Blog | Tuesday, December 30, 2014

Are doctors good businessmen? Get a second opinion!


We've all heard or used the phrase, “leave it to the professionals.” It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a ‘toolbox’ at home, but it is stocked similarly to the first aid kit that your new car is equipped with. It contains a few BandAids, adhesive tape and, hopefully, the phone number of a local doctor. My home tool box has an item that can practically fix anything – the phone number of a handyman.

It is essential to know one's limitations, regardless of one's profession.
• Politicians shouldn't speak authoritatively as if they are climatologists.
• Gastroenterologists should not prescribe chemotherapy, even though we are permitted to do so.
• Bloviating blowhards on cable news shows are likely not military experts.
• The guy who fixed your toilet might not be a top flight kitchen remodeler even though his business card includes home remodeler, along with railroad engineer, IT professional, seamstress and stand-up comic.

Some of us are good at a lot of stuff. Some of us have a narrower, but deeper range of competence. Yes, we're all good at something, as our moms and teachers taught us during our early years. Without doubt, most of us are not good at lots of stuff, and it's important to know where our comfort zone approaches the chaos zone. In my own profession, it is absolutely critical that physicians readily solicit assistance from a colleague when additional knowledge, experience or judgment is needed. Asking for help to help a patient is evidence that the physician is focused on his patient's welfare. Every doctor has witnessed circumstances when a physician is reaching too far beyond his tool box, and it's not pretty.
• Should a surgeon perform a complex operation that he only seldom performs?
• Should a local oncologist treat a patient's rare cancer or refer the patient to the expert downtown?
• How long should an internist struggle with a patient's hypertension before recruiting an expert?
• If an allergist's patient keeps losing weight, is it time to consider a cause beyond the scourge of gluten?

Last year, our practice needed some restructuring. We met with our accountants for advice on streamlining and managing our practice. I was impressed how quickly these pros looked over our financial statements and readily understood the state of our practice. Of course, these guys see the world through Excel spread sheets, just like we GI physicians do through our colonoscopes. To us physician clods, these reams of number filled pages containing every permutation of various financial reports were encrypted codes that would require NSA cryptographers to decipher. Most physicians are not good businessmen, although many feel otherwise. Luckily, my partner and I know the truth about ourselves. We didn't ask the accountants for a “second opinion.” We came to them first, and we're glad we did. I presume that when they need a colonoscopy, they won't try it themselves.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.