How to choose a really good doctor - says oncologist Ilya Fomintsev

Should I choose a doctor?

The choice of a doctor is an indicator of a person's attitude to his health. Some people just go to the nearest clinic, others carefully study reviews, ask friends for advice about a doctor or clinic before going there.

Much depends on the reason for visiting the doctor. If you need to remove a cork from your ear, then there is not much point in choosing a specialist carefully. But when it comes to a serious illness, the careful choice of a doctor is much more justified.

Is there an objective way to choose a doctor

There is no 100% objective way to choose a doctor. A more or less reliable method would be a valid examination for doctors, but the ideal examination does not exist in nature.

A valid exam is an exam based on which a study has been conducted proving that it is this methodology that reliably divides doctors into more and less professional ones. Such an examination produces few false-positive and false-negative results.

For example, American doctors take the United States Medical Licensing Examination to get a license. The exam lasts nine hours, takes place under cameras. The questions are very difficult, and the answer is given for one and a half minutes. This exam, as well as professional community exams, are well validated. Their results are publicly available. The higher the score, the higher the professional qualities of the doctor.

Israel also has a valid exam called Rishion. Every country in Europe has its own valid examinations for doctors.

In Russia, there are also medical exams, but they are not valid. Eventually Patients more often use subjective assessment methods: the Internet, reviews, personal impressions of a meeting with a doctor.

Is it possible to choose a doctor based on reviews on the Internet

With the help of the Internet, we can get much more information, real reviews about the clinic or a particular specialist than from acquaintances. But there are two difficulties here. First, which reviews should you trust? How to distinguish reviews of real patients from advertising or even negative written by competitors?

I would only trust sites that really value their reputation and have multi-step reality checks on reviews.

I can say for sure that real reviews are published on the ProDoctors, SberZdorovye and NaPopravka portals.

But there is a second difficulty: just based on the reviews it is very difficult to understand whether a doctor is a good one or not, even if he has many positive ratings. Because reviews are subjective. Patients share mostly emotions from the visit. Such reports do not give an idea of ​​the competence of the doctor.

Reviews can be the primary filter when choosing a doctor. Then you have to make a decision based on other parameters.

What to check before going to the doctor

After the initial screening, the patient is left with one or more "candidates". To make a choice and proceed to the next step, you need to check the following.

Do other doctors recommend it?

Ask a friend or just your doctor for an opinion about the specialist you have chosen. It is easier for a physician to evaluate a colleague, he has much more information: how and where he studied, where he worked, what are the reviews about him in a professional environment.

There is a very simple way to understand whether a doctor really thinks highly of the specialist he recommends. Ask him: “Would you refer your mother to this doctor?”

When my father got cancer, I referred him to my graduates from “Graduate School of Oncology». I had absolute confidence in them because I knew how they learned. I didn't trust anyone else. If I sent my father to others, then I would be worthless as the organizer of this school.

There is a free referral service for cancer patients and their loved ones.just ask». We made this service so that anyone can get up-to-date information about the disease and support from specialists. Here, oncologists recommend oncologists, help with routing. To get advice, you just need to write about your problem. The expert will study the issue and give recommendations on what to do next and where to go.

Do patients recommend it?

Try to find a person who was treated by this doctor, and ask him in detail.

Only such a detailed personal patient experience can help predict your relationship with the doctor in the process. treatment and diagnostics.

How many surgeries did he have

In the minds of patients, a good doctor is a highly experienced specialist with thousands of surgeries and tens of thousands of patients behind him. But it's not.

There is a concept of "learning curve". In surgery, for example, this is the number of operations that must be performed in order to reach the average level of performance in the specialty: average time operations, the average rate of complications, blood loss and so on. Each major has its own learning curve. An oncologist surgeon, on average, needs to perform from 100 to 200 operations in order to achieve average statistics.

If he has done, say, 150 such operations, then from a scientific point of view he is an absolutely experienced doctor.

The 151st operation will already add much less quality, the 152nd even less, and so on.

Ask how many surgeries the doctor has had. Of course, he may not answer your question or answer dishonestly. But we should at least see what he has to say. His answer can also be revealing.

How many patients with the same diagnosis are treated in the clinic

It is important to know how many patients with your disease are being treated at the center where the doctor works.

The doctor, as a rule, treats the patient not alone. Around the patient a whole team of specialists. If a lot of patients passed through this team in the center, then, no matter how unprofessional the doctors were initially, they would have learned. This is not an ideal criterion, of course, and a decision cannot be made on its basis alone, but it is an important indicator.

The more patients with such a diagnosis, the higher the likelihood that the treatment will be of high quality. The probability of complications and unpleasant situations in the center, where there are many patients with the same pathology, is much lower. This is called a high volumes center - a center with high volumes of treatment.

The rule also works in the opposite direction: if there are very few patients with such a diagnosis during the year, then one can hardly expect high quality treatment from the team and the center.

What not to look for when choosing a doctor

Advice from the Internet and stereotypes about doctors that have come down to us since Soviet times have formed false criteria for the professionalism of a doctor. It's time to put aside such delusions.

Diplomas and certificates on the walls

I do not advise you to choose a doctor, impressed by the wall with diplomas within.

Most of these certificates of honor are awarded by simple letter. These are not awards to be earned.

Mostly on the walls of doctors we see certificates. If we talk about oncologists, then the certificate of a member of ESMO (European Society for Medical Oncology), the European Association of Oncologists. Such medical There are organizations in other areas as well.

To become a member of ESMO, you just need to submit a written application and pay a fee of $200. A certificate of membership in an international organization actually means nothing. Another thing, if the doctor passed the ESMO exam, is a different calico. But there are very few such doctors. Most of them have certificates that make no sense to look at at all.

Titles and regalia of a doctor

Patients mistakenly consider professors or doctors of the highest category to be more professional than ordinary practitioners. doctors.
Regalia is not an indicator of professionalism. Positions are rather an indicator that a person is good in politics, and scientific titles in Russia practically do not say anything: the system for defending dissertations is built in such a way that real science it has little to do with it. This is a process for the sake of the process.

The system for obtaining these regalia in Russia and in general in the entire post-Soviet space does not correlate with professionalism.

For example, a doctor receives a category not for some professional merit, but literally for length of service. He worked as a doctor for 10 years and received the highest qualification category. This is not the mark of a good doctor.

Physician's age

Another myth: a good doctor is an elderly doctor, supposedly such a specialist has more experience. In fact, if a doctor has been properly trained, he reaches the average level of performance in his specialty (learning curve) at a fairly young age.

Age and professionalism are not directly related. Aren't there stupid old people? There are.

And why then do people think that there are no such doctors among doctors? Quite calmly, you can be a gray-haired fool.

Beliefs that the doctor is an adherent of evidence-based medicine

All doctors or very many now call themselves adherents of evidence-based medicine. But in reality, few of them put into practice this approach in the very meaning that the principle of evidence-based medicine carries in itself. This term does not mean at all the rejection of fuflomycins and homeopathy.

Evidence-based medicine is a way of thinking that helps to avoid distortions and apply scientifically verified data to the benefit of the patient. This is the ability to understand the meaning of research and draw the right practical conclusions from them.

How do you know you've got a good doctor?

So, you found a specialist, came to him for an appointment, started treatment. Pay attention to how the doctor communicates with the patient. There are criteria that will help you check if you made the right choice or if it is better to go to another doctor.

Can explain expected benefits and risks of treatment

A good doctor knows how things might play out in terms of a patient's treatment. He will never say: "Well, how it goes, we'll see there" or "How God will send."

When doctor offers some kind of treatment option, he must name the scenarios, what complications are possible and what is their probability in percent. If he does not know these numbers, then he is unlikely to make rational decisions regarding patients.

Does not decide for the patient

A good doctor always provides a choice. Talks about the features of each of the treatment options, the pros and cons, the likelihood of complications. But the patient makes the decision.

If the doctor presses, insists, because allegedly “this procedure is indicated, and the other is contraindicated,” then such a specialist cannot be called good.

This is your life, and only you know the circumstances that are important to you when choosing a treatment method. The doctor risks nothing by imposing his choice.

I'll give you an example. There are two gentlemen with the same diagnosis - prostate cancer, the same social position. There are two equal options: the first is to operate prostate cancer, the second is to observe. Outcomes in terms of survival are the same.

The first gentleman has a family, he wants to live in peace and not think at all that cancer is sitting inside him. But the operation has such a nuisance as a 15-20 percent chance of complete impotence and urinary incontinence.

This probability does not suit the second gentleman. He has a young mistress, and even not one. And the doctor, suppose, insists on an operation for him. Is this correct on the part of the doctor? No! A doctor cannot decide for a person which tactics to choose. The doctor does not know about all the life circumstances of the patient, and should not.

Does not intimidate or humiliate

A very important indicator is how the doctor talks to the patient. If he gets annoyed with questions, gets angry, utters phrases like “did you decide that the smartest one is here?”; "you know a lot"; "I'll tell you, but you do it and don't argue"; “Don’t bother me to work already” – such a doctor is not a doctor for you. A good doctor does not humiliate the patient, treats questions, doubts and suggestions with understanding and respect.

After visiting a doctor, a person should be left with a clear understanding of the situation, and not in a panic. Only a bad doctor will intimidate to convince the patient to choose the treatment that the doctor himself considers appropriate.

The feeling of fear of the doctor is a sign that you and such a specialist are on the wrong path. Especially if it's a fear of harm, lest the doctor make things worse.

This is what happens when serious illnesses. Patients are afraid to leave the doctor for some fear of revenge. This is a very abnormal situation. If such thoughts appear, overcome the fear and leave the doctor.

Able to create a trusting atmosphere in the office

A doctor should not try to be a friend to his patient. But he must be able to create a trusting atmosphere inside the office.

A few years ago, a social project “Doctors in gowns: facing the patient” was launched in Russia just in order to raise a conversation in society about patient orientation, about the relationship of a doctor and patient.

The bottom line is that effective treatment is possible only when the relationship between doctor and patient is partnership, not paternalistic.

That is, we are talking about tandem equal, and not about a team where one leads, the other obediently follows.