So, I wanted to find House, MD (the king of diagnostic physicians on TV) in my local area. I research online to find out there is no Diagnostic Specialty. Although this seems ludicrous, I continue. My search leads me to find that most doctors believe they are diagnosticians. And they are, to some extent. Most doctors will take a history, declare that you have a cold or a bruise or a pain or worse and send you to a local specialist in the region/system of your body that is affected.
This redirection to specialists doesn’t speak to finding a doctor with diagnostic ability. Only that you are being directed to someone else whose credentials you don’t have. Shouldn’t each doctor have a diagnostic rating, if the medical system doesn’t include this as a specialty? How about a rating on a scale of 1 to 10 for level of diagnostic skill set? A peer-rated system would work well, alongside a customer rated system. Delving, deducing, concluding and having the ability to integrate and pull from vast knowledge in infection, degeneration, heredity, mental and environmental health require a special skill. So, why not have a separate specialization and definitive certification in Diagnostic Medicine? If we wait a few years, for political correctness, Internal Medicine will probably be called Diagnostic Medicine with no change in requirements.
THE DOCTOR IS IN THE PATIENT’S EMPLOY
On this search, we must start out by putting roles into perspective. WE, THE PATIENTS, are the employer, by hiring the doctor. Unfortunately, the demand for competence and diagnostic skill is higher than the supply. So, we forget our roles, for the most part, and consider ourselves lucky when the employee allows us to hire her/him. Bottom line: when we are in need of doctoring, our perspective changes and we lose focus.
Even though we usually forget, we, in the role of employer, can monitor, direct and impact the behavior of the doctor, in the role of employee, to some extent. True, each doctor delivers service in her/his own way and has the right to do so. But, we have the right to ask questions, extend our time of service if we need it, be satisfied that we have been well attended to and terminate employment of the doctor, if we are not satisfied. Hint: talk to the doctor, and don’t be shy. Doctors like to clarify.
In many cases, although doctors have taken an oath of service, they may feel the need to act pompous and ego-filled. This may be a result of their wanting to wear on their sleeve the blood, sweat, tears and coin they expended to complete medical school. It happens. It’s a natural occurrence when you learn a great deal that the pride and the skill can leak out arrogantly. It’s bad manners; it’s not always; it’s human and what’s a little insecurity among fellow humans who save lives? Bottom line, doctors, usually, do not think of themselves as YOUR employee or YOUR servant.
Because of caseloads, rising malpractice insurance costs, “allowable amount” cuts from insurance companies, increased sickness; doctors, typically, spend less time their patients because their roster has grown along with expense. Typical consumers do not pay for “exclusive” care. The concierge doctor set-up is a great option, resulting from an overstock of patients or from consumers’ dissatisfaction with five-minute-only appointments with doctors. Choosing to pay double or ten times the fee for the security of a 20-, 30- or 60-minute appointment is part of our free enterprise system. Long live it!
We are told to research internists, that they are the closest thing to a diagnostician. But should we have to become customers before we do our research or in order to do our research? Should we have to pay to interview our employee? Should we have to purchase a service we know nothing about? Shouldn’t we have open online access to a central, non-fee based doctor information system where we can find all the credentials on one page, or a spec sheet, like the MSDS, (materials safety data sheet) for manufacturing?
Let’s go back to my term “doctor.” I have been using this term to mean anyone who does doctoring. I am not using the words “anyone who practices medicine” because I don’t subscribe to the word “practice,” in this usage. I want someone who already has the knowledge, not someone who needs to practice to get the knowledge.
Yes, we learn by experience, but doctors must be doing, not practicing, if I have the choice. I’m the first one to say that you can receive guru care from someone with less or different training from the doctor who got the best grades or went to the best medical school. The truth is that training dearly impacts the student, which means that someone with less formal education but passion and a brilliant teacher, can result in becoming a better-skilled doctor than the straight A-student with no passion who memorizes, so long as exams are passed and a skill test is administered.
So why are these credentials left to our research and not listed, as a general rule? Is it because, at any time, a patient can complain, and a doctor would rather have no credentials or reviews, than deal with negative reviews?
We should have full access to the primary medical school and board certification expiration date of all doctors who hang a physical or internet shingle. Strangely, these data are NOT commonly offered. Is it fear of judgment? Or is it to create a demand for this information so that service associations, often owned by doctors, can charge for the gathering of the most up-to-date information?
Should doctor information be mandatory, like nutritional labels? And, what about the diagnostic rating system? I believe in disclosing ingredients as I believe in disclosing who is a great diagnostician and what method of measurement was used to decide.
A free site I have used for researching hospitals and doctors is www.healthgrades.com. Whichever service you use, you want to make sure that the doctor you are checking is not able to pay for nice, positive comments to be placed in the comment section.
Finding a diagnostician is not easy. We have briefly touched upon the concepts of credentials, ratings, med schools, research. These issues are prerequisites to the search. It is not enough to place a suffix after your name without credentialing your suffix. If that, we could all emulate Frank AbagnaIe, Jr., who impersonated a doctor (whose life was played by Leo DiCaprio in Catch Me If You Can).
In the next article, we will look at common traits of a diagnostician and look at how they exist in a specialty that does not exist, Diagnostic Medicine.