who decides who is best

Tuesday, March 1, 2011

Supposedly, the Oscars celebrate the best actors and movies of the year. Millions anticipate the results, watch the ceremonies and then celebrate or berate the winners and losers. People develop emotional attachments to the films because art affects each person differently. There are thousands of movies made every year and many are incredibly good but the Oscar winner is the one placed firmly in the public eye.

There is a similar “award” ceremony that anoints the best doctors in the country. Whether it is the best doctor on the cover of the local city magazine or an advertisement in the back of an inflight magazine, the publicity machine is similar to the Oscars. Is there only one best plastic surgeon, obstetrician or pediatrician to care for 300 million people in the United States? More practically, how do you find your best doctor? Just as a film becomes a personal experience, so becomes the relationship that should exist between the patient and the physician. The best doctor for one person may not be the best for another.

There are some deal killers to consider. Medical licensure and board certification are baseline requirements. Each state decides whether to grant a license to practice medicine. Usually, it requires graduation from an accredited medical school and completion of a year of post graduate training, called an internship (or a first year of residency). This is a pretty low competency bar to achieve. The next minimum rung on the ladder is completion of a residency program. Primary care specialties like internal medicine, pediatrics and family medicine require three years of hands on training after medical school. Other branches of medicine like surgery take a minimum of five years of training. Just like any other trade, the resident is an apprentice who learns at the side of the master specialist. That specialist has to sign off on the training before the new doc is able to take the board exams (written, oral or both) that confirm the knowledge base and decision making. Board certification says that the physician has met the standards of being a specialist but the process does not end at this point. The certification has an expiry date and continuing education and recertification exams will happen every few years.

A solid education looks good on paper but does not necessarily make a good doctor. Ideally, the patient should want a level of empathy and caring that allows a personal connection with the physician. This is especially true of the personal physician, the person who will potentially listen and understand some of the deepest emotions and secrets of the patient and who can act as an advocate for their beliefs and wishes while guiding the patient through the sometimes high tech medicine that has become a difficult maze.

People spend more time trying to find a good mechanic, hairdresser or plumber than they do looking for a doctor who may be their medical soulmate. The process could be the same, asking family and friends for recommendations, checking websites and asking people in the medical profession, but often it isn’t. People tolerate being shepherded to a doctor only because an appointment was available or because that person was up for the next unassigned patient. Instead of being a passive player in what may be one of the most important relationship[s in their life, patients need to take some control if possible. Like dating, there has to be some chemistry and trust and there is no harm in looking for a new doctor who might be a better fit. It is hard to say “no thank you” to a physician because there is an imbalance in the power of a relationship. While the doctor is often perceived as the dominant partner, in reality, the patient is the driver of the boat, listening to the doctor for advice but ultimately making the final decisions on most things including deciding whether that doctor is the right one.

Finding the right fit takes time and effort. The concept of who the best doctor might be is as subjective as the Oscars. Even the best serious films don’t work if the viewer was ready only for a comedy. Best medical care only happens one patient at a time when both parties are equal partners in trying to reach the same goals

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