The Peter Attia Drive - Qualy #109 - How does one select the right physician as a patient?

Episode Date: February 11, 2020

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.   The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

Welcome to a special bonus episode of the Peter Atia Qualies, a member exclusive podcast. The Qualies is just a shorthand slang for Qualification Round, which is something you do prior to the race, just much quicker. The Qualies highlight the best of the questions, topics and tactics that are discussed in previous episodes of the drive. So if you enjoy the quality, you can access dozens more of them through our membership program. Without further delay, I hope you enjoy today's quality. MD selection, I think you've received this question more than once. How do I find a good doctor? So, what is the best way to find a really good primary care physician? Are there specific

tell-tale questions labs I should bring up with a perspective PCP? I think we covered that, but also to see if they've picked up a medical journal in the last 20 years. You know, I sort of actually had this discussion with a patient on Monday who's looking for a concierge, you know, primary care physician since I'm not a PCP and many patients come to me already with a PCP but sometimes they don't and they want to have this question. So, you know, I kind of walked him through my mental model

which is there's no one size fits all here. You just have to decide what it is you need and want. So I think about availability, affability, ability, and advocacy as sort of the four broad pillars that you're looking for in a physician. And it's pretty much impossible that you'd find all of those in the same person. So what do I mean by those things? So advocacy is the physician who's connected and knows how to help you navigate through a storm. When you need to go get a colonoscopy, they know the absolute best endoscopist. And if God forbid, like something comes back with a positive finding, they know

exactly the right surgeon and boom, boom, boom. And not only do they have the roletex, but they know how to help you get through that, they will be your, you know, your advocate in the system. I personally think that's very important. I think many people aren't actually thinking of that, but it's important to sort of ask a doctor explicitly and directly about that. Ability to me is obviously I just think that that's the single most important thing. I mean in the end, bedside manners, great affability is important, but I'll never take affability over ability you'd want both. They're not mutually exclusive, but don't be confused by affability at the expense of ability. So we'll come back to how maybe how you can assess ability,

but that's important. Affibility business, like do you get along with this person? And I think you should be able to get along with your doctor. I think the days of going to the doctor who talks down to you and is basically preaching a bunch of commandments, it just doesn't make any sense. Like you just don't want those kind of people around

because yeah, in the end they might be the expert, but if they can't bring you along, then the relationship probably doesn't fit. And if I have a patient in which I feel like I can't bring them along or I don't connect with them, I certainly say to them, look, maybe this isn't working, you know, and in the end, you maybe need somebody different from me who can communicate in a way that you like to be communicated with. Availability is basically or access is like, are you looking for someone that you can call 24-7? And that's when people are looking for concierge docs, that's generally what they're looking for. There are lots of non-concierge docs though that still have,

and within the world of concierge look, you've got like the $30,000 your concierge guys, and you've got the $3,000 concierge guys. And so you also have to be able to think about, okay, well within that, like, what's the difference between those two? What's worth $27,000 more per year? If that's the, and those are literally, like, that's probably the range that I see in New York for concierge PCP. But I guess the person asking this question is probably thinking mostly about ability. I think, you know, the question included something about, have they read a medical journal in the last 20 years? I mean, that's a good question because so much of what we learn in medical school

is pretty much irrelevant by the time we're practicing and the lag between when something becomes a finding and when it becomes mainstream or obvious enough that everybody's doing it, I've seen that number estimated at anywhere from 12 to 20 years. So yeah, it seems like a pretty inefficient system. So I think there you just want to talk to your doctor

and say, look, how busy are you clinically? How much time do you spend reading literature? And again, I wouldn't use buzzwords like evidence, do you practice evidence-based medicine? Because what doctor is going to say no to that question? Like it's sort of a silly question. So it's mostly just trying to inquire about the curiosity of the person, their passion around learning. Because I think in many ways, if you're not learning quite a bit as a doctor, you're probably not practicing great medicine.

If you're not sort of trying to get smarter on diagnostics or, you know, advancements in the field, then I, you're probably stagnant. And it's not to say that a doctor who's stagnant can't do great work on certain things, but for most people, they don't want to have like six doctors in their life. You know, they sort of, you want to go to one person. So I think that's how I sort of think about that. Unfortunately, I'm not really a fan of a lot of the labels that people put on. Like, well, I, you know, I practice functional medicine or I'm part of, you know, this organization or that organization, I just, I don't know, I think in the end,

you got to just evaluate the person individually regardless of those features. And I don't know if the answer is the question, but... I think so. I think one of the things I was thinking about is people will ask, people will be relatively specific and they'll say, I live in Boise, Idaho, do you know a good doctor there? You may or may not know a good doctor there. However, it probably brings up the point that if you can get a referral from somebody that you really respect and think is a great doctor

and knows their stuff, that a referral probably would be pretty valuable there too as well. But it's very hard probably to refer somebody if you're in your own practice as a doctor to really voucher somebody else across the country. Yeah, I mean, my ability to do that is, if it's going to happen, it's going to be my luck.

It's going to be, I already have a patient there and they've got a doc who I've entered. Like, I've patient in Seattle who's got an amazing PCP up there who I won't name now or else he'll get inundated with a million people, but frankly, I think his practice is probably full, but every time I've had a patient move up to Seattle, it's like that's gonna be your doctor because the guys, like he is the epitome

of what a great PCP is. And I love reading his notes. I just, I love interacting with him. And I love that, you know, we complement each other. In other words, there's a whole bunch of things that I do that, you know, look, he sort of knows a little bit about, but he wants to know much more about lipidology and cancer screening and some of the exercise stuff

we're doing. But then there's a bunch of stuff he does that I, like his knowledge of when the patient's traveled to this part of the country, you gotta be aware of this particular parasite that can show up. And here's how we're gonna vaccinate you against this. And here's how we're gonna, you know, you were in that cave in Texas, well, you're very susceptible to this kind of thing. And just, you know, someone's got like an HSV flare and like he knows all of the

tricks. And so that's probably the easiest way for me to refer people is that I've worked with the doc directly. Going back to the point though, I don't think people should be afraid of this process taking a while. In other words, if you go down the path and you find somebody and you think this is going to be my doc, and you know, six months in, you don't like him or her, do it again. Keep doing it, keep doing it. And a lot of the questions you ask, the doctor's reaction to those questions is probably a litmus test. So if you sense that a doctor is put off by a curious patient who's showing up wanting to be actively involved in their health, well then I you don't want that doctor.

You don't want someone who's intimidated or put off by your interest and obsession in this stuff as a patient. Hope you enjoyed today's special bonus episode of the quality. New episodes of the quality. New episodes of the qualities are released Tuesday through Friday each week and are published exclusively on our private member only podcast feed. If you're interested in hearing more, as well as receiving all of the other member exclusive benefits, you can visit peteratiaemd.com forward slash subscribe.

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