Saturday, October 11, 2014

Choosing Doctors

My husband's Subaru WRX STI

We need to choose doctors and our health care with
the same intensity as our cars!
Intensely Interested in Cars

My husband has always been intensely interested in cars. Airplanes too, but his severe nearsighted eyes, let alone his heart murmur, were enough to prevent him from becoming a test pilot. I have always been glad he could not pursue that high risk dream!

He has purchased reference manuals for the cars he has owned over the years. He can tell you minute details about the engine, brakes, tires, and the fluids he uses. No detail is too small to be ignored! He has meticulously maintained his vehicles over the years, and he has the records to prove it. The reward has been the outcome, hundreds of thousands of miles of trouble free driving.

We discovered a real gem, an independent garage that is just great! A visit to them is always a special treat, where there are others as intensely interested in motor vehicles as he is! What a difference from the more typical, often stressful experience, where no one cares very much about the car or the customer, but everyone definitely knows how to present you with numerous charges for parts and labor, whether you are satisfied with the outcome or not.

What About Our Bodies, Our Hearts?

Dr. Marty Makary, in his book Unaccountable, writes about this in Chapter 6, Navigating the System. He also uses the analogy of buying a car. "Second opinions are always possible in America, even when you are admitted to a hospital. When your health is on the line, don't take chances with your life and wellness that you wouldn't even take buying a car." I highly recommend Dr. Makary's book. Much of what he writes, we learned the hard way. We certainly did not start out understanding what we do today.

Second Opinions

If you have followed our story from the beginning, you know that we went from an ER referral list of doctors to an internist, an internist to a cardiologist, and the cardiologist chose the surgeon. We did not seek a second, independent opinion. We were rather like little lambs. I believe one of the reasons was that there was no mystery regarding what was wrong and what the solution was. My husband was also very sick. We trusted the doctors we had met, believing they would have referred us elsewhere if that were necessary. I will have more to say about referrals another time.

While we were waiting, there would have been opportunity for another opinion. Someone who worked with my husband asked him if he would have his surgery at one of the major medical centers in the area. We knew about those centers, but did not consider them seriously. It might have been possible, but there was no real internet presence then, no easy way to research medical centers and physicians online. And some centers and physicians, even to this day, will not accept a patient unless they are referred by another physician. No doubt they have their reasons, but I view this as an obstructive approach that is not pro-patient and simply remove them from my list of options. I would make an exception only if I believed they were the best/only expert, and I must see them. Then I would find a way to be referred.

Checking Out Doctors and Medical Centers 

Dr. Makary writes about transparency in medicine. Transparency has begun to happen and will continue to unfold. The New England Journal of Medicine held a web event recently called "Innovation in Health Care Leadership. Transparency in Quality Data, Pricing, and Medical Records". The announcement includes the words, "Transparency is coming. This is not up for debate." The speakers listed included Dr. Cosgrove, a heart surgeon who heads the Cleveland Clinic.

Yes, things are changing. 
It should become easier and easier
to find out what you need to know,
to make wise decisions about your body. 

You may have many cars over your life time,
 but you will have only one body.

Inside Information

The internet was not there to help us. We went to the local library and looked up the surgeon. We found out that he was trained in Boston, certainly a city well known for heart surgery. We did not know anyone who worked at that hospital, but if we had, we would have asked them questions. We asked our friend, who once was a nurse and knows many people through working in real estate, what she could find out about these doctors. Word came back that the cardiologist had a terrible bedside manner but was thought to be smart, good at what he did. The cardiologist had chosen the surgeon for us, telling us he was the best. I assume he meant the best among the heart surgeons in the group who practiced there.

We Chose the Anesthesiologist!

It amazes me now that the one doctor we chose ourselves was the anesthesiologist. I knew that the anesthesiologist holds life in their hands while the surgeon works. I wanted to know who would hold my husband's life in his hands while that new valve was being installed!

The cardiologist's assistant was very helpful to me, answering practical questions for me during this time. I wanted to know how things would happen, such as pre-surgical testing, hospital admission, etc. One day I asked her about anesthesiologists, and she told me there were several there that worked in heart surgery. I asked her which one she would use, and she was willing to tell me! She told me the name of the one she had chosen when she had her hysterectomy. She had been very pleased. She helped arrange that he would be the one who would hold my husband's life in his hands as the surgeon worked. To this day, both my husband and I have very fond memories of him. I will call him Dr. T.

Time for Surgery

Yes, now it was time for my husband's surgery. We had done what we could to prepare. In all this time, we had never met the surgeon, the man who would open my husband's chest and work on his failing heart.

Today patients and their families arrive very early on the morning of the event, but back then they admitted patients the day before surgery. He was admitted in the afternoon. The anesthesiologist, Dr. T., had already come by and met us for the first time. It was later, towards evening, that we heard heavy footsteps on the hard surface of the hallway floor, getting louder, coming toward us. Thud, thud, thud. . . . They stopped outside my husband's room. Into his room came the heart surgeon. He wore a kind of hard-soled boot that had announced his presence before we saw him. My husband would be his first case in the morning.

It was the first time we had met him.

My husband has had a total of three open heart surgeries. This was the first one, and the last time we would ever allow anyone to perform surgery on him without being truly informed of everything, well in advance.

This is not a criticism of the surgeon. He saved my husband's life. It is a statement of the importance of being well informed, of having all our questions answered, and getting additional opinions.

My husband would never have bought a car this way!

With all best wishes,
- Arlys Velebir

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