What Do You Look For in a Doctor's Doctor?

As a med student, I was introduced to the concept of a "doctor's doctor." At the time, the phrase referred to a pathologist, someone to whom other physicians turned to when they themselves needed medical answers. The notion resonated enough to have me considering path as a specialty for myself.

I guess it is not all that surprising that I wound up as a radiologist, another specialist referenced as a doc's doc in subsequent years. It often lets me be the answer man, if not with specific diagnoses, then at least with actionable guidance for referrers.

Sometimes, of course, I'm also a doc seeking another doc. This may stem from consultations in the course of my work, administrative stuff pertaining to my job and, yes, when I'm a patient myself.

Fortunately, that last one hasn't had to happen too much. I'm a healthy cuss. While I can take credit for some of that due to my lifestyle choices, much of it is luck. Still, one doesn't want to wait for injury or illness before looking around for trustworthy primary (and preventive) care.

That is particularly an issue for docs like me. I wish I could just shrug, pick a name out of a directory, and tell myself that I could switch if whomever I chose turned out to be a dud. Chalk it up to my insider experience of the health-care system for the past few decades. Call me a worrywart or nitpicker but I'm extremely averse to getting involved with Dr. Piginapoke. Plus, there's the matter of wanting to spend as little time as possible rather than enduring a series of "intake" appointments until I happen to hit paydirt.

My search has been repeated a few times. For instance, when changing jobs, I have to find someone local who's in whatever network my new employer uses and is currently accepting new patients. When I've been an independent contractor, I had to figure out what insurers wanted to be bothered with a lone wolf like me (and not gouge for a small fortune in the process). It got even more complicated during years when the federal government kept changing the rules regarding what health care I should be allowed to get.

All these considerations aside, it's very much been on my mind that my doc and I need to be on the same health care/philosophical page. I'm far from unique in this regard, but I've been surprised how little I hear other people talk about it.

Readers who've attended med school or similar may remember learning what I'm talking about here. Doctor-patient relationship models have been described in various ways (paternalistic, informative, interpretive, and deliberative to name a few). The upshot is that not everybody's style and expectations will harmoniously mesh.

An old-fashioned patient, for instance, might expect to have the physician size up his or her situation, and wisely proclaim what is to be done. If the doc instead spews a bunch of data so the patient can make up his or her own mind or takes a touchy-feely approach of "let's figure this out together," the patient might doubt the doc's confidence and capability, or even get annoyed at what seems like game playing.

Meanwhile, a more modern and assertive patient who has already consulted Dr. Google and knows exactly what he or she wants might hate the wise/decisive doc mentioned above. This could especially be the case if said doc blithely waves aside the patient's notions about the proper course of action. The "let's figure this out together" doc could achieve far greater patient satisfaction here.

Being an experienced physician myself, I'm liable to seem more like patient #2. Hopefully I wouldn’t be quite that demanding. I am of course seeing another doctor to get a perspective beyond my own, so the last thing I'd want is to ignore his or her advice.

However, I do have definite ideas about how I want my health care managed. I'm much more about quality of life than quantity. I'm not the sort of person who wants a lot of diagnostic testing done "just in case." I took it very much to heart when I learned as a medical student that 80 percent of diagnoses came from clinical history. If I don't have any issues to report, I have little motivation to go looking for trouble.

So, going back to the notion of randomly picking a doc's name out of a directory, it's entirely possible that whomever I chose would be fine with my approach. On the other hand, physicians are somewhat notorious for being bad patients, and I can easily imagine one seeing a fellow doc coming in the door and thinking uh-oh.

Maybe the doc doesn't give a darn if I turn out to be selectively noncompliant. But maybe it annoys him a little that I seem to think I know better than him or the guidelines set forth by the primary care industry. Maybe he or she doesn't like the medicolegal liability of having to document every single time I choose to do my own thing. Perhaps the doc imagines a lawyer for my estate turning up someday, claiming that he or she didn't do enough to convince me.

I would just as soon ensure that none of this will be an issue before we waste a single moment of each other's time. Unfortunately, there's no medical version of eHarmony out there that matches up docs and patients for sympatico health care. The only way I can think of to do that is show up to a primary care appointment and lay my cards on the table, hoping that the doc will seriously think about it and give an answer that's honest and fair to both of us.

I did try another approach, sending a few emails or phoning offices in the hope of not having to actually make an appointment. To date, I've gotten zero responses. I chalk that up more to disorganized offices than unprofessional snubbing.

Maybe it's inconceivable to the clinicians. Most of them don't reach out to us and ask if we'd mind reading the studies they refer in a certain way, and offer to find other rads if we say we'd rather not. They just assume we will do it. Of course, if we don't do it that way, we will hear from them (requests for addenda and the like).