4. Take Charge
Once you decide what you need, work to make it happen
Getting in to see the physician may call for string pulling. If you were applying for a job, you could send your resume to human resources, which is what most people do. Or you could ask a friend, or a friend of a friend, to pass it on to someone in the department where you want the job. Which gives you a better shot?
Trying to see a doctor in high demand is the same. You'll get an appointment--eventually--if you call the general line. Network instead. Whom do you know who might have a relative or friend in the physician's office and could put in a word for you? "My friend's kid had a small hole in his heart and wanted to see some of the physicians at Columbia," says Evan Levine, a cardiologist in New York and author of What Your Doctor Won't (or Can't) Tell You . "He called [the appointment number] directly, and it was a four-month wait. I knew a number of people there, and he had an appointment in a week." Fair? Maybe not. But when a medical problem is serious, shouldn't getting the best care be the priority?
Without connections, you'll have to be persistent. Give the scheduler your cellphone number and offer to be flexible if there's a last-minute cancellation. If you're in the neighborhood, you could drop by to make an appointment in person--it's harder to say no to someone standing right in front of you. (Just be polite.) You can also ask if the physician has partners who may be less renowned but have similar treatment philosophies and success rates. Or find out if the doctor has trained other nearby specialists or is familiar enough with their work to be able to vouch for them.
Telltale heart. Once you're in front of the doctor, your care is still in your hands as much as it is in the physician's. You need to be assertive, as Shelly Weinig found out. The 76-year-old retired entrepreneur and adjunct professor of engineering at Columbia University woke up one day with double vision. He got a quick appointment with his personal physician and mentioned that he could actually hear his heart beating, very loudly. "Those are the kind of stories I hear from old ladies" is how Weinig recalls the doctor's response. "That galled me," says Weinig. "Don't ridicule me if you don't know what my symptoms mean." He eventually found a specialist who diagnosed a network of swelling capillaries behind his eye. Left alone, it could have burst or put pressure on nearby blood vessels, leading not only to loss of vision but also to a possible stroke. The amplified heartbeat was a symptom of this spider's web of blood vessels, called a hemangioma.
Even when the diagnosis is clear, the treatment proposed might not be the one best suited to your case. Not all doctors are up to date on the latest research, and every specialty exhibits self-bias: Surgeons think in terms of cutting, radiologists in terms of radiation-based solutions. Even where you live can have an influence. The ongoing Dartmouth Atlas project has found significant treatment differences from region to region and even within states. In California, for instance, elderly Medicare enrollees in Palm Springs had double the rate of knee replacement surgery in 1999 that comparable Medicare patients did in Stockton. You can use the Dartmouth Atlas to examine statistics for elective procedures in your own community. (Go to www.dartmouthatlas.org and follow the link to Web database tools.)
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