Whole Living Guide > Devilish Doctors

Marcus Welby, Where Are You?
By Russell Wild . Illustrations by Jacob Goble

The doctor will see you now. But is that a good thing? The announcement recently of federal prosecutors accepting a $54 million settlement from Tenet Healthcare is scary business indeed. For if it is true that Tenet’s doctors have been sticking tubes up arteries and opening people’s chests to perform unnecessary heart procedures, what does that say about your doctor?

We’ll assume that most doctors, like most people, are trustworthy. We’ll assume that most doctors adhere to the American Medical Association credo: Under no circumstances may physicians place their own financial interests above the welfare of their patients. But we know, not only from the Tenet case, that not all doctors are honest, and not all doctors do put the welfare of their patients above their own financial interests. Consider the following:

• In one study, researchers found that five percent of physicians applying to a managed care plan had made up phony credentials—including false residency training, board certification, and clinical experience.

• In another study, 12 percent of all “specialists” advertised in the Connecticut Yellow Pages did not have the standard board certification for their specialty.

• A 2001 hearing before the us Senate revealed that many doctors have been attending seminars whose sole purpose is to teach doctors how to bilk patients and insurance companies.

• In January of 2003, a Florida doctor was charged with watering down a cancer drug that he was administering to his patients.

• Everyone—even doctors themselves—seems to have at least one story of dubious doctor behavior. "My mother recently was told by an eye doctor that it was an emergency to operate on her cataracts!" says Kathryn Stewart, MD, MPH, medical director for care management at Mt. Sinai Hospital in Chicago. "He told her that if she waited, it would be too late to do the surgery. That, in my opinion, is bogus."

There’s a feeling out there in the stethoscope community and elsewhere that, if anything, deceitful doctor behavior may be on the rise. "The world of medicine of late has become an increasingly difficult place for physicians," says Leonard Morse, MD, chair of the American Medical Association’s Council on Ethical and Judicial Affairs. "Costs have risen. Incomes have dropped. As a result, some doctors may become more, er, ‘creative’ in how they generate income for the office."

And of course, other health professionals—chiropractors, nutritionists, dentists—may also be assumed to have a few rotten apples. “I was out of town when I had a crown come off, so I called a dentist referral service,” says Dr. Stewart. "The dentist I was referred to went through my mouth finding all sorts of things that were ‘wrong,’ and recommended that they be fixed right there on the spot. I had just been to my own dentist, whom I trust, and he told me that my teeth were just fine. So I politely declined and asked the man to just glue on the crown and let me go on my way. Clearly, he had dollar signs in his eyes.” According to estimates compiled by the fbi, fraud and abuse in health care may account for as much as 10 percent of the nation’s health care expenditures. From the fbi Web site: Many of the fbi’s 56 field offices rank health care fraud as their number one white-collar crime. Of course, doctors aren’t the only ones to game the system. But they are the ones we put our trust in.

So how do you know if you’re dealing with an exceptionally “creative” doctor or dentist or chiropractor who may be padding your bills, providing unneeded treatments, exaggerating or outright lying about experience and training? It’s sometimes not easy, but by keeping your eyes open and applying a little footwork, you should be able to weed out the few deceitful health care professionals from the many honest ones.

Check credentials. If a doctor claims to be a specialist in a certain area, you have a right to know what exactly qualifies her to be so. Board certification is important.

Ask about experience. If a doctor is suggesting a specific surgery, ask how many times he has performed that surgery. “If he says ‘lots,’ or ‘plenty,’ or gives you any answer that sounds at all evasive, that should be a big red flag,” says Miles Jones, MD, a doctor in private practice in Kansas City, Missouri, and medical director for NetDoctor International, an online pharmacy. “A doctor who has performed, say, 350 surgeries should have no problem providing you with that number.” Beware, however, of numbers that are too high. The doctors involved in the Tenet case performed more heart procedures in a month than many cardiologists do in a year.

Ring up the local hospitals. As far as checking credentials and experience are concerned, you don’t have to do all of the sleuthing yourself. Hospitals, before they grant a doctor privileges, do plenty of sleuthing on their own. “Call the best hospitals in your area, and ask if a particular doctor has privileges there. If you keep hearing ‘no,’ then you have to wonder why that is,” says William Silver, MD, a Manhattan-based physician, and vice president of the American Academy of Facial Plastic and Reconstructive Surgery.

Get a second opinion. It’s always, always good policy before undergoing any serious procedure to check with a second, and possibly a third, physician. If the first doctor, the one recommending the procedure, is out primarily for your money, a second opinion should reveal that. Don’t be afraid to tell doctor number one that you are seeking a second opinion. Any doctor with principles and integrity will encourage a second opinion.

Steer clear of Pollyannas. Every surgical procedure has its potential dangers and complications. If a doctor presents you with a Disneyesque view of what’s in store for you, that’s dishonesty. And there is probably more where that came from.

Watch out for merchandizing. Know that with a few exceptions (such as ophthalmologists who sell contact lenses), the medical establishment frowns upon doctors who sell products from their offices. “Doctors should be paid for exercising their professional skills, not for dealing in goods,” says the ama’s Dr. Morse. “Such marketing of goods may be a warning sign that the doctor has other motivations apart from the welfare of patients.”

Beware of fad medicine. “Doctors who are anxious to grab a quick buck will often gravitate to whatever medical procedure is hot and new,” says Elliot Jacobs, MD, a board-certified plastic surgeon in New York City. “I’m not saying that any doctor who embraces the latest technology is operating out of greed, I’m just saying that you need to be especially careful when asked to submit yourself to anything experimental. Ask lots and lots of questions.”

Look out for treatment overkill. Dr. Jacobs also advises caution and skepticism should you ever encounter a doctor who starts to “laundry list” you. “If you come to see a plastic surgeon to discuss what can be done about the wrinkles around your eyes, and all of a sudden, without anything being said on your part, the doctor starts talking about what he can do to your nose and chin and thighs, watch out,” says Dr. Jacobs. “I would tend to assume that that doctor is thinking with his wallet.” Notice the fancy-schmancy accoutrements. Remember the dentist who wanted to do major excavation on Dr. Stewart’s mouth? “He had this really fancy office with televisions over every dental chair and fancy fiber optic equipment that he could use to blow up the tiniest abnormality in my mouth to the size of the TV screen. He was trying to impress me with all the razzmatazz gimmickry—and all I kept wondering about was who was paying for all this.” The answer, of course, is you.

Don’t leave without a diagnosis and a game plan. “Your doctor should be able to provide you with three things,” says Dr. Jones—“a diagnosis, a clear treatment plan that makes sense, and an expectation of when your medical problem is likely to respond to the treatment.” If you leave a doctor’s office without those three things, but rather, a hazy diagnosis, a treatment plan that just doesn’t seem sensible, and appointments for treatments without end, then you may have met a doctor who is working you or working the system.

In short, says Dr. Jones, the best protection against dishonesty in medicine is for you to trust your instincts, ask lots of questions, and walk away when you sense anything but complete candor on the part of a doctor. “You sometimes will need medical care, and you hope that the person you see cares for your well-being.” That will usually be the case. But not always. “Ultimately,” says Dr. Jones, “it’s your body, your responsibility. There’s no room for blind trust.”