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The paradox of choice

By Dr. Teeb Al-Samarrai

In the debate over health care reform the issue of choice is often brought up.  I’m not referring to a women’s right to choose or the birth control controversies but the simple idea of individuals being able to choose their health plan or physician.  However most physicians would probably agree that for much of health care, especially unexpected and sudden illnesses, the idea of choice is an illusion.  Patients rarely choose the doctor that examines them in the emergency room, the cardiologist that does an angiography, in the middle of an MI, a patient will not ask about door to balloon time at the hospital when they walk in, complication or readmission rates at that hospital.  Rarely, if ever, do patients ask us if we are diligent about reading the New England Journal of Medicine or what our Board scores were what medical school we went to.… Ultimately all of that doesn’t matter in the calculus or an emergency nor does it really matter in making a choice about a primary care doctor.

I recently relocated and decided I should see a primary care doctor.  I’m fortunate in that I’m insured and feel like I’m relatively well informed. I’m a physician who trained in internal medicine so, how hard can it be to find a doctor? But I found myself utterly puzzled, how do I even go about it?


I tried asking friends for recommendation but inevitably their different insurance plans didn’t cover the same physicians or they went to Kaiser Permanente which had a closed plan and assigned patients to physicians.


I have insurance that gives you access a web-based database of their affiliated physicians that simply provides names and location.  In addition to location, I could filter by gender, language(s) spoken, whether they were family medicine or internal medicine trained, and board certification.  I was still bewildered. The list was too long and I didn’t know how to make sense of it.  I tried googling some of the names. As wonderful as google is, this felt very unscientific.  Where does it say whether the physician is competent, a good listener, and nice?


The irony that I was a physician bewildered by the task of choosing a physician for myself was not lost on me.  It made me wonder about not only the tools out there for patients to make an informed choice in choosing a physician. And what does an informed choice mean?


As the health care coverage expansion begins (thank you Supreme Court!), what are the tools we need to have in place to help patients navigate this process? What are the tools that are already out there? And if choice is overrated, how do we advocate for and build a system that is coherent and ensures access not only to a physician but one who is competent, caring and close!

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