Avoiding Catastrophes

Pods

The story of “The Professor” illustrates one of the troubling characteristics of the practice of Medicine in the United States today.  Doctors tend to practice or refer within their personal/professional “Pod”.  A pod can be a clinic, as in this case, or the pod can be a medical building, a strip mall, a community hospital, or even a University Hospital. A doctor often will refer to someone who is geographically close to him, in the same building, or on the same hospital staff, even though within a 100 mile radius there may be a representative of the specialty the patient needs, a true expert, who may not be considered. Proximity and personal acquaintance is often the criteria for referral, not skill or training.

Direct questions to the referring Physician can prevent a “pod” referral. Why are you referring me to this specialist? Is there a better choice for the specialty in another hospital or at a greater distance? What is the Doctor’s background or record? Experience with prior diagnosis?

Ego

“Dr. Bob’s Ego” gives a clear illustration of this issue in the process of patient care.

Certain specialties in Medicine require and can reinforce inflation of a doctor’s ego.  This is not necessarily bad, if the resulting ego remains reality based.  The surgical specialties illustrate this most clearly.  For example a successful Heart Surgeon will receive praise from patients, patients’ families and peers.  This is normal and helps the Surgeon grow his referral base. However, if the Surgeon is coasting on prior accomplishments and his more recent experience because of age, relocation or change in appetite for the more risky operations, do not warrant his old exalted reputation, then the surgeon may have a retained ego status that is no longer in line with ability. This is very dangerous. A doctor must constantly be aware of his/her present experience and expertise.  Self downgrading is a difficult task; recognition by the doctor, the referral base, and the patient of the current status of a practicing doctor is essential to excellent patient care.