You'll find out, in sum, whether you can trust her and whether she treats you as an intelligent human being who acknowledges the doctor's expertise and experience but has her own views. And if not, try someone else.
4. Ask good questions, insist on good answers. Blind obedience is out. Finding good specialty care is less of a challenge, if still daunting. We'll look at an example—a patient who stands for millions of individuals a year who face the prospect of surgery. In this case, it is heart bypass surgery.
Let's say you've been having chest pain when you exert yourself. After looking at the electrical patterns generated by your heart on an ECG test, your PCP sends you to a cardiologist, who orders up an angiogram that displays dye-outlined X-ray images of your heart in motion. The pictures reveal extensive blockages in several of the coronary arteries that feed the heart. The cardiologist points out one blockage that nearly closes off the first section of the left anterior descending, or LAD, a big vessel the surgeons dub the "Widowmaker." You're lucky, she says. If that section shuts down completely, your family might learn the reason for the nickname.
You ask: "What are my options, and what are the pros and cons of each one?" She explains that because you have serious heart disease in three arteries and one of those is the LAD, your best option is heart bypass surgery. It's possible to avoid surgery, she says. The vessels could be opened up by guiding balloons inside the blockages, blowing them up, and inserting mesh tubes called stents to keep blood flowing. But the latest guidelines from heart experts advise against that when three vessels are involved, especially when one is the LAD. The chances of a lasting fix aren't good enough. Bypass surgery is a better bet. You scribble a note to yourself to check this out.
"Where would you recommend I have the procedure?" you ask. She names a local hospital. "Why there?" The doctor is briefly startled—not many patients want to know her reasons—and assures you the hospital does a large number of bypass surgeries. She suggests a particular surgeon. You scribble more reminders.
5. Be your own researcher. Back home, you head for Medline Plus, the National Institutes of Health consumer page, to learn more about stenting vs. bypass surgery. You follow suggested links and confirm her endorsement of surgery. You move to the recommended hospital's Web page but can't find volume or results-related statistics. Nor does the state health department's Web page turn up that information. (Only a handful of states, including California, Maryland, New York, and Pennsylvania, give residents performance data on individual hospitals.)
You see if the hospital is mentioned on the Cardiology & Heart Surgery Web pages of U.S. News's Best Hospitals, which looks at Medicare data for the sickest patients in 16 specialties. The hospital is not among the ranked facilities in the top 50, nor is it a "high performer" among the top 25 percent of all hospitals evaluated. Finally, you look up the name of the recommended surgeon on U.S. News's Top Doctors page. It's not there.
You do more homework and discover that the Leapfrog Group, a business-supported standards-setting organization, puts the minimum recommended annual number of bypass surgeries at 450 for a hospital and 100 for individual surgeons. Armed with this information, you call the cardiologist and ask that she suggest a different hospital and surgeon. She does. You call the surgeon's office and ask for his bypass death and complication rates for the latest 12 months. Both are in the low single digits, which is reassuring. You decide to go ahead.