Getting the Best Care in Today’s Complex Medical World
An Interview with Leslie Michelson, author of The Patient’s Playbook.
Few things are more important in life than getting the right medical care. But finding the best doctor can be tough. You could ask a friend, or even do research online, but that doesn’t always yield the best results.
Importantly, it’s essential to have an action plan for your medical care in place well before you need it. If an emergency strikes, which hospital do you want to be admitted to and how can you ensure the best specialists will be on your case?
To help navigate today’s ever-changing medical maze, we spoke with Leslie Michelson, author of The Patient’s Playbook: How to Save Your Life and the Lives of Those You Love. Leslie has spent more than three decades helping patients master the health care system in a variety of capacities. As he notes in his new book, the difference in quality from one doctor to another can be far more substantial than most people imagine. Below he offers advice for being your own patient advocate.
You say it’s essential for everyone to start by having a primary care physician they trust. What’s the best way to find one?
The first step is to write down all of the things that are important to you. Do they need to be in your insurance network? Must they have after-work office hours or use electronic records? Next, consult with friends and family members for recommendations about their favorite doctors. It might be the pediatrician they use for their kids, or the orthopedist who took care of their torn knee. Call those physicians and ask not only who they might recommend as a primary care doctor but also who they use. Then, go online. At the Federation of State Medical Boards website (fsmb.org), you can link to your state’s medical licensing body and look up or verify a license. Make sure the physician candidates have no administrative proceedings against them and that they’re board-certified, part of your insurance plan and have admitting privileges to the hospitals you feel are the best in town. Finally, call their offices and make an appointment for an initial consultation to interview them.
You mean you can actually set up an appointment to interview the doctor before becoming a patient?
It’s funny because in everything else in life, it seems perfectly normal to interview a person before you hire them to do something important for you. But with doctors, people feel as if that’s offensive. Fortunately, physicians are increasingly becoming comfortable with this idea. It’s invaluable to verify that you have interpersonal chemistry with the doctor, and this is one way to find out before you commit.
Some doctors have great expertise yet a poor bedside manner. Which is more important?
For primary care, I believe feeling a strong interpersonal connection is important. At the end of the day, you also need to use your intuition. Does this feel like the right person to take care of you?
Is it the same process for identifying a specialist?
Yes and no. For specialists, my recommendation is to find someone who is an inch wide and a mile deep. If you get diagnosed with the most aggressive form of breast cancer, known as triple negative breast cancer, you want an expert who has specifically treated many triple negative cases. Even oncologists who see a lot of general breast cancer cases may not have a similar template to help you most effectively. As in all other aspects of life, experience matters and practice makes perfect.
How do you find someone with that level of expertise?
There are several ways to do it, and they’re all online. Start with the websites of major hospitals in your community. Almost all list detailed biographies of physicians on staff, their areas of interest and their publications. Second, visit philanthropies and foundations dedicated to your specific disease. They all have a medical advisory board, and these people are not randomly selected. They’re leaders with deeper expertise in that disease area. Finally, expertscape.com searches all the articles that have been published on PubMed (an online medical library) over the past 10 years. Type in your condition and in a few seconds you’ll have a prioritized list of experts and institutions that have the most distinguished records of publishing scientific articles about your disease.
A lot of people ask their primary care physician for specialist referrals. Is that a good strategy?
It is, but not every primary care doctor has spent the time doing what I just described. It may sound a bit daunting or awkward to do this research, but once you see the benefits, it will become second nature to you.
What do you think about some of the online review sites, such as Yelp, in terms of evaluating medical professionals?
In general, the data on social media rating sites isn’t terribly meaningful. All too often people comment on things like whether their parking was validated or the room was well lit. They don’t give meaningful information on a doctor’s expertise.
You write in your book that you should always get a second opinion after receiving a diagnosis. Why?
I train people to go through a six-step process called the “No-Mistake Zone.” Step one is to make sure your diagnosis is specific and confirmed. We’ve had cases of extremely wealthy people being treated for the wrong cancer because they had a misdiagnosis. I even encourage people to have a biopsy read by a pathologist at another center who is an expert on the disease. Step two is to make sure you understand when and why the disease needs to be treated. For most back pain, as an example, you should avoid surgery for as long as possible. By contrast, if you get pancreatic cancer the way Steve Jobs did, it should be treated right away. The third step is to educate yourself on the condition. There’s a terrific website, uptodate.com, which has patient-friendly information on virtually every disease. The fourth step is to meet with physicians who are experts in exactly what you have. Step five is to visualize your treatment plan and how you will be treated. The final step is that gut check — believing it’s the right course of action and the best physician to carry it out.
All of these steps are great when you have time to plan, but what if an emergency hits and you need to make important decisions right away?
First, know that emergency rooms are graded from level one to level five. Level-one trauma centers have the greatest capabilities. So in an emergency, make sure the ambulance takes you to a level-one hospital. Then, be certain you have someone who can come with you to ensure the physicians and nurses are all knowledgeable about who you are, what happened, what allergies you have and so forth. Emergency rooms are chaotic, so close and clear communication is essential.
With all the changes in health care, some doctors no longer accept insurance or are only on limited plans. Have you found any correlation in quality among such physicians?
Let me give you a little trick of the trade. It’s a secret I’ve learned in over 30 years of doing this. There is no meaningful relationship in medicine between cost and quality, unlike almost every other sector of our economy. What that means is there is an opportunity for each individual to exploit that disconnect. Here’s how you do it: For significant conditions, go to those institutions most likely to have more volume and expertise in your problem than your local community hospital. Most Americans live within an hour’s drive of a major city housing a prominent medical center. Just about every one is in-network for Medicare and most PPO insurance plans because they have to be. If the center takes your insurance, the doctors who practice there will as well, and they are generally the most experienced professionals around.
Speaking of experience, do you recommend doctors who’ve been practicing for a long time, as opposed to those more freshly minted out of college?
It depends on what they are being asked to do. If it’s a normal childbirth, an appendectomy, setting a broken ankle or a similar routine procedure, even a new physician should be able to handle that fine. But if it’s a heart transplant or other extraordinarily complex and technical procedure, you want someone with a lot of demonstrated experience. It’s less about age and more about the level of expertise, which comes back to all the other techniques I just let you in on.