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Old 21.11.2020, 12:05
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Good Doctor, Bad Doctor- How to Know

Internations Zurich is doing a presentation in a week or so

https://www.internations.org/event/p...4?ref=pw_ce_tl

The person focused is a Dr. from New York who has written a good book. In it he has a list of questions you should be asking your Doctor.

I have recommended that we ask questions which many people are doing now adays. Often there are alternatives to medications. You need to do your research which many people on this list
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Old 21.11.2020, 12:11
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Re: Good Doctor, Bad Doctor- How to Know

Good doctor, bad doctor? what does it mean?


Objectively, it is difficult to judge - most people judge by what they think is a good or bad doctor- and that may be very different.


Is a good doctor the one who gives you what you want, expect, demand? be they drugs or operations, treatment, etc?


Or the one who takes time to explain why it may not be a good idea, and that alternatives may be better. Or ??? But who will be more expensive because explaining and educating takes time and care.
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Old 21.11.2020, 18:03
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Re: Good Doctor, Bad Doctor- How to Know

I think a good doctor
  1. listens to the patient's questions and provides answers, as far as possible
  2. tries to look beyond and see what else is crying out for attention, that the patient may not know or may not have thought to mention
  3. asks whether the patient wants to be informed fully (some prefer not to really know and just to follow the doctor's guidance)
  4. writes down the main points for the patient to take away
  5. states clearly when he/she does not know what to do next, and suggests specialists to whom the patient could be referred
  6. is not afraid of dealing with the relevant insurances, to motivate that the costs of a necessary procedure be covered
  7. involves other medical professionals, and the patient's family, only with the express consent of the patient.

As you say, JackieH, each patient will have a different view.
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Old 21.11.2020, 18:37
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Re: Good Doctor, Bad Doctor- How to Know

Talking GPs: If you feel taken seriously and taken care of: Good doctor.
Talking surgeons: Same as above plus how many of their patients recovered .... how many are dead?
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Old 21.11.2020, 20:47
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Re: Good Doctor, Bad Doctor- How to Know

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Talking surgeons: Same as above plus how many of their patients recovered .... how many are dead?
Good idea, yes. And how do you find this out?
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Old 21.11.2020, 21:32
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Re: Good Doctor, Bad Doctor- How to Know

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Good idea, yes. And how do you find this out?
Not sure.
That's why I always first contact my GP when I have a problem. He seems to like me.
Actually when my GP passes me on to a specialist he always tells me what he appreciates about the the specialist and how long he has worked with them successfully so far. And I was never disappointed. So yes, one's GP is a good reference.
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Old 21.11.2020, 21:54
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Re: Good Doctor, Bad Doctor- How to Know

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Good idea, yes. And how do you find this out?
You can ask directly if you're brave/forward/direct enough. In the States I had no issues with asking surgeons how many times they'd performed a specific procedure and how many times there were serious complications.

Here in CH I have been a bit less brave. I asked one potential surgeon to tell me a bit more about himself and how he came to be in Bern (he's not Swiss). I then asked how often he'd seen major complications in the surgery we were considering. He told me a number I found rather shocking, but he followed it up saying A) none of his patients had died as a result of the surgery or complications and B) not all patients want to know that level of detail up front. Some want the surgery no matter what and don't want to stress out over potential complications.
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Old 21.11.2020, 22:07
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Re: Good Doctor, Bad Doctor- How to Know

One of the attributes of a good Doctor is a good referral network, and I’ve had good referrals here.

The other question it‘s common to ask is „would you recommend this treatment to a member of your family?“

And for procedures, you want someone who does a lot of them. Ten years ago, I was referred to a gyn to do my lumpectomy. I asked her how many surgeries she did in a year. She was completely unused to the question - it‘s not common at all to ask that here. Turned out she does a lot and did a great job. Three years ago, I had my knees done and the ortho was more accustomed to that question. Also does a lot and was happy with the outcome.

But it‘s difficult. When you‘re not feeling well decision making is not always easy and it‘s easy to be overwhelmed, especially in a foreign language and different medical culture. You always need to be able to stop and ask ... unless it is an emergency.
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Old 22.11.2020, 00:15
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Re: Good Doctor, Bad Doctor- How to Know

A good doctor will
  • not lose patience when the patient stops to say: "I just need a moment, please, to check my list of questions, to see whether I've now asked you everything I'd jotted down beforehand."
  • accept and welcome, into the conversation, whomsoever the patient has decided to bring along, to better understand, or to sit quietly taking notes, or perhaps to help in the discussion and in taking decisions.
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Old 22.11.2020, 11:38
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Re: Good Doctor, Bad Doctor- How to Know

Dorofiz- agreed- and yet. You also need someone with a good diagnosis. Empathy and time are wonderful, but in medicine, without good diagnosis and skills, not enough.




Such a shame that in Switzerland, because of cost- many do not register with a doctor and get to know her or him until in an emergency, as we see regularly on EF. In the UK, where visits are free, it is very common for people when moving to a new area to ask for an initial visit with a GP to see if they are 'compatible'- to 'interview' them on basic values and experience with treating certain ailments. OH always appreciated people who asked to talk to him before registering with him- and from time to time- it was decided that he would not be the best person, by mutual or one-sided (either way) agreement.
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Old 22.11.2020, 12:03
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Re: Good Doctor, Bad Doctor- How to Know

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Such a shame that in Switzerland, because of cost- many do not register with a doctor and get to know her or him until in an emergency, as we see regularly on EF.
I'm not sure it's cost that keeps people from asking for an introductory visit, but rather, my experience has been that this is simply not something many GPs here commonly offer. The GPs I have seen expect a patient to have a sufficiently serious reason - an acute illness - to make best use of their time. During my many years-long search for a GP able to take on new patients several practices I contacted explicitedly said that they do not do introductory visits.

Perhaps this is because of the GP shortage - few practices have capacity for new patients, the GP's schedule is overloaded as it is. Taking time for a patient who is not acutely ill just isn't possible.

I would guess that in areas where there are more practitioners an introductory visit might be more common.

---

I really don't have a relationship with a GP any more.

After a succession of GPs who each retired shortly after I was able to get on the books (triggering a new lengthy search for a provider) I was able to get into a group practice. You see whoever is available that day, and as young doctors seem to rotate through the practice on their way elsewhere the chance of seeing the same GP from year to year is small. I've sort of adjusted my expectations - the Praxis Assistants seem to stick around longer, so that is the person to build a relationship with rather than the doctors.
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Old 22.11.2020, 12:33
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Re: Good Doctor, Bad Doctor- How to Know

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I really don't have a relationship with a GP any more.

After a succession of GPs who each retired shortly after I was able to get on the books (triggering a new lengthy search for a provider) I was able to get into a group practice. You see whoever is available that day, and as young doctors seem to rotate through the practice on their way elsewhere the chance of seeing the same GP from year to year is small. I've sort of adjusted my expectations - the Praxis Assistants seem to stick around longer, so that is the person to build a relationship with rather than the doctors.
That’s pretty much how it is in the UK now too. The vast majority of GPs work as part of a group practice and whilst you are technically registered with a specific GP in the practice in reality if you need an appointment you see whoever has an available spot. GPs are overstretched everywhere.

I have a fabulous GP here, we were very lucky that when our old GP retired the practice was taken over by a lovely young doctor. I appreciate that this is a pretty rare occurrence these days.

Going back to the OP. Whether a doctor is good or bad or not is a very subjective thing, what one person considers to be a good thing somebody else may think is bad.

I remember when we were living in France and soon after we arrived a new GP practice moved into the building next to ours. We thought it was a really handy thing to happen and used him as our GP. He was relatively young, empathetic and competent in our opinion.
Our old french neighbours had a GP in town that they’d always used but when they needed a medical certificate for their son before he went on a diving trip with the summer school she was in holiday so they asked the GP next door instead. They were horrified that he refused to issue the medical certificate without first seeing and examining their son. Apparently they just had to phone their regular doctor and she would provide one despite having never seen or examined the boy.
In their eyes this made him a terrible doctor and they vowed never to use him.
In our eyes this made him a very good doctor and we continued to use him. We thought issuing medical certificates without seeing patients a very irresponsible thing to do and would never have used their doctor.
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Old 22.11.2020, 12:34
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Re: Good Doctor, Bad Doctor- How to Know

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I think a good doctor
  1. listens to the patient's questions and provides answers, as far as possible
  2. tries to look beyond and see what else is crying out for attention, that the patient may not know or may not have thought to mention
  3. asks whether the patient wants to be informed fully (some prefer not to really know and just to follow the doctor's guidance)
  4. writes down the main points for the patient to take away
  5. states clearly when he/she does not know what to do next, and suggests specialists to whom the patient could be referred
  6. is not afraid of dealing with the relevant insurances, to motivate that the costs of a necessary procedure be covered
  7. involves other medical professionals, and the patient's family, only with the express consent of the patient.
In my opinion, I think you've missed out the most important point - a good doctor is not afraid to tell a patient, in no uncertain terms, that neither they, the doctor, nor medication, nor throwing money at it will help the patient's condition and they need to make some effort themselves to sort out their medical conditions.

My GP here is pretty honest and worked in my hometown in the U.K. for many years before coming here.

He told me that whilst in the U.K, a large number of his patients had conditions related to their obesity, here there are many more conditions related to the patient's smoking habits - lung conditions, sinus conditions and so on.

I think a good doctor needs to (in a caring way) tell the patient that they need to change their lifestyle choices to improve their health.
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Old 22.11.2020, 12:51
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Re: Good Doctor, Bad Doctor- How to Know

Agreed, but this is much easier to do in the UK, where a patient is registered officially with one GP- it gives a real chance to 'educate' over a longer period of time. As you know I grew up in CH, and in our village, there were 3 GPs - one was famous for giving time off and any drugs/treatment on request. People thought he was mar ve lous... The other two would not give drugs, antibiotics or treatments or referrals like sweets and tried to get to bottom of cause and discuss changes that could help massively. Their patients appreciated that and tried to work with them. But the one getting rich fast was the first one ...


When I had to have a first knee operation in UK (had 2 knee replacements later here in CH)- I asked OH and a couple of medic friends who to go to. The verdict was clear- go to Mr A- his bedside manner is appalling, he is an utter b****rd- but he is the best surgeon. Mr. B and Mr C. are good too, and they are really nice people, but A is the best surgeon. I went to Mr A (surgeons are called Mr in the UK- call them Dr and they won't be happy) - he was horrible- but he did a great job. It was actually quite funny, as I was prepared.
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Old 22.11.2020, 13:25
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Re: Good Doctor, Bad Doctor- How to Know

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Agreed, but this is much easier to do in the UK, where a patient is registered officially with one GP- it gives a real chance to 'educate' over a longer period of time. As you know I grew up in CH, and in our village, there were 3 GPs - one was famous for giving time off and any drugs/treatment on request. People thought he was mar ve lous... The other two would not give drugs, antibiotics or treatments or referrals like sweets and tried to get to bottom of cause and discuss changes that could help massively. Their patients appreciated that and tried to work with them. But the one getting rich fast was the first one ...


When I had to have a first knee operation in UK (had 2 knee replacements later here in CH)- I asked OH and a couple of medic friends who to go to. The verdict was clear- go to Mr A- his bedside manner is appalling, he is an utter b****rd- but he is the best surgeon. Mr. B and Mr C. are good too, and they are really nice people, but A is the best surgeon. I went to Mr A (surgeons are called Mr in the UK- call them Dr and they won't be happy) - he was horrible- but he did a great job. It was actually quite funny, as I was prepared.
I'm registered officially with one GP - this is part of my insurance conditions.

I'm not sure why you think the UK is different (other than in the negative sense that you can't see a GP other than the one you register with, and typically can't even see your own without a week or two notice).
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Old 22.11.2020, 13:39
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Re: Good Doctor, Bad Doctor- How to Know

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I'm registered officially with one GP - this is part of my insurance conditions.
Anybody who has the GP model here will have a GP as it is a prerequisite for the insurance.
I read somewhere that it is the most commonly used insurance model here so in theory a lot of people in Switzerland will have a designated GP.
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Old 22.11.2020, 14:31
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Re: Good Doctor, Bad Doctor- How to Know

When I was having chemo in 2011, I saw my oncologist every week. He recommended a few things, which I followed and my GP was offended as I’d not consulted with him. At point I asked about it and he said, well yes, cancer is more important right now. But I had the distinct impression he didn’t like my oncologist. Doctors are people too.

Anyway, we moved shortly after that and I found a new GP. And she’s been very good. But I’ve been lucky...both GP’s I picked out of the phone book as closest to me. We’ve also made it a point to live in high population areas. Both GP’s are in practices, but you see mostly one person.

I don’t have the GP model though....I do have a non binding telmed model with SWICA.
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Old 22.11.2020, 14:32
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Re: Good Doctor, Bad Doctor- How to Know

It would be interesting to see the figures and proportions for people with GP Model. However, the GP Model is quite recent. Most people I know here do not have GP model as they want to be free to choose and shop around- and many do. Very expensive and to some extent, dangerous. If they are given advice they do not like, they just go to another until they hear what they want to hear.
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Old 23.11.2020, 11:08
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Re: Good Doctor, Bad Doctor- How to Know

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It would be interesting to see the figures and proportions for people with GP Model. .
According to this article in the 20 Minuten, about 70% of Swiss residents have either a Hausarz, Telemed, or other type of managed care model.

https://www.20min.ch/story/bundesrat...n-369690598027

FYI, the article reports on a cost-saving proposal by Berset to limit or eliminate the option of free choice of doctor in the basic insurance. Critics of the proposal point out that with managed care already at 70%, the savings potential of this proposal is less than the BR expects, and that a better route might be to make managed care more attractive - or free choice more expensive.
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Old 25.11.2020, 03:09
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Re: Good Doctor, Bad Doctor- How to Know

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Anybody who has the GP model here will have a GP as it is a prerequisite for the insurance.
I read somewhere that it is the most commonly used insurance model here so in theory a lot of people in Switzerland will have a designated GP.
All too much "in theory". I know several people who are in a GP or HMO model but still do not, in fact, have a regular GP.

They attend a group practice which is on their medical insurance's approved list. But when they do so, they are seen by whomsoever is on duty at the time. This is so for urgent, unplanned needs, but also for appointments made well in advance.

They all find this system annoying and inefficient. They say that it takes them, and the doctors, longer to get anything done. There's no opportunity to build up a professional relationship, and at each appointment the next randomly assigned doctor in the practice first has to spend time reading up the medical record, and asking the same questions, and sometimes doing the same examinations, from scratch.

One friend told me: "I've now had three first appointments about my foot."

In another case, the doctor told the patient he would read up on a procedure, and discuss his case with a specialist, but when the patient returned to the next appointment just weeks later, he was seen by someone else. When he asked, no-one knew anything about any discussion of that procedure and he was told that, anyway, the doctor he'd seen last time no longer worked there. Back to square one.
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