The Professor
An intelligent university professor and his family had received excellent but routine care from a General Internist at a respected, large clinic. Unfortunately, the professor developed symptoms of coronary artery disease, a serious illness. As his treatment began, the Professor neglected to ask necessary and appropriate questions and was quickly exposed to a series of different Clinic physicians who he, incorrectly assumed, would deliver the same excellent care he had received from his General Internist.
The first step is the most important step in receiving excellent care in this patient’s new experience - a serious illness. The steps, which follow, are a downward spiral, which becomes progressively difficult to stop. Although the new physicians providing a patient’s care will be more sophisticated in terms of training, the patient must continue to scrutinize the doctors’ credentials and record.
The Professor was referred to the Cardiologist in the Clinic. The Cardiologist was not awful or incompetent, just ordinary. Considering the Clinic was surrounded by world class Cardiologists, why did the Internist send this high profile patient to the Clinic cardiologist? Because the Clinic roster included a Cardiologist and clinic Internists usually refer within the clinic.
Unfortunately, “in the Clinic” is too often the only justification a patient will receive for a particular referral.
Luckily the Cardiologist completed the necessary arteriography without complication and Cardiac Surgery was recommended. However, the Cardiologist referred the Professor to the clinic’s Cardiac Surgeon, who had the worst record of complications and deaths in the area.
Why was the Professor referred to this surgeon? Simply because the surgeon was “within the clinic.”
The Cardiac Surgeon was pleasant, reasonably intelligent, nice looking, well dressed – qualifications one might look for in a maître d’, not a Heart Surgeon. His appearance, affable personality, verbal and intellectual skills had carried him along in his career, but his results spoke otherwise. A four graft, unnecessarily long operation followed and was followed by the Professor’s long and difficult recovery.
To make matters worse, three months later the Professor’s symptoms returned. Repeat studies revealed that all the grafts placed at the operation had closed. The Cardiologist and the Cardiac Surgeon blamed the poor result on the “unusual nature” of the patient’s healing process, essentially blaming the body and not the work of the surgeon. Subsequently the Professor went to the Cleveland Clinic where he underwent repeat surgery with an excellent Cardiac Surgeon and had an excellent result.
What went wrong?
The simple truth is the Professor had a technically inadequate operation performed by a technically inadequate surgeon. This was avoidable if the Professor had been armed with the correct “tools” – when he was referred to the Cardiologist and the Cardiac Surgeon.
Observe the experience of an individual Internist in this Clinic. They are all busy. Most of the patients they treat have minor problems. In general the Internist usually has only a shallow knowledge of Cardiac Surgery and no knowledge of the Clinic’s Cardiac Surgeon’s total record. The Internists are dependent on the administrative department of their clinic to hire and possibly fire any given doctor in the Clinic. No one in the Clinic had the time or the insight to fire this “nice guy-Cardiac Surgeon.”
In addition, the Professor personally had no tools to evaluate his new physicians. He trusted his internist to make the “best” recommendation; however, the internist only went so far as to follow his standard procedure and refer “within the clinic.” When faced with an illness, and particularly a serious illness, you must research your medical care professionals. A recommendation, and specifically one “within the clinic,” is never a guarantee for superior or even quality medical care.
*Real names have not been used and all facts and dates have been changed to avoid identification.*