How to Choose a Doctor...Excerpt from Choosing a Doctor Webinar

This video provides an in-depth exploration of how patients should choose a doctor, emphasizing that this choice is the most powerful tool a patient possesses in navigating the healthcare system. The speaker, Dr. Bricker, begins by highlighting the fundamental issue of non-standardized medical practice, illustrating this with striking examples of varying treatment approaches across different geographic regions and medical institutions. He argues that because doctors practice medicine differently, the patient's choice of provider significantly impacts their care trajectory and outcomes.

The core of the presentation revolves around a practical framework for selecting a doctor in non-emergency situations, which constitute the vast majority of healthcare encounters. This framework is built upon four logistical criteria: the severity and complexity of the patient's condition, geographic constraints, appointment availability, and affordability/in-network status. Dr. Bricker meticulously explains how these criteria must be applied differently depending on whether the medical situation is of low or high severity, underscoring that a one-size-fits-all approach to doctor selection is ineffective and potentially detrimental.

He provides specific clinical examples for both low and high severity scenarios. For low-severity conditions, the emphasis is on convenience and accessibility, suggesting options like telemedicine, urgent care, or simply getting an appointment with an available primary care physician. Conversely, high-severity conditions demand a more rigorous and time-intensive selection process, prioritizing quality and expertise over convenience. The video concludes by summarizing the four basic needs of patients with employer-sponsored health insurance: understanding their benefits, finding a doctor, navigating the complex healthcare system, and ultimately, getting better.

Key Takeaways:

• Non-Standardized Medical Practice: The practice of medicine is not standardized, leading to significant variations in treatment approaches and outcomes. For instance, spine surgery rates can vary by 300% between different cities, and 55% of cancer treatment plans may be changed upon seeking a second opinion at a Center of Excellence like the Mayo Clinic.
• Patient Choice as a Powerful Tool: For non-emergency situations, choosing the right doctor is the most impactful decision a patient can make, directly influencing the quality and efficacy of their care.
• Four Core Criteria for Doctor Selection: Patients should evaluate doctors based on the severity/complexity of their condition, geographic convenience, appointment availability, and affordability/in-network status.
• Severity Dictates Selection Strategy: The approach to choosing a doctor must fundamentally change based on the severity of the medical condition; a strategy suitable for a minor ailment is inappropriate for a serious illness.
• Low Severity Prioritizes Convenience: For low-severity conditions (e.g., URTI, UTI, minor sprains, hypertension, high cholesterol), the priority is often simply getting in the door quickly and conveniently, utilizing options like telemedicine, urgent care, or readily available primary care physicians.
• High Severity Demands Rigorous Selection: Serious medical situations (e.g., cancer, joint/spine surgery, diabetes, autoimmune diseases) require a significant investment of time and effort, potentially involving travel and less convenient options, to find the highest quality care.
• Academic Medical Centers for Complex Cases: For high-severity conditions, physicians at academic medical centers (university hospitals) are often preferred. They are typically salaried (reducing financial influence on clinical judgment), have dedicated time to stay current, and manage a higher volume of complex patients, leading to greater expertise.
• Utilize Outcomes Data When Available: For certain diseases and conditions, data on doctor and facility outcomes exists and should be leveraged to inform selection, though such data is not universally available.
• Chronic Conditions Can Be High Severity: Conditions like diabetes and autoimmune diseases (e.g., Crohn's, rheumatoid arthritis), while chronic, are categorized as high severity due to their long-term dire consequences, complex management, and reliance on expensive specialty medications.
• The "Center of Excellence" Model: Programs like Walmart's Center of Excellence, which direct patients to top-tier institutions like the Mayo Clinic for complex conditions, highlight the value of specialized care and demonstrate the prevalence of treatment plan variations.
• Fundamental Patient Needs: Patients primarily seek assistance with understanding their benefits, finding a suitable doctor, navigating the often-complicated healthcare system, and ultimately, achieving better health outcomes.

Examples/Case Studies:

• Spine Surgery Variation: In New York City, there are 2.5 spine surgeries per 1,000 Medicare patients, compared to 9 per 1,000 Medicare patients in the suburbs of Dallas, illustrating a 300% difference in treatment rates for similar pathologies.
• Walmart's Cancer Center of Excellence: Walmart's program sends plan members to the Mayo Clinic for second opinions on cancer. A striking 55% of these patients have their original treatment plan changed, demonstrating the significant lack of standardization in cancer treatment.
• Low Severity Clinical Examples: Upper respiratory tract infections, urinary tract infections, minor muscular sprains (ankle, shoulder, knee), hypertension, and high cholesterol are cited as conditions where convenience and timely access are paramount.
• High Severity Clinical Examples: Cancer, joint or spine surgery, diabetes (due to potential long-term blindness, dialysis, amputations), and autoimmune diseases (e.g., Crohn's disease, rheumatoid arthritis) requiring expensive specialty medications are presented as conditions demanding a highly selective approach to doctor choice.