Sunday, July 17, 2016

Patients Need to Do Their Research

Be like Barry...

Barry Kanick Showing His Research on Heart Surgeons

I make it a point to tell all of my patients to get a second opinion. I often wonder why we will visit 4 or 5 car dealerships when when looking for a new car, but we often take on face value the first recommendation we receive when looking for a new doctor?

Of course, there are some important differences.  It doesn't cost you anything to visit car dealerships, whereas it often costs a lot of money to visit various doctors, especially specialists.  Moreover, when you need a specialist, you often don't have the luxury of time.  Specifically, if you need heart surgery, you may not be in an "elective" situation --you may have to make a quick decision based on limited information.  Lastly, your health insurance may not give you many choices.

That last point is an important one.  Your insurance and/or your health network may govern your choices. For example, chances are today that your doctor is employed by a health network.  Recently, many of the best health networks are merging with each other, forming larger, hopefully even better health networks. Many will even offer their own insurance product. The big buzz word in health care today is "Accountable Care Organization" or ACO, which combines the efforts of many physicians and hospitals to share in the care and cost of caring for a population of patients.

Hopefully in the long run, all of these changes will be good for our community, especially if these larger health networks provide more "value" to their patient populations. Most large, high quality programs such as Lehigh Valley Health Network define value as providing higher quality health care at a lower cost.  Therefore, patients should do their research and make sure they are aligned with a health care organization that is focused on providing value for their family's health, not just services.

The problem is... we haven't gotten there yet.  What I mean is that despite a tremendous effort to improve health care by many stakeholders --doctors, hospitals, insurance companies, and the government-- the care we provide in the U.S. remains inconsistent.  Dr. David Nash, Dean of the School of Population Health at Thomas Jefferson University refers to this phenomenon as "unexplained clinical variation."  Simply put, for any given diagnosis or surgical procedure, different doctors or surgeons may approach the exact same problem in significantly different ways, often resulting in significantly different outcome.

So what can you do if you need to find a doctor?  First, when you sign up for your health insurance or align yourself with a hospital network, you need to read the policy carefully and determine what is allowed with regards to obtaining a second opinion or seeking a specialist out of the network.

In many instances, you may have more choices than you think.  No doubt, if you need a specialist, your physician will likely select someone who they trust within their network. And that's fine. We do the same thing at Lehigh Valley Health Network.  The fact is, at LVHN we have very high standards of excellence and a long history of quality outcomes, so it would only follow that our doctors would recommend the colleagues that they trust.

And yet, even if you are at a fine hospital, with trusted, experienced physicians, it is important to do your research and ask important questions.  Moreover, if you are at an institution that doesn't have the volume of experience or the latest technologies, or the recognition for quality that you desire for your family, all the more reason to seek a second opinion.

The Internet has become a great source of information.  There are many very good educational sites, such as Adam Pick's website: www.heart-valve-surgery.com or my own: www.heartlungdoc.com.  Also, you can find a lot of important information from state and national public report cards, such as the Pennsylvania Health Care Cost Containment Council (PHC4): www.phc4.org, or the Center for Medicare and Medicaid Services (CMS) website: www.medicare.gov/physiciancompare/search.html.

Of course, the Internet is not perfect and although you can acquire a ton of information, some may be misleading or incorrect.  That's why whenever possible you should try to get a second opinion in person. You should write down a list of questions for your doctor.  For example, if you are meeting a surgeon to discuss having an operation, some things you may wish to ask include:

1. How many years have you been doing this procedure?

2. How many of these procedures have you performed in the past two years?

3. What is your success rate?  Your complication rate?  Your mortality rate?

4. Will you be taking care of me after the surgery?

5. What are the alternatives to this surgery?

6. What are the long-term expectations?  For example, will I need another operation down the road?

Two final thoughts.  It's important to "ask around."  When you find out that you need a doctor, you will be surprised to learn how many of your friends already have experience or knowledge that may help guide your decision.  And, here's a little inside tip... in addition to asking friends who may have been patients, ask friends who are doctors and nurses.  Often the best advice will come from them.

Barry Kanick was one of the most informed patients that I have ever met.  The picture above was taken the day he was discharged from Lehigh Valley Hospital after his heart valve surgery. He gave me permission to post it on my website.  Barry first came to my attention after he emailed me from my website.  He had read Adam Pick's book and had scoured the Internet but requested to see me for a second opinion.  I called him on the phone after he emailed me and we talked for quite some time.  Then we met in my office and we continued to email each other back and forth.

To be honest, I don't think Barry decided to have me do his surgery because he necessarily thought my skills were any better than the fine surgeons on his list, but rather that I was the most responsive and transparent with my experience and results.  How a doctor communicates does matter, as does bedside manners and trust.  After literally months of research, Barry felt most comfortable with me.

His surgery went very well and he was ready for discharge to go home after only a few days.  He had little to no pain and was of course the ideal patient, very motivated to get better.  He was walking the halls on the first day!

He didn't bring out his "scorecard" on surgeons until the day he went home. I had not seen it before that day. I must admit, I almost fell over when I saw his chart.  The names on that list are among the most well known heart surgeons in the country.  I was truly honored to see my name on the same page as Dr. Joseph Bavaria, Dr. Marc Gillinov, and Dr. David Adams, to name a few.  No doubt, Barry would have done just as well if he had his surgery with any of these great colleagues.

In the end, Barry had narrowed his research to a very good short list of options. True, because his condition was stable, he had the luxury of taking his time in order to make the best decision for him.  But there still is an important lesson to learn.  That is, whenever there is a question about your health, please do as much research as you can before selecting a physician.  And, even if your insurance policy or health network governs your choices, it is still equally important to do your research and ask important questions.

Be like Barry...

2 comments:

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  2. Thanks for the nice words Dr Singer. ,,,,,,Arming myself with the right knowledge & networking with the right people from around the Country via Adam Pick's website(www.heartvalvesurgery.com) worked out just beautifully!!! ,,,His website is a wealth of resources for any patient going thru any Heart valve replacement procedure. ,,,,,,But the discovery of your expertise in combination with your Surgical Team's track record of experience & longevity is what ultimately gave me the total peace of mind to commit to having the Surgery done right here in Pennsylvania at LVHN. ,,,,,,,And the Level of Care was just excellent!!!,,,,,,,,Barry Kanick

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