Dr Pamela Prince Pyle

How to Find a Good Doctor

In a recent post called, Living on Borrowed Time, and in a Zoom recording I posted to my Youtube Channel, we met Jim. Jim was given a terminal diagnosis over five years ago. He is living past his expiration date and is using this time teaching others how to have hope when facing death. I highly recommend watching the video to see a man facing death with gentle courage and confident faith. He knows how to have a good death based upon the confidence of his destination. 

But his healthcare journey began like many who are given a serious or terminal diagnosis. He heard the words but did not receive comfort, hope, knowledge, or wisdom. Without guidance from a trusted clinician, he was forced to seek knowledge from Dr. Google which can be terrifying for any diagnosis without context, especially one for which there is no cure. 

At the time of this writing, there are 18,700,000 results for his diagnosis. That could be paralyzing! In an upcoming post, I will share how to qualify your sources for information. Jim quickly discovered that his diagnosis was serious and had a fatal prognosis. 

He began what would become, his long goodbye. 

The Good Doctor

Jim is like so many of us. We are working hard, perhaps raising a family, growing older, trying to keep up. We don’t think about a doctor except for those urgent care visits for the miscellaneous. But our failure to seek a primary care clinician leaves us in a terrible position. 

We discover we have missed out on health screening, wellness care, and access to a doctor whom we know when we need it most. Having a primary care physician prevents a stranger telling us we have a serious diagnosis when time running out on the allotted appointment is more important than our time on life running out. 

What are the qualities of a good doctor and how do we find them?

From 1969-1976, Marcus Welby M. D. was one of television’s most popular shows. Marcus Welby was often called “the good doctor” because he made house calls, oozed wisdom and had a caring bedside manner. 

Since then, television has depicted a host of other smart, compassionate doctors. There is even a series currently running called The Good Doctor. Most of these TV physicians are amazing. They can save lives even while flirting across the surgical table. 

Some are known for their unique ability to make an accurate “Zebra Diagnosis.” That medical term refers to situations where run-of-the-mill diagnoses abound (picture a big herd of common horses), but then a gifted doc shows up and offers an exotic, but accurate, “zebra” diagnosis that no one had considered previously. This especially savvy doctor identifies the problem right away, prescribes the best treatment and saves the patient. 

Good doctors like Marcus Welby might seem rare (in fact, like zebras themselves), but the reality is that they are out there. (I know this from many years of medical practice, and from being a patient myself.) So why do so many patients have trouble finding them? 

In this post and the next, I want to talk about how to find a good doctor; your own personal Dr. Welby, MD. How can you spot a zebra among all the horses? This is important to begin this process as early as possible to evaluate candidates and develop trust. 

What to Look for in a Good Doctor

Let’s begin with the qualities and traits to look for in a clinician. Beauchamp and Childress list four ethical standards as non-negotiable for doctors:

  • Beneficence – acting for the patient’s good
  • Non-maleficence – doing no harm
  • Autonomy – giving each patient a right to voice his or her own values and make his or her own choices about medical care
  • Justice – distributing healthcare resources equitably and treating patients fairly

Let’s expand upon these standards from a patient’s perspective:

  • Is a prospective doctor trustworthy? Above all, you must have confidence in your physician. You must believe that he or she will always act in your best interests. Trust is something that is earned, generally over time. It is not abstract, and it is deeply personal and visceral. You need to trust that your physician knows when to refer. You need to trust that he or she will send you to doctors they believe in. You need to trust that your clinician will not simply tell you what you want to hear or give you what you want to receive. If trust is present, you will have a satisfactory doctor-patient relationship. 
  • Is a prospective doctor competent? All physicians, upon completion of training, take the Hippocratic Oath, which includes the statement next to non-maleficence, the concept of “doing no harm.” This ancient pledge has many statements that reflect the qualities of a good, if not great, physician. 

Some more specific questions that can help you get a sense of a physician’s competency are:

  • Is he or she Board Certified? Check out the website www.certificationmatters.org. Due to the changing dynamics and cycles of how certifications are reported, it is also wise to check with your state’s medical board.
  • Is a prospective doctor in good standing with his or her medical board? This information is readily available through each state’s licensing board. 
  • What do other patients say about the clinician? Websites such as www.healthgrades.com allow patients to post reviews about clinicians. This information is valuable if there is a strong trend for or against a clinician’s competency. 
  • Do trusted friends and neighbors regard this doctor as competent?
  • Does a prospective doctor respect the autonomy of his or her patients? Will he or she take the time to listen to you? Does the clinician interrupt you and dismiss your concerns, opinions or objections? Do they explain obscure medical terms? Do they do an adequate physical exam or rush through it? Are you given time to think through your options?

In the search for a zebra (i.e., “a good doctor”), we have looked at some essential ethics. Is he or she trustworthy, competent, a respecter of patient autonomy, and an advocate of health care justice?

 While that is a great list, a few other factors also make for a satisfying doctor-patient relationship:

  • Quality Time – Quality time is a subjective measure of a doctor-patient visit. Considerations for these measurements include:
    • Were they informed about your condition?
    • Did they listen to your symptoms and concerns?
    • Did they complete a physical exam?
    • Did they review your labs and medicines with you?
    • Did you leave knowing your questions were answered and you understood the plan of care?
    • Did you feel rushed? 
  • Participatory decision-making style – While this falls somewhat under the category of autonomy mentioned above, the point here is that a good doctor facilitates engaging healthcare conversations, invites questions and presents options so that patients always have their voice respected and able to make informed decisions. 
  • Empathy – Two aspects of empathy allow for optimal doctor-patient relationships. The first is “cognitive” empathy, or the ability of a physician to correctly identify a patient’s emotions and reflect those emotions back when discussing aspects of care. The second is “affective” empathy, which is the ability of a doctor to truly feel the emotions a patient is feeling. While cognitive empathy should be a minimal standard of good patient care and genuine affective empathy should be on display in crucial conversations, both can sometimes be absent in the clinical world. Why?

I saw a movie years ago that helped shape the way I practice medicine. The Doctor (1991), starring William Hurt, was loosely based on the book A Taste of My Own Medicine: When the Doctor is the Patient by Dr. Edward E. Rosenbaum. 

The movie tells the story of Jack McKee, a gifted, successful, self-absorbed surgeon who is diagnosed with cancer. Suddenly the doctor’s eyes are opened to the nuances of suffering that a patient goes through while receiving treatment. Jack befriends a fellow cancer patient, June, and watches her slow march to death. Will he be next? 

His experience causes him to see that personal empathy is every bit as important as medical brilliance. The movie ends with – spoiler alert – the doctor surviving and creating an experience in which students and residents become temporary patients to effectively learn the value of empathy. 

I am grateful to have watched that movie when I did. It gave me a perspective that I deeply needed but did not receive in medical school. I am glad to report that since the release of that movie there have been slow, steady improvements in empathy training.

Most physicians do not begin their medical training with a lack of empathy. However, due to physician “burnout,” time constraints, and even necessary self-preservation (imagine trying to feel and carry the health burdens and deep emotions of dozens of patients daily), empathy can ebb and flow. In your search for a good doctor, if a prospective physician has a bad day, that is one thing. If he or she displays a disturbing lack of empathy, especially over consecutive visits, then perhaps seeking another physician is in your best interests. Dealing with a serious diagnosis, or the clinical depression that can stem from a chronic disease, is hard enough without also being under the care of a dispassionate clinician. 

  • Communication style – Studies reveal that brief conversations between doctors and patients about non-medical topics improve a patient’s perception of the visit. Your clinician may initiate this type of communication or you, as the patient, can do so. “Hi, Dr. Ryan, how are things? How’s your family? How were your holidays?” can make for a better relationship. 
  • The “It” factor – Dr. L is my doctor, and she is special. However, on any given day I know that I will wait one to two hours to see her. In fact, those of us who are patients in that waiting room come prepared to be there awhile. This is not because of poor scheduling or Dr. L’s indifference to her patient’s time. In fact, quite the opposite. It is because of the way that she cares. 

Sometimes, I will have a normal visit that lasts a normal amount of time. Other times, I have more concerns or more questions. Rather than attempting to rush me out of the room with short, quick answers, Dr. L answers all my questions and asks some of her own. She does this for all her patients, and we know that. 

I step into the waiting room and are greeted by her kind office staff. I look around the room of waiting patients (as in “calmly accepting the delay”) and smile. Simple blue chairs like you might see at a banquet hall line the exterior walls. They are interspersed with tables overflowing with old magazines. 

I see the book reader, the social media poster, the thinker, and the worker clacking away on an old laptop. We each know that Dr. L is not just a zebra, she also has the “It” factor. This is why we wait patiently. We know if she is late, it is because she is delivering the best possible care to someone who may need a little more time on that given day, as she has done for each of us on various occasions.

 “It’s okay,” I tell the newbie who repeatedly pulls the glass back to remind the receptionist of his appointment time (as if she didn’t know). “Dr. L is worth the wait. Here’s a magazine.”

There comes a time when we need to hear from the doctor with the “It” factor. They deliver hard truths with genuine empathy. Often such doctors work in specialties such as oncology, hospitalist care, critical care, palliative care or hospice care. Many have had personal experience with suffering and dying, and they understand chaos and fear can accompany a serious diagnosis.  

One final note on this subject of finding a primary care physician. If you cannot seem to find a good doctor in your community, all is not lost. The use of mid-level clinicians (i.e., physician assistants and nurse practitioners) has increased in recent years, and many of these healthcare providers are extremely knowledgeable, well rounded and empathetic. 

Earlier, I described your primary care physician as the quarterback of your healthcare team. Those with a significant illness that is organ specific or disease process specific will want to have a specialist as a secondary care physician. This allows for a second opinion to be built into a patient’s ongoing cadence of care. 

Depending on the kind of specialist that a patient needs to see and for what reason, there may be other considerations. For example, a patient in need of surgery may opt for the area surgeon with the most experience rather than the one with the best bedside manner. Those facing an extended hospital stay may choose the hospital with the best-reviewed hospitalists. The best and most comprehensive comparisons between clinicians and clinical facilities can be found at www.medicare.gov. As with picking a primary care physician, use multiple sources to help you seek specialist care. Rely on the recommendations of doctors you trust (starting with your own primary care doctor), and do not discount your own intuition. 

How to Have Hope When Facing Death

Jim began searching for good doctors. However, his first stop was Dr. Google. In the next post I will discuss when to consult the internet for information, how to qualify the websites to search, and sources for finding zebras.

There are many sources for hope when facing death. It may seem strange to discuss facing death when I am writing about finding good doctors. The truth is we are each facing death, we just don’t know it. Any of us may be one moment away from a traumatic accident, a call that delivers bad news from our test results, or like Jim his moments are lived on borrowed time. 

Jim’s source of hope is his Christian faith. But in the beginning, he hoped to find a good doctor. Searching and finding your trusted clinician now will change this hope to reality. Then you can begin to hope for something more and my prayer for you is that you find hope through faith. 

“May the God of hope fill you with all joy and peace as you trust in him, 

so that you may overflow with hope by the power of the Holy Spirit.”

Romans 15:13

One Response

  1. Thank you for your sage advice. Do you know a Primary Care Doctor you might recommend in the Spartanburg/Greenville area. I have been trying to find a doctor and am a bit overwhelmed and surprised how difficult it is to get an appointment. Any insight would be helpful. Thank you

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