Dr. Lung . . . . . .Pulmonologist
Dr. Heart1 . . . . .Cardiologist
Dr. Heart2 . . . . .Cardiologist
Dr. Virus . . . . . . Infectious Diseases
Dr. Baby . . . . . . .OB/GYN
How should a person choose a doctor?
Dr. Heart1: Looking at where a doctor went to medical school is a good place to start. You shouldn’t necessarily knock someone off who comes from a foreign medical school or an unknown school in the Midwest, but top-tier schools have already done the legwork of weeding out people. It’s like having a personal shopper give you the top ten suits to choose from—instead of having to go to the department store and look at them all yourself.
Dr. Virus: I think it’s the same as choosing a car mechanic. You have a person who does your taxes, and you make a decision about which person to hire. Maybe you have a lawyer as well. You deal with professionals who know more than you in all walks of life, and you somehow learn how to find out who’s full of shit and who’s not.
This is a matter of life and death. You’re saying it’s like choosing an accountant?
Dr. Virus: Well, yeah, I am saying that. I think better doctors are typically at better hospitals. If I were to pick a financial planner, I wouldn’t go to Joe Shmoe’s down the street; I’d go to Smith Barney, Goldman Sachs, whatever. Start with a brand name and find someone you connect with.
So can I assume that if I go to a major teaching hospital, I’ll have a good doctor?
Dr. Virus: No, but your statistical risk of turning up a clown is much lower.
Dr. Baby: How anyone who lives an hour away from Manhattan is going to Guardian Angel Hospital in New Jersey or some 40-bed schlock house in Queens is beyond me. If it’s “Manhattan scares me” or “I don’t want to go to a big hospital,” that’s your first mistake. If you’re not sure of a doctor, at least go where there are residents. Residents are your checks and balances, they protect you from an unscrupulous or incompetent doctor.
Dr. Heart1: I don’t disagree, but there’s a caveat: If you have heart disease, you don’t want to go to the top heart-disease person at a university hospital. He’s at the top because he’s published the most papers, has the most research money, his name is out there, he gives a lot of talks, other doctors know him, and so forth—but it doesn’t always mean he takes care of patients well.
Dr. Lung: There can be good doctors in small hospitals and bad doctors in big hospitals. That’s why you also want a patient recommendation.
How can a patient get an appointment with a busy specialist?
Dr. Heart1: It’s all about who referred you. If you don’t have someone who referred you to them, then you’re sort of in the general pool with everybody else. The second most important factor is what insurance you have. Doctors will pick. First of all, some doctors don’t participate in some insurances by definition. Second of all, some insurances will pay higher than others. So if you have an insurance that makes the doctor jump through three hoops to order a CAT scan for you and needs preauthorization, yadda yadda yadda, then that’s something that the doctor may make choices on.
Why do patients have to sit so long in the waiting room?
Dr. Baby: For a new patient, I book it for 40 minutes. Some doctors make it ten. For a second visit, some make it five. If you’re an HMO doctor, the network will tell you to see, on average, a patient every seven minutes. HMOs tell us to see more patients; malpractice insurance tells us to take all the time we need.
Dr. Lung: You never know how much time a patient will require. Sometimes they have a bad diagnosis, sometimes they have a family death, and the other day one of my patients was telling me about how her estranged husband was murdered. And she was telling me she was having trouble with her teenage daughter. You can’t rush that situation. I always tell the next patient, “You know, I had a little problem with an earlier patient, so I’m a little late.”
Dr. Virus: When you’re in the room, you’re happy I’m spending extra time with you, because your problem is urgent to you. If I scheduled you for a 30-minute appointment and it goes on for 45 minutes, you will like the interaction a lot. That happens every day, because someone shows up sicker than expected. At the barbershop, they know that every haircut takes X number of minutes, and they can roughly gauge the time. At the restaurant, they know 90 minutes, it’s a rough estimate. But at the doctor, one unexpected problem and you’re an hour behind.