Consumer Watchdog: Take an active role in choosing a new doctor [Detroit Free Press]

Oct. 07--Sydney Zaremba's mother developed a large growth on her neck in summer 2011, which turned out to be diffuse large B-cell lymphoma.

The 88-year-old Rochester Hills resident's primary care physician referred her to an Oakland County specialist for treatment. Helene Zaremba died that November.

Today, close to two years later, Sydney Zaremba is fraught with questions over the decisions she made about her mother's care: Did she need so much chemo? Was she on too many medications?

Zaremba, 58, of Rochester is suspicious of the doctor who oversaw the treatment -- a specialist she didn't vet and instead took at the recommendation of her mother's primary care physician.

Experts say it's common for people to rely on the recommendations of others or fail to thoroughly research doctors, with some studies showing people spent more time researching a new vehicle purchase than choosing a physician. A bad car can translate into years of grumbling -- but a lousy physician can mean life or death.

As more people are signing up for health insurance under the Affordable Care Act, along with increases in referrals to specialists, experts say it's more important than ever for people to take an active role in their health care and who provides it.

-- Full coverage: A guide to the Affordable Care Act

"The stakes are higher, and health care is complicated," said Dr. Ardis Hoven, president of the American Medical Association, which counts 225,000 of the 1 million-plus doctors in the U.S. among its members. "I wish there was a magic answer to plug in there for you. At the end of the day, there isn't one, and that's why front-end selection (is important)."

Hoven's advice: Trust your instinct.

"You've got to keep your eyes and ears open and not be afraid to ask questions," she said. "People have got to learn it's not like going online to find a good restaurant to eat. It's a different situation, and you must use all resources available to you."

Referrals growing

Helene Zaremba was treated by Dr. Farid Fata, the hematologist-oncologist and owner of Michigan Hematology Oncology Centers who is currently awaiting trial in a $35-millionMedicare scam. Authorities allege he gave patients medically unnecessary treatments, including chemotherapy, and misdiagnosed healthy people with cancer to bill for treatments.

"We took the recommendation," Sydney Zaremba said. "I don't know if we found out anything about him because everyone thought he was great. I did look him up online and the center because you want to know about the doctor. It was nothing, just about his education. ... I was told he was good from (her physician, Dr. Bradford Merrelli), and we thought it was a good place to go."

Merrelli, who has practiced family medicine for 27 years, said he screens the specialists to whom he directs his patients.

"He had the training. He had the personality, and he was extremely available," Merrelli said of Fata. "Patients don't just wander into oncologists' offices. They go there because someone trusted their care. He obviously convinced a lot of people."

Gina Balaya, spokeswoman for U.S. Attorney Barbara McQuade, declined to comment on how Fata got his referrals.

Americans are going to medical specialists more and more. According to a recent national study in the journal Archives of Internal Medicine, the probability of receiving a referral during a doctor's visit increased from 4.8% to 9.3% between 1999 and 2009.

Wayne State University health economist Gail Jensen Summers said the increase stems from the growing number of managed-care plans that have replaced self-referrals with the primary care physician serving as a gatekeeper, for efficiency and cost savings. She also noted physician group practices are expanding to include auxiliary services such as labs and physical therapy, and many have medical specialists on staff.

Feedback is key

Doctors use different criteria when offering referrals to their patients, but they say patient feedback is an important consideration.

Dr. Mumtaz George, a Royal Oak internist for close to four decades, compiled his referral list using geography, how well specialists treated his patients in the past and board certification. He also takes note of the experts who speak at the county medical association's annual meeting.

"I'm real close to Beaumont Hospital, and they have a physician directory with all the specialties, and I look through that and made my own list of people in the area," he said. "When I get feedback from my patients, if it's positive, I keep them on the list. If it's negative, I take them off."

He estimated 10% is negative, adding that most of time it's because of personality and not bad medicine.

St. Clair Shores internist Dr. Chris Crader, a 20-year veteran, also values patient feedback and takes note of how well specialists relay their findings back to her, and whether they order inappropriate procedures. Plus, she relies on the referral list her practice partners use that predates her.

"We are very particular about who we send our patients to. There are a lot of unscrupulous doctors out there. They'll order a million tests," said Crader, whose mother saw Fata for iron deficiency and loved him. "I think it does fall back on the primary care physicians to review the information that comes back. ... I've had experiences where I didn't think the patient was well cared for."

And when a poor-quality referral slips through, no one benefits.

"It's just a bad thing for everyone because it destroys trusts on multiple lines," Merrelli said. "It destroys trust in all physicians who refer patients. It destroys trust patients have in the medical system and their physicians. It destroys trust in the hospitals (the doctor) had privileges at."

Checking on your own

Even if your primary care physician gives you a referral, experts say it's a good idea to do your own checking.

Start by running through the health professions division of the Michigan Department of Licensing and Regulatory Affairs'Bureau of Health Care Services or the state medical boards, which track license suspensions and revocations.

The Licensing and Regulatory Affairs Department received 737 allegations against physicians and 236 against osteopaths between October 2012 and September 2013. There are 36,793 MDs and 8,542 DOs in the state.

The American Medical Association's DoctorFinder lists data such as schooling, residency training and specialty for members; for nonmembers, it lists just the specialty.

"Part of the challenge patients face is they wait until they're sick and then try to find a doctor," Crader said. "That's when it becomes more hastily done."

Some patients turn to websites like www.healthgrades.com or www.vitals.com, which are the medical equivalents of Yelp. The anonymity of the those sites can be problematic because anyone can post false information, and they have a limited number of reviews per physician -- so one bad review out of a sample of four could make a doctor appear to be a poor practitioner.

"Unfortunately, there's not a grading system out there right now that in fact does that," Hoven said about evaluating doctors, adding that the federal government is considering one in the future, like the Centers for Medicare & Medicaid Services now does for hospitals. "But that's in a really rudimentary stage right now because you need to compare apples to apples."

Summers suspects establishing such a system would take at least five years.

"The doctors are resistant to this. But there's another problem. How do you measure quality? It's not easy to measure in the case of physicians," she said.

Doing it differently

If Zaremba had it to do over, she says she would have sought a second or third opinion and talked to more people -- including her own primary care physician -- before settling on a specialist for her mother's care.

"I'd get a couple of opinions from friends or relatives, people in general who might know someone," said Zaremba, a fitness company owner. "If not, we look online or in the phone book. We don't always go with least expensive. That's probably what I should've done with my mom, but we were told aggressive cancer."

Zaremba failed to get a second opinion herself when she had thyroid cancer 11 years ago. But in that case, it worked out -- her doctor referred her to an endocrinologist she still praises today.

"I had a fantastic team," she said. "It went well, and I guess we thought it would go well for my mother."

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