"How to Survive Your Doctor's Care" by Pamela F. Gallin
An excellent consumer guide on how to use medical services., December 24, 2005
This is a good manual about the medical establishment written by an insider, Pamela Gallin, M.D. First, she describes in detail how the medical world works. Second, she tells you how to obtain the best medical care.
The medical profession is organized around teams. The teams are hospitals or medical centers. There are three leagues. At the top are hospitals providing tertiary care. These represent the best city hospitals. They deliver the widest array of specialized medicine services. Their specialists are often among the leading authorities. If you have a complex medical condition that is where you should go. Next are hospitals providing secondary care. They have very good resources but for the rare diseases mentioned above. Finally, you get hospitals providing primary care. These are good for mundane conditions only. For others, they will refer you to the nearest hospital that delivers secondary or tertiary care.
The medical profession has a military like hierarchy. At the bottom are several ranks of nurses. Above them are many ranks of doctors with different level of experience and specialization. There are also hospital administrators who are doctors who got promoted upstairs into managerial roles.
There is a key defense line among doctors that consist of the radiologist, anesthiologist, and pathologist. The author calls them the invisible doctors because they have no patient contact. But, their work is key. The radiologist gives others the broad road map of a disease by interpreting X-Rays. After reading the chapter about the anesthiologists you appreciate their importance. If a surgeon makes a mistake, you are typically ok. If an anesthiologist does, your dead! The pathologist is the true scientist who analyze the disease at the cellular level. He is the one that advise the surgeon if he has cut enough cancerous tissue. These three "invisible" doctors, together are more important than the surgeon.
The main advice the author gives regarding how to get the best care is original. The most important issue is to select the best hospital or medical center. The best hospital will have the best team of doctors, including the key invisible ones mentioned above. Only then, should you focus on choosing a primary doctor. And, she gives good advice on how to select both a hospital and a doctor.
My only issue with the book is that we often can't choose a hospital as she suggests. Employer sponsored health insurance (HMO/PPO) restricts you to a given hospital. Yet, her advice kicks in when you are referred to a hospital outside of the HMO/PPO network. Overall, this is still an excellent insider's view on a hermetic profession.