How Does One Choose A Doctor?

“Dr. Lapius, how do you choose a doctor?”

“You choose a doctor like you choose anything else in life.  Look him up in the yellow pages.”

“Do you choose just any doctor?”

“No!  You will note that the specialty of each doctor is listed under his name, and all doctors are listed in alphabetical order.  Of course, this has recently become more complicated.”

“How so?”

“Ordinarily one would start off with a general practitioner, otherwise known as family practice, primary care physician, initial provider, or some such.

“You don’t mean to tell me that the term general practice has been changed?  For what reason?”

“For the same reason that a housewife has become a homemaker, and that a garbage man has become a sanitary engineer.”

“Suppose a patient wants to go to a specialist?”

“Simple.  First the patient must make the initial diagnosis.  If he has done this successfully he or she can go directly to a specialist, but I don’t recommend it.”

“Why not?”

“The patient might make the wrong diagnosis.  They might diagnosis tennis elbow, whereas in reality they have neuralgia.  In the case of tennis elbow they would have to see an orthopedist, but for neuralgia they might have to go to a neurologist.  Furthermore, some people get their terms mixed, and confuse the specialties.  Neurologist sounds like urologist, and the patient with tennis elbow might suddenly find themselves upended with a catheter in the urethra, wondering what this has to do with tennis elbow.  Certainly it would seem safer to go to the generalist first.”

“What is a generalist?”

“Another name for general practitioner.  I had forgotten to mention it.”

“Well now that we have determined how to choose a doctor, how can a patient establish him or herself with a doctor?”

“What do you mean ‘establish’?”

“Well you know, to sort of hire a doctor to take care of his family.   Call him up and ask whether he is taking new patients.”

“Don’t you think the prospective patient ought to meet the doctor and see whether he likes him.  See whether the doctor has a suitable personality?”

“Well, that might be risky.  There is supposed to be a doctor shortage.  If the patient is going to screen the doctor’s personality, he must take the chance that the doctor will also be checking his personality.  The patient might reject a doctor he doesn’t like.  But the doctor could probably reject the patient on the same basis.”

“That doesn’t sound right.”

“But it is right.  If a doctor doesn’t feel comfortable with a patient he probably shouldn’t accept the responsibility for treating him, except of course, in an emergency.”

“You seem to be skirting the question.”

“Not at all.  The problem is the term ‘establishing’.  Patients come to the office and say they would like to establish themselves with a doctor.  It sounds ominous, almost as if they want to marry him.  After all, the standards of medical education and licensure are quite uniform, and the general level of competence of doctors is quite uniform, and the general level of competence of doctors is quite similar within their specialties.  In reality, patients eventually find a doctor through a ‘hit or miss’ process, and tend to remain with the doctor they trust, and with whom they feel comfortable.  It’s as simple as that.  Another reality is that even if a patient feels that he has established himself with a doctor, the doctor may not always be available.  He might be busy at the moment with another patient, established or not.”

“You don’t seem to like the concept of ‘establishing’.”

“Correct.  It is a snare.  As a matter of fact there is something to be said for a patient changing doctors on occasion.  After all when a doctor becomes friendly with a patient his objectivity may be altered.  None of us like to see our friends get sick.  Sometimes a doctor with no emotional involvement with the patient will do a better job. Suppose a patient doesn’t have a doctor and suddenly becomes seriously ill?  If that happens he should go to the emergency room of the local hospital.  Each day a staff man is on duty, and will take responsibility for the patient’s care.  The doctor is obligated to care for that patient, whether or not he can afford to pay for the service.”

“Do you find that patients are considerate of their doctors?”

“By and large, yes.  Except for one example.  I was called to travel thirty miles one morning about 2 a.m.  When I arrived a distraught woman told me her husband had died and wanted me to sign a death certificate.”

“That wasn’t very considerate.  Why would she do a thing like that?”

“She said that I had been highly recommended.”

“That was flattering.”

“Yes and exhausting too.”