire isn't
available, someone else in his or her practice probably is. "You might be
better off with that doctor's associate," says Neuwirth, "someone who isn't
as senior or doesn't have the same reputation but is equally competent."
Indeed, that junior doctor, intent on building a practice, may also take
your insurance, while the senior guy only takes cash.
Still insist on seeing the big kahuna who steadfastly insists he's taking no
new patients? "If you have another way in to that doctor aside from bullying
the receptionist, use it," says Stephen G. Baum, chairman of medicine at
Beth Israel. "Have your internist call on your behalf. If you know someone
who's been that doctor's patient, have him intervene for you."
Most of us find our doctors through the recommendations of others, and that
can be a blessing -- or a curse. One physician's type-A-personality bedside
manner may be perfectly suited to your hypochondriac best friend's needs but
not to your laissez-faire approach to survival.
Whether you're in an HMO or have the means to go to any doctor you desire,
nothing is more important than getting comfortable with your primary-care
physician, typically an internist with a specialty in some field of
particular relevance to you. If you're not comfortable with the gatekeeper,
you won't be comfortable with his or her referrals, which are often sought
during times of crisis, and you'll end up shortchanging your health in ways
you wouldn't dream of doing to, say, your appearance.
If you're fortunate enough to have a friend who's a doctor, ask for
referrals, for scuttlebutt, and for guidance. But Mack Lipkin, a professor
of clinical medicine and director of the primary-care division at NYU
Medical Center, who frequently finds himself serving as a medical
clearinghouse, says his recommendations are only as good as the information
prospective patients provide at the outset. To get started, you should:
* Familiarize yourself with your HMO's Website in order to get basic
information about primary-care physicians who match your requirements of
location and subspecialty. Also useful: medicalconsumers.org, which offers
information about the number of times a doctor has performed a particular
procedure; and nydoctorprofile.com, a site run by the state Health
Department that has information about whether a physician has ever been
disciplined.
* Consider your comfort level with a doctor of the opposite sex (something
that women grow up with but that more men are confronting -- maybe not a bad
thing, since women tend to spend more time forming "partnerships" with
patients). Similarly, is a doctor's age a factor in your comfort level?
* Take into account your special medical needs and likelihood of needing
hospitalization. If you are at high risk for a heart attack or require
ongoing treatment, you'll want a doctor who has privileges at the hospital
you need to be in.
Most crucial to lipkin is the tricky task of matching doctor-patient styles.
If, for example, your mode of self-care involves vitamins, acupuncture, and
the Alexander technique, you're unlikely to do well with a doctor who either
doesn't know from Alexander or doesn't approve of such things. Some people
prefer to try to change their unhealthy lifestyles and avoid medications -- and
for them, there's no point in going to a doctor who just prescribes
medication. Other things to consider along these lines:
* Do you prefer a doctor who lays out all the options and asks you to decide?
Or one who says, "This is what I think would be best"? Or one who says,
"This is what has to be done"?
* Do you want a doctor used to sharing a great deal of information, or one
who is more low-key and reserved? "A stock analyst or lawyer or academic
needs information," says Lipkin. "That's their stock-in-trade. They're not
going to be happy with a doctor who boils something down to the nub. If they
have congestive heart failure, they want to know exactly what it is and what
it involves rather than being told the pump isn't working."
Our best advice: shop around. we are willing to interview a battalion of
pediatricians before settling on the one who is right for our kids, yet too
often we don't do the same for ourselves. "It's crazy to enter into a
long-term relationship," says Lipkin, "where your safety and well-being and
longevity are at stake, and not be in the right relationship.
"If you feel not understood, not cared about," he continues, "if you feel
that you can't ask for a better explanation of something, that you can't
negotiate the approach to your care, you're not going to be able to tell the
doctor about difficult things like that you're not taking your medicine or
that you're drinking more than you feel is right. You're going to jeopardize
yourself when it really counts. You're going to wake up one night, feel
really sick, and not call the doctor."
So move on. If you can hire a doctor, you can fire a doctor. Here in New
York, there are plenty more where that one came from.
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Castle Connolly Guides
For the fifth consecutive year, New York Magazine has collaborated with
Castle Connolly Medical, the research-and-publishing company, on its "Best
Doctors in New York" issue. The 2002 list is based on research for the
upcoming seventh edition of Castle Connolly's Top Doctors: New York Metro
Area, to be published next winter. The selection process began last year,
when questionnaires were sent to 8,000 top physicians in the New York area.
Those surveyed are asked, "To whom would you send a member of your family?"
Nominees are sought in every specialty, with the emphasis on direct patient
care. The results are combined with data gleaned from previous research as
well as 12,000 local surveys that were sent out for the next edition of
America's Top Doctors, a companion guide. In addition, Castle Connolly's
physician-led staff conducts hundreds of phone interviews with leading
specialists, chiefs of service, and other hospital personnel. Each doctor's
education, training, hospital affiliation, board certification, and
disciplinary history are reviewed before he or she can be selected as one of
the book's 6,000 M.D.'s. For New York, Castle Connolly makes an additional
pass, narrowing the list to the top 1,500 included here. We list
primary-care physicians -- the doctors you go to for your annual checkup or
general health problems -- and specialists in every field from addiction
psychiatry to vascular surgery. Because most doctors participate in a wide
variety of insurance plans -- which change so often these days -- we note only
those doctors who accept no managed-care plans (listed as no hmo/ppo).
Current editions of Castle Connolly's Top Doctors: New York Metro Area and
America's Top Doctors are available in bookstores or by calling the
publisher at 800-399-docs or visiting www.castleconnolly.com.
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| From
the June 10, 2002 issue of New York Magazine.
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