Qualy #109 - How does one select the right physician as a patient?
This Qualys episode, an AMA #1 segment, discusses how to find a good primary care physician. It introduces the "Four A's" framework—Availability, Affability, Ability, and Advocacy—to guide the selection process, emphasizing the importance of a doctor's continuous learning and patient engagement.
Deep Dive Analysis
5 Topic Outline
Introduction to The Qualys Podcast Series
Finding a Good Primary Care Physician (PCP)
Four Pillars for Physician Selection: Advocacy, Ability, Affability, Availability
Assessing a Doctor's Commitment to Learning and Staying Current
The Value of Referrals and Persistence in Finding the Right Doctor
4 Key Concepts
Advocacy (in a physician)
This refers to a physician's ability to navigate the complex healthcare system on behalf of their patient, knowing the best specialists and helping them through critical medical events like a positive finding from a colonoscopy.
Ability (in a physician)
This is the doctor's core competence and medical expertise, considered the single most important factor. It should not be confused with or overshadowed by affability or bedside manner.
Affability (in a physician)
This describes how well a patient gets along with their doctor. The relationship should be one where the doctor can bring the patient along in their care, rather than talking down to them or issuing commandments.
Availability (in a physician)
This concerns the level of access a patient has to their doctor, ranging from standard office hours to 24/7 contact, often a key feature of concierge medical practices with varying price points.
5 Questions Answered
When looking for a physician, consider four main pillars: their advocacy skills (ability to navigate the system), their medical ability (competence), their affability (how well you get along), and their availability (access). You likely won't find all four perfectly in one person, so prioritize what you need most.
A doctor's ability is the single most important factor; while affability is valuable for a good relationship, it should never be chosen at the expense of a doctor's core competence and medical expertise.
Instead of asking buzzword questions like 'Do you practice evidence-based medicine?', inquire about how busy they are clinically and how much time they dedicate to reading medical literature and staying updated on advancements in the field.
The estimated lag between a new medical finding and its widespread adoption in mainstream medical practice can range anywhere from 12 to 20 years.
No, you should not be afraid for the process of finding the right doctor to take a while. If a doctor isn't a good fit after several months, you should continue searching for someone who meets your needs and values your active involvement in your health.
10 Actionable Insights
1. Choose Doctor by Four Pillars
When selecting a physician, consider four broad pillars: Availability (access), Affability (getting along), Ability (competence), and Advocacy (navigating the system), understanding that it’s challenging to find all in one person.
2. Prioritize Doctor’s Ability
Always prioritize a doctor’s ability and competence above all else, as it is the single most important factor, and do not let affability overshadow true medical skill.
3. Assess Doctor’s Current Knowledge
Inquire about a doctor’s clinical busyness and the time they spend reading medical literature to gauge their curiosity and passion for continuous learning, which is crucial for staying updated in a rapidly evolving field.
4. Doctor’s Reaction as Litmus Test
Use a doctor’s reaction to your questions as a litmus test; if they are put off or intimidated by a curious patient actively involved in their health, they are not the right doctor for you.
5. Be Persistent in Doctor Search
Do not be afraid for the doctor-finding process to take a while; if you are not satisfied with a physician after a few months, continue searching until you find the right fit.
6. Seek Referrals from Trusted Doctors
Obtain referrals from doctors you highly respect and trust, as their recommendations for other physicians can be very valuable.
7. Avoid Condescending Doctors
Do not choose a doctor who talks down to you or preaches commandments, as a good relationship requires effective communication and mutual respect.
8. Explicitly Ask About Advocacy
Directly ask prospective doctors about their role as an advocate, specifically how they help patients navigate the healthcare system and connect with specialists during critical times.
9. Evaluate Doctors Individually
Evaluate physicians based on their individual merits and competence rather than relying on labels like ‘functional medicine’ or affiliations with specific organizations.
10. Avoid Buzzwords in Questions
When questioning doctors about their practices, avoid buzzwords like ’evidence-based medicine,’ as such questions are unlikely to yield genuine insights into their approach.
3 Key Quotes
I'll never take affability over ability.
Peter Attia
If you're not learning quite a bit as a doctor, you're probably not practicing great medicine.
Peter Attia
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.
Peter Attia