The search for the right doctor

[rayinpenn]

These old knees were killing me so I went to my GPs recommendation suggestions
Lose weight, limit walking and shots for my knees; the shots are a kind of lubricant.

The shots
I arrive at his office and am shown into one of the many exam rooms. The nurse walks in with two needles, two band aids and two cotton swabs. The doctor walks in and sprays my knees with a freezing solution... Bam under 4 minutes we are done. He billed like $500 for the procedure. I needed 3 doses about 10 days apart. The final dose was given by the PA as the doctor was busy. Doctors words of unsolicited wisdom "you know Ray it's just some plastic and metal.." A guy with bum knees doesn't need to hear that.

Sadly it didn't work then we leaned the doctor billed me an extra $400. It took my wife a month and half to get the money back. My plan has been to lose weight I've shed more then 15lbs and I'd like to lose another 15 then find a surgeon.

The question is how do you find the right doctor- I'm not impressed with my current billing machine.


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[ERD50]

Why do you assume those charges were unreasonable? Unfortunately, it does not seem to be easy to get comparative pricing for medical procedures.

You got your money back? I didn't know doctors were expected to guarantee results for something like this (though my Dentist does guarantee his crown work - I was having a little trouble adjusting to it, and he offered to re-do it, no-charge, but I gave it time and it settled down)? Or was this a double-billing error?

Maybe surgery isn't the right move for you? Does that come with a guarantee?

I didn't understand your 'plastic and metal' comment?

-ERD50

 

[rayinpenn]

The comment was made by the doctor ...about replacement knees
The money back was for the overcharge...
$500 for 5 minutes work...yeah I'd say it s a bit much...

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[MRG]

Ray I just paid out 10k for 2 ten minute epidurals. We'll my insurance did, my 1k deductible is done.

Don't go by price, it's about quality of care.

 

[rayinpenn]

Really money isn't the driving factor.... More how do you find a good doctor?
I only have one set of knees...


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[robertf57]

The comment was made by the doctor ...about replacement knees
The money back was for the overcharge...
$500 for 5 minutes work...yeah I'd say it s a bit much...

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I am assuming the medication injected was included and it must be expensive.... I don't know what you received but $500 just to inject a knee seem really pricey

 

[David1961]

Back to the OP's question. When I look for a new doctor, I tell family and friends what kind of specialist I am looking for and ask if they (or anyone they know) recommend anyone. I have had success with this - sometimes I was referred by friends of friends.
The few times I picked a doctor on my own, I was not very pleased. There are web sites now where patients can rate their doctor, but I don't have any experience with using these reviews to find a doctor.

 

[Meadbh]

Back to the OP's question. When I look for a new doctor, I tell family and friends what kind of specialist I am looking for and ask if they (or anyone they know) recommend anyone. I have had success with this - sometimes I was referred by friends of friends.
The few times I picked a doctor on my own, I was not very pleased. There are web sites now where patients can rate their doctor, but I don't have any experience with using these reviews to find a doctor.

In my experience, the reviews on doctor rating websites (assuming they are genuine) focus mainly on "customer service" aspects, such as office delays, rude receptionists and poor communication. These are all important aspects of the patient experience. However, as an ex doctor, I have looked up reviews of physicians that I know to be exceptionally skilled healers and some that are diagnostic doofuses, and I don't see any correlation between the patient reviews and the outcomes of care. Just saying.

 

[Dash man]

The best doctors I've found are the ones who take the time to listen to you for a few minutes and talk with you as a person. It's basically trial and error by making appointments with them, hopefully by learning of them by referral from a trusted friend or relative. It took me two years to find a pain management doctor that I am comfortable with. My PCP fortunately has been very good at suggesting other specialists as I need them.

 

[Likes_to_Lurk]

Like David1961, I ask friends and family first. I have also have some success using the Employee Assistance Program at w*rk to get a referral. They will verify credentials and check on insurance. I found my ophthalmologist this way and he is excellent. You can also get some referrals from local hospitals.

Do you want to consider an orthopedist? If so, you can ask your GP for a recommendation.

It can be hard to find a good doctor with a decent staff and accurate billing. Good luck.

 

[ERhoosier]

In my experience, the reviews on doctor rating websites (assuming they are genuine) focus mainly on "customer service" aspects, such as office delays, rude receptionists and poor communication. These are all important aspects of the patient experience. However, as an ex doctor, I have looked up reviews of physicians that I know to be exceptionally skilled healers and some that are diagnostic doofuses, and I don't see any correlation between the patient reviews and the outcomes of care.....

Well said!

Nicest bedside manner means NOTHING if the medical/surgical care is poor.

And with most US docs now being employees (vs private practitioners), they no longer control those rude receptionists, office delays, etc.

 

[Live And Learn]

Ask your friends and family if they know any surgical nurses. A neighbor is a surgical nurse and his recommendations all turned out to be very positive experiences.

 

[Meadbh]

Ask your friends and family if they know any surgical nurses. A neighbor is a surgical nurse and his recommendations all turned out to be very positive experiences.

That's fine if you are looking for a surgeon. What if you are looking for a different type of doctor? E.g. Dermatologist, psychiatrist, pediatrician.......

 

[Walt34]

$500 for 5 minutes work...yeah I'd say it s a bit much...

Understanding that I know zilch about medical treatments but... How long does it take the doctor to learn how to do that? How much did the drug company spend to develop and test that drug, to get it certified as safe and effective? How much of it do they have to sell to break even on the development of it?

I'm grateful for physicians and the medical care we have. I'm named after an uncle who died at the age of 3 from an infection from a scraped knee. Penicillin had not yet been invented and I'd wager a shot or two would have fixed him right up. I'm sure my grandparents would have paid the $500 (or equivalent then) for a shot of it. Kinda changes the equation, doesn't it?

Had your shot worked thus avoiding even contemplation of surgery would it have been worth $500 then?

Just some thoughts...

 

[Bamaman]

You'll have to often excuse the bedside manners of orthopedic physicians. They're a little more blunt than most physicians--not hand holders.

My daughter's had all the left knee surgeries that are possible, and she continued to hurt. That greasy shot you're talking about is all that's helped her.

When your knee gets to the point where you're completely miserable from the pain, it's then time to see an orthopedic surgeon that specializes in lower leg injuries. Many ortho groups have specialty doctors that excel in different surgeries. My orthopedic surgeon specialized in knees and shoulders. Others do backs. Others do hips.

We try to use the best internal medicine physicians. They're pals with the best surgeons and specialists locally, and we can usually get in promptly to see the surgeons.

Remember, the good doctors and the great doctors cost you the same amount of co-pays and/or deductibles since you're insured.

 

[Badger]

I've had mixed success with knee surgery - 1 good and 2 poor. Years later one knee received cortisone injection and it helped. 1 1/2 years later the pain is getting too much again but then I've lost too much cartilage on the medial side and the bones are grinding a little. So I'll try the cortisone again unless the Hyaluronic series is recommended. That is probably what you received. Once those treatments lose their effectiveness I'm hoping that maybe stem cell growth of my cartilage will be possible instead of a knee replacement.

Some of your cost may have been the addition of special imaging to guide the needle to the exact correct spot for the injection. The $500 bill seems cheap to me. I would gladly pay twice that for pain relief. I wish they had something for my fused back instead of hydrocodone and its family. It's been over 5 years of chronic pain with no relief in sight and medical MJ is not available where I live.

 

[AllDone]

Get your GP to refer you to physical therapy for your knees, then ask the therapist for recommendations. As a retired doctor, I second what MeadBh says. Particularly with surgeons, bedside manner isn't that important. Orthopods tend to be athletes and a little impatient with those of us of the schlumpier persuasion. If my joint problem were a knee, I'd have that sucker replaced in a redhot minute. It's just a simple hinge and the replacements work well.

The last time I had a guy spend ten minutes cleaning out a drain at my house, he charged me $200 and did the job with one hand while chatting to his girlfriend with the telephone in his other hand. $500 for medical school, a billing service, office help, office overhead, injectable medication, sterile supplies, malpractice insurance and knowing what the heck to do if you vasovagal doesn't sound bad.

 

[braumeister]

I only have one set of knees...

FWIW, I have a friend who is on her third pair of knees. She has also had five hips. Modern medicine is truly amazing.

 

[Brat]

DH had both knees replaced about 10 years ago. He selected an ortho who had replaced thousands of knee joints, used replacements that had been in service over 5 years, and who got a thumbs up from the local PT clinic.

IMHO the best way to vet a ortho surgeon is to ask health care professionals to have cared for their patients long after the surgery.

 

[Katsmeow]

Finding a doctor is difficult, I think. Saying to ask friends or family is good if those sources are available.

I've lived in the Houston area for over 30 years. And, for a long time I had a good list of physicians. I had a family practice doctor I was happy with and he could usually refer me to a specialist (I would always check out the specialist). Also, through my work I knew a number of physicians and could sometimes get referrals from them.

But, 3 years ago we moved to Montgomery County. This is still in the Houston area but isn't close to where we used to live. It has been a struggle to find physicians (I still haven't found a new primary care physician). We don't have any family in the entire Houston area (except our own kids). So, nothing through that.

We don't have a lot of friends in the area we live in now. The friends we had before we moved here don't know physicians in this area.

Places we have gotten names from: When my daughter had to go to the ER for a problem, they gave the name of gastroenterologist to follow up with. We looked him up and he had good qualifications. I researched him and didn't find anything negative.

I do look up online reviews of physicians and take that into consideration. I do understand that people reviewing may well not really know if a physician is truly competent or not. And, I know that bedside manner isn't everything. But, there are reviews I've read that are sufficiently compelling to cause me to not want to see that physician (one bad review won't do it; I look at everything as a whole).

The review sites sometimes do a nice job of collecting information. I can look up and see where the physician went to school, background and experience, where he/she did residency and fellowship. I can see if the physician has had disciplinary action. I also Google the physician. There was one that I had actually been referred to in this area by my old primary care physician. After I did an internet search on the recommended physician I crossed him off my list.

I know that none of this is foolproof. In fact, even a recommendation from a friend isn't everything. Your friend may not know if the doctor is truly good either. That is, your friend isn't much different from the people on the review sites.

What I've ended up doing the most is that when I've found a physician that I like and who has done a good job for us (such as the one who did my husband's rotator cuff surgery last year), I think ask that physician for referrals to the others that I need. I recognize that this isn't foolproof either but it gives me a name to research in any event.

 

[Brat]

One option would be to call a highly regarded hospital in your area and ask where you can find a list of physicians (particularly when you are looking for a surgeon) admitted to practice at that hospital. There is data on hospital acquired infections and surgical outcomes by hospital on the internet so I would make my hospital list from that. Then I would see if any of those folks are in a practice concentrated on your health care need.

In our area there are groups of orthopedic surgeons, heart surgeons.. etc.

 

[imoldernu]

No medical recommendations here, but over the years, DW and I have faced the same kinds of challenges of finding the "right" fix for whatever the problem may be.

Our first step is to spend as much time as necessary to find out everything we can on-line... not just one or two websites. To learn the terms... the medical terms... so we can read and talk intelligently about the problem. Smetimes this takes many hours, but our time is cheaper than the doctor's fees. Usually this means we end up having the most up to date info on the medical issue involved. In the case of GP's, at least we are prepared to ask the right questions.

A simple search for "alternatives to knee surgery" brings up many sites, including some that may be cutting edge, such as stem cell therapy. A good fried just avoided replacement with a relatively new flexible arthroscopic insertion of a nylon type chip on the wearing surfaces. There are also many new "fixes" such as drilling for increased blood flow, using a type of "glue" to seal in healthy growing cartilidge inserts, electronic stimulation of growth cells etc...

For whatever problem, going in "prepared" is our approach to finding the right doctor.

 

[AllDone]

Rayinpenn -- You have done physical therapy, right? Knees are simple hinge joints and they usually respond pretty well to stretching and strengthening exercises. It's certainly worth a try. If you combine exercise with weight loss, you might be able to delay surgical intervention. I'm hoping for cartilage rebuilding stem cells, myself, since they look promising.

 

[lizh]

The ketogenic diet completely cured my husband's painful knees. It is certainly worth a try!

 

[John Galt III]

A surgical nurse lives right next door to me, but we don't get along, so I won't be asking her what surgeon is good. Plus the surgery I am contemplating is too embarrassing for me to mention to anyone. So I am left looking at websites that evaluate the various surgeons in my area. Some of the reviews are pretty bad (outcomes, not front desk rudeness). The surgeon with the best review is 75 years old. DO I trust his eyesight? His memory?

I asked my GP for a referral and he just referred me to the hospital he works for. I should have asked him what surgeon he would go to, if he needed this particular operation.

I'd like to go to a surgeon who does this operation all the time, like 200 a year or so. Haven't found that info yet. Probably are "centers" that perform this surgery over and over. Still looking.

My gf had to have a shoulder joint replaced due to an injury. A friend recommended Dr. X. But Dr. X wasn't available soon enough, so he recommended his associate, Dr. Y. We talked to Dr. Y, asked him how many shoulder replacements he'd done. He said a few. I asked 5, 10, 20? He just said "a few" again. I guess the thought is that certain operations, like joint replacements are trivial, like getting an oil change. Once you've done one, you're an expert. To his credit, he sensed our lack of confidence in him, and suggested we go to a specific teaching hospital in a nearby city, where Dr. Z does hundreds of shoulder ops per year. We took that advice, and after checking out Dr Z online, had the op done there. It was a success, thankfully.

I think the surgeons know who is the best among them, for specific operations, and one needs to be able to get that "insider information" somehow.