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how to learn about tiers of medical care?
Old 04-17-2011, 09:12 PM   #1
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how to learn about tiers of medical care?

How do you go about finding the top tier medical specialists for a given surgical procedure? For example, some types of conditions are common enough that they are routine and can be handled by many doctors in any given locale. But others are not so common, and there are a few specialists who seem to be the ones who write papers about it, speak at conferences, etc. These people are usually attached to large teaching hospitals in bi-coastal areas, but often have their own practices too.

I'm guessing, the doctors with the best results, and best ability to deal with any unexpected complications, are most often the ones who do a particular procedure the most often. But for a fairly unusual condition, how do you locate not just someone who can do it, but someone who has made a career out of doing it?

I hope this request makes some sense. Thanks for any inputs!
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Old 04-17-2011, 09:56 PM   #2
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If the procedure you are seeking is or was cutting edge, I would go to PubMed PubMed home or Google Scholar and type in the name of the procedure. Then read some or all of the abstracts that turn up, looking for the authors with the most publications, particularly those describing large studies, especially double blind randomized controlled trials. Often the most senior surgeon will not be the first author, because that honour often goes to the person who works really hard on the research study and writes the first draft of the paper. When a center is publishing many papers on a related procedure, the author whose name appears in all papers, later in the list, is often the senior author. If you have access to a university library (often your health centre or hospital will have access for the public) you will be able to download the PDF of the paper, which will tell you the study centre (or coordinating centre in the case of multicentre trials). Armed with this information, you go to that centre's website and search for the type of surgery and the senior author's name.

Sounds complicated. But that's how to do it.
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Old 04-17-2011, 09:58 PM   #3
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It's procedure-dependent in many cases. Experience counts a lot, but sometimes too many cases suggests a high volume "mill" kind of practice. I have no specific recommendations but if you wish to share the procedure in question by private message, I can see if I can get more specific.
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Old 04-17-2011, 10:05 PM   #4
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Once again, Rich_in_Tampa takes the pragmatic route, while I take the academic one!
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Old 04-17-2011, 11:13 PM   #5
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Once again, Rich_in_Tampa takes the pragmatic route, while I take the academic one!


Your approach is undoubtedly more robust. But sometimes it's easy to forget how unapproachable the medical literature is for non-physicians.

Funny thing is, I was in academic practice virtually my whole career. Still don't know how to identify a good surgeon besides asking around over coffee in the doctors' lounge.
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Old 04-18-2011, 12:24 AM   #6
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Originally Posted by Rich_in_Tampa View Post


Funny thing is, I was in academic practice virtually my whole career. Still don't know how to identify a good surgeon besides asking around over coffee in the doctors' lounge.
Word of mouth remains very accurate (judged by your peers) - however, this information is unlikely to be accessible to J6P. It might be easier to find the medical centre/hospital that specializes in a specific surgical procedure. There is more to the surgery than just the surgeon - if it is a cutting edge procedure, the whole team would be as important as the surgeon, if not more. Your primary care doctor should do most of the hard work here.
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Old 04-18-2011, 12:57 AM   #7
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I worked in blood banks from time to time, in large tertiary care hospitals. A blood bank was a good place to get a line on surgical results and reputations. Not as good as being an OR nurse, or in the recovery room or ICU, but not useless either.

I formed the opinion that the best paper writers were not always or perhaps even frequently the best surgeons. There's cutters and thinkers, each useful in his or her own sphere. The docs would come by sometimes, late at night when a huge trauma load came in to give a heads up about what to expect. You also got a feeling for how calm they were.

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Old 04-18-2011, 11:25 AM   #8
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Thanks all for the input, I think I've come to realize that there is no "one way" to find information on the top medical specialists in a given field. Yes, there is Newsweek's "top docs" resource list and similar things. Searching pubmed for authors of papers about the condition is a good idea. Calling a university associated hospital and asking them who specializes in this field is good too!

Thanks Rich, and everyone else!
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Old 04-18-2011, 12:58 PM   #9
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Your approach is undoubtedly more robust. But sometimes it's easy to forget how unapproachable the medical literature is for non-physicians.

Funny thing is, I was in academic practice virtually my whole career. Still don't know how to identify a good surgeon besides asking around over coffee in the doctors' lounge.
I once bemoaned to a couple of MDs I worked with about this - how could I find out about who was good in their field.....and when I worked with them I finally said that if anything happened to me they better take care of me cuz I was always taking care of their needs (buying their 'toys' for their practices). Now, I'm in the same place as everyone else - hope that who you end up having as your clinician is good...
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Old 04-18-2011, 01:25 PM   #10
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I used to be married to a hospital nurse. What I found out then was that everyone knew who the drunken and incompetent docs were, but the docs wouldn't badmouth their own. The nurses were less restrained in sharing.
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Old 04-18-2011, 02:18 PM   #11
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Trying to evaluate the scholarly literature directly sounds too hard, to me. The doctor grapevine and the nurse grapevine have been mentioned, and of those, if you can hook into it, I'd guess the nurse grapevine would work better. Nurses are sometimes quite willing to make critical comments about doctors (perhaps they don't much like them). But don't leave out the patient grapevine. These days you can do that by finding an online forum and search its archives or just post a question. Patients can be pretty sophisticated -- occasionally you'll find ones who are doctors or researchers themselves, and lots of nurses seem to post, too.

Oh, and don't forget the regular mechanism for finding appropriate institutions and specialists: ask your own doctors for referrals.
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Old 04-18-2011, 04:55 PM   #12
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You can also try the US News "Best Hospitals" issue, and then check their home pages for staff in your intended specialty.
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Old 04-19-2011, 02:57 PM   #13
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I used to be married to a hospital nurse. What I found out then was that everyone knew who the drunken and incompetent docs were, but the docs wouldn't badmouth their own. The nurses were less restrained in sharing.
We don't badmouth the nurses either.

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Old 04-19-2011, 03:03 PM   #14
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An easy way to know if your Doctor is any good is check out his waiting room . If it's empty and you can always get a quick appointment maybe ask around . If he doesn't have a receptonist run like h--l !
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Old 04-19-2011, 03:49 PM   #15
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We don't badmouth the nurses either.

How does the medical board find out who is incompetent?
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Old 04-19-2011, 03:53 PM   #16
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How does the medical board find out who is incompetent?
Investigation of unexpected patient deaths, patient complaints, peer review processes, audits.......etc.
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Old 04-19-2011, 04:34 PM   #17
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I really did NOT expect to die from that procedure. Note to self: draft strongly worded letter.
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