We have a pediatrician doctor we love. But our family doctor has been a revolving door of fine people who last only a few years and then move on. I had been asking my friends for suggestions of great primary care doctors without getting many recommendations. I decided to ask Dr. Joseph Stirt, the “World’s most popular blogging anesthesiologist“  what is the best way to find a great doctor. He wrote me a lengthy reply , which I thought useful enough to post for others. Blogger that he is, Joe started with a story:

Q. What do you call the guy who finished last in his medical school class?

A. “Doctor”

With that introduction, a true story. My dorm floor advisor in my sophomore year of undergraduate work was a fourth year UCLA medical school student. A few years later, I  started med school myself at UCLA. I kept in touch with my old dorm house advisor, who was a super nice, cool guy, surfer, etc.  Years later an apartment I lived in in Westwood, near UCLA,  found me occupying a one-bedroom unit right above a guy who’d recently graduated from UCLA med school. He and his crazy flight attendant girlfriends drove me insane with their loud music and screaming, object-throwing fights and slamming doors. I happened to mention the guy’s name to my old dorm floor advisor one day, and he started laughing. Why? Because my downstairs neighbor had finished last – dead last — in his graduating medical school class (same class as my ex-advisor) and was considered a complete flake/bozo by everyone in the class: no one could believe he got his M.D.

The downstairs  guy went into private practice and was obviously making a shitload of money, judging by the Ferrari, etc., and his drop dead gorgeous suits. I continued to live in the upstairs apartment and I’d talk to him occasionally . He would tell  me little  medical facts that were so bogus, I’d laugh to myself.

Fast forward a few years. An issue of then very popular Los Angeles magazine featured as its cover story “The Best Doctors in Los Angeles.” Guess what? My downstairs neighbor was named the top family doctor in L.A! I wouldn’t have let that guy housesit my pet turtle, he was such an idiot.

But you know why he was voted the best doctor?

1. His patients loved him, as did the doctors he referred to.

2. Professionally he was very personable and interested in each person he cared for.

3. He was always available by pager or phone.

4. He was handsome and well-dressed and looked the part of a doctor.

5. He never rushed through his appointments but always took as much time as his patients needed.

6. He was smart enough to realize he was stupid and so referred anything at all out of his expertise, which was essentially nil, to specialists: the specialists thus named him as being excellent ($$$ is how you spell referrals) and his patients thus thought he was even more caring.

There are many doctors out there who are loved by their patients who are actually incompetent. That’s why you don’t really want a doctor “that you love.” Because that is precisely the wrong attribute to be most desired, or even considered important. What you should be seeking is a doctor who is competent, and able to understand when she/he needs another opinion.

So how do you find a competent doctor? What should you do?

1. If you’re in a city with a teaching hospital, call the department you want a doctor in (Family practice, ob-gyn, urology, whatever).

2. Ask them for the name of recent chief residents who stayed in the area and are now in private practice.

3. Call them and make an appointment: you’ve found your doctor.

Chief residents are chosen by both fellow residents and faculty: they are always good and interpersonally skilled — because they have to be. They’re also clinically adept and knowledgeable. That’s what you want and need.

But I am an anesthesiologist. You couldn’t find me this way. Anesthesiologists are unfindable — as a rule they’re assigned to cases and you haven’t a clue who’s putting you to sleep — or if they’re any good.

How to get a good one? At a teaching hospital, call the anesthesiology department and ask to speak to the chief resident.  Push — you’ll get to her/him. Ask the individual to personally do your/your child’s anesthesia. They’ll be delighted to do so and flattered as hell.  If your health care is out of a hospital and in a private setting? Ask your surgeon who’s the best anesthesiologist in the group. He/she’ll say they’ll all excellent. You’ll reply, which one would you select to do your anesthesia? There’s your guy.

Although I had never thought of this method to find our family doctor we did use to find a specialist for my wife. She had broken her wrist falling on a hard tennis court, and sadly the severed wrist  bone was not healing after 6 months. She was due for another very technical surgery to rebreak it, clean it and bind it in metal. Slowly, through a number of clues, I began to conclude that the doctor who set her bone in the emergency, and was overseeing her non-healing, may not be the best surgeon in the world to do this, although he thought he was. Another doctor friend suggested this simple procedure. Call up the operating room at the hospital the doctor works at and ask the chief nurse “when was the last time doctor X did this operation (which I described)?” In our case the answer was “about five years ago.” Yikes!  No way, buddy.

We got a lead for another doctor, who gave the correct answer: “I just did this exact operation this morning. I do it several times a week. It’s my speciality.” She was great and quickly healed it.

The answer to how to find a doctor, then, is to not to ask other patients, nor just any non-specialist doctor, but to ask either  a chief resident or a chief nurse  who they recommend for themselves because they are the ones who must deal with the competencies of other doctors. But you have to solicit the recommendation in a way such as they are not dissing their colleagues. When was the last time they did X, would you use them for your child?

Doctors are human beings. They ALL make mistakes. You can’t expect infallible care. Even the best will be wrong sometimes. But some are more expert than others. Discovering and evaluating competency way outside your own is very difficult.  The key is to ask, who cares? In this case, who cares about doctor competency? Chief residents and chiefs of operating rooms do. So you ask them.

If anyone else has a good heuristic for finding great doctors (or other specialists), I’d like to hear about it.