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 Best Doctors
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.
 

To help find the medical care you deserve, New York has again teamed up with the staff of Castle Connolly, the medical-research firm, to survey local doctors and choose their worthiest peers: 2,000 top doctors in the five boroughs, Westchester and Nassau Counties, northern New Jersey, and Fairfield County, Connecticut.

 
2002 Best Doctors Hall-of-Famers
About Castle Connolly Guides
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.

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.
 
   
 
From the June 10, 2002 issue of New York Magazine.