I attended the fourth annual Castle Connolly National Physician of the Year Awards last night in New York City. It was truly moving to hear the incredible stories of triumph of each honoree – from military surgery (Dr. Judd Moul), to curing head and neck cancer (Dr. Carol Bradford), to expanding palliative care services for people not expecting a cure (Dr. Diane Meier) – each awardee embodied the very best character and principles one can hope for in a physician.
But perhaps most moving of all was the story of lifetime achievement award-winner, Dr. Emil Freireich. Dr. Freireich was born to Hungarian immigrants, his father died when Emil was 2 years old, his mother worked in a sewing factory to provide for his needs growing up. Through sheer grit and determination, Emil managed to get himself to college and then medical school. He began his career in 1955 at the National Cancer Institute (and has been working at MD Anderson Cancer Center since 1965) where he was provided a challenge: to cure childhood leukemia. Here is what Dr. Freireich had to say about how things have advanced in the field of leukemia in his lifetime:
In 1955 when I began my career at the National Cancer Institute, children diagnosed with leukemia usually lived for about 8 weeks. They had about a 1% chance of surviving a year – and they had a median age of 5 years old at diagnosis.
The worst thing about leukemia was not the short life expectancy, but the way the children died. You see, leukemia destroys blood platelets (the part of the blood that allows it to clot), and produces its own anti-coagulant. So every child with leukemia died of massive hemorrhaging. As a doctor in 1955, when I entered the leukemia ward, all I saw was blood. The children were bleeding in their urine, stool, lungs, and even from their eyes. They would cough to breathe and spew blood as high as the ceilings. The wards were red with death.
But now, thanks to years of research and the development of combination chemotherapy, leukemia is not a death sentence. In most cases it can be cured, and in all cases we can stop the bleeding.
The most rewarding part of my career has been treating young children with leukemia, and watching these same children grow up to become physicians who treat other children with leukemia. I have passed the torch on to them, and I believe that they will one day find the cure for other cancers too. I believe we will get there soon.
I had the chance to interview Dr. Freireich for this blog last year. You may read more here. Congratulations to all the awardees of the event – carry the torch high for us docs, we need more stories of hope like yours… and thanks to Castle Connolly for such an inspirational evening.
I’d like to point out an error I made during a more optimistic time in my online career. Last year on my blog I suggested that physician ratings were “here to stay” so physicians should “embrace the inevitable.” What I hadn’t thought through at the time was the fact that virtually no one would use the ratings tools. I had made a fairly narcissistic assumption: that everyone cared so much about their healthcare experience that they were dying to describe it online.
The truth is that any online tool, portal, social network, or health 2.0 application must deliver a compelling “value proposition” to the user, especially if participation requires any degree of effort. It is human nature to take part in activities that reward us for our time. For example, we may slave over a hot stove because we stand to gain a delicious, satisfying meal in the end; we continue to work at jobs that we dislike because the paycheck makes it worthwhile. But why would a patient fill out a lengthy survey about his or her doctor when there’s no obvious value to them in doing so?
A recent article in Slate (h/t to the ACP Internist) makes a compelling case for why physician-rating sites have such low participation rates as to be fairly useless. The return on investment (time spent filling out a long questionnaire) is extremely low, and is worthwhile to only the most irritated patients. And of course, there is no policing of contributions – physicians can rate themselves into the highest quality rankings by logging in as fictional patients.
So does this mean that there are no worthwhile physician rating tools online? The Slate author would have you believe that there are none. However, I would suggest that Castle Connolly’s America’s Top Doctors list is a reliable, if somewhat limited source. Why? Because teams of staff (who are paid by Castle Connolly) do the heavy-lifting, requiring no effort from patients or online raters. Castle Connolly reviewers first request nominations for physician excellence from within a given specialty and region. Peers nominate others for the honor and then the Castle Connolly staff seek corroborative data from surveys sent to physician peers, hospital administrators, and support staff to ensure that nominated physicians are indeed highly esteemed by many of those with whom they work. In the end, about 10% of physicians are fully vetted and included in the list - and I’d say that the selection process is quite sensitive but not specific. In other words, a physician listed in America’s Top Doctors is likely to be excellent, but many excellent physicians are not captured by the methods.
I spoke to John Connolly in a recent interview about how to find a good physician and you may listen to the podcast here. Locating a good doctor is not too difficult – but finding one that will take your insurance (or still has some slots available for new patients) is another story.