How to Choose a Clinician

By Daniel S. Frank, MD

A great feature of MedNorthwest is the many highly trained clinicians who practice here. But if you’re looking to establish a concierge medicine relationship, how do you choose a physician? I’m going to try and answer that question, but—full disclosure—what follows is just the very opinionated views of one physician, albeit someone in practice for over 30 years.

A helpful reminder: Although it is important to have a “point person,” you belong to all of the clinicians in the office. You are a patient of MedNorthwest, not of just one clinician, and every doctor, every nurse practitioner, and every medical assistant is here to help you. We try to schedule a “meet and greet” visit with several of our clinicians so you can meet more than one. If you pick someone to be a point person and later decide it is not the right fit, just pick someone else and tell the front office staff to switch you over. We have no ego in this process. Everyone in the practice wants only for our patients to be happy and get good care.

Before I dive in on my opinions, I’d like to review the scientific research that has been done on picking a primary care provider (PCP). Dozens of research papers have been published, and the consensus is that women produce slightly better health outcomes than men. In addition, nurse practitioners get higher patient satisfaction ratings and provide care that is just as good as MDs working in the same setting. So, if you want a choice supported by 30 years of health-services research, just pick Melissa Kester, DNP or Ivy Evans, ARNP, MPH.

But not so fast, because other research shows that doctors with high medical licensing exam scores produce better patient outcomes than those with average or low scores. Dr. Panchanathan’s licensing test scores were so high that of the 6,522 internists who took the exam his year, there were only a few dozen that scored higher, and most of them became sub-specialists. I would venture to say that he probably has the highest exam scores of any general internist in the state of Washington. So, just pick Dr. Panchanathan and your choice is supported by decades of data on physician performance. (Dr. P also out-scored 97% of all neurosurgeons, by the way, and Ivy and Melissa are, like Dr. P, excellent test-takers.)

Another approach is to put on a blindfold and shoot one of those toy suction cup darts at your computer screen on the About Us page at MedNorthwest.com. Why a suction cup dart? Well, a regular dart would probably just bounce off and you’d be no closer to making a decision but have a scratch on your monitor. Actually, other research suggests that the care from facility to facility varies much more—from good to awful—as compared to the care among clinicians in the same facility. The fact is that all the clinicians at MedNorthwest practice collaboratively, and our standards are pretty ding-dang high. Care is going to be pretty similar across our group of clinicians. Every clinician here is held to the same high standard, whether an MD, ARNP, DNP, internist, or family medicine doc, and even the janitor has to be able to manage diabetes and hypertension. The big choice is coming here or going elsewhere and so aim your dart, with your blindfold off, in that manner.

Ok, on to my own opinions. You can compare MD physicians, nurse practitioners, physician assistants, or whatever, but it really boils down to two elements: The person and the environment. A gifted clinician, someone who is born to do this sort of work, practicing in a great environment, will generally produce very good patient care. That said, if you take a chef from Le Courdon Bleu and put him on the Sunday breakfast rush at Denny’s, I’m sorry, but the food is not going to be world class. Great, demanding, exacting environments that enforce high standards of excellence produce good health outcomes. Not everyone wants to sign up to work in a place like that, but MedNorthwest is such a place.

As for the person, being a good clinician is a talent, like being a great juggler or violinist, and requires two simple things: Possessing good instincts about what is the right thing to do, and walking around all day long with the sensation of a knife plunged deeply into your abdomen, twisting, and telling you that you are inadequate and need to work harder. That is what makes a great clinician, regardless of the specific educational route one takes. It’s been said that a typical general surgeon is only two bad outcomes away from wanting to kill himself. I’d add that a great clinician who only berates himself for a year following a missed diagnosis is getting off easy.

Since the person and the environment matter more than the degree, I would suggest going with your gut when you choose a physician. If you want a female clinician who has an MD degree, go with Martha Fitelson, MD. If you have the sense that a nurse practitioner might be a better listener and spend more time with you, go with Ivy Evans, ARNP, MPH or Melissa Kester, DNP. If you want an MD physician who has higher test scores than his professors in med school, go with Dr. Panchanathan.

All the clinicians at MedNorthwest consider ourselves to be first and foremost generalists, but because Ivy is an adult-gerontological nurse practitioner, she has extra training in geriatrics and takes care of several complex, frail, older patients. Martha Fitelson, MD has special expertise in palliative care and is fluent in Spanish. Dr. Panchanathan has extra training in radiology. Although we may have some areas of particular interest, we are, above all else, generalists. The excessive focus on specialization in medicine has produced some really bad outcomes for patients. Somewhere, there must be a group of clinicians who will be supreme generalists and “captain the ship,” overseeing and supervising the work of the specialists. That place is MedNorthwest.

If you still are unsure about whom to pick, you can always call me and I will provide additional insight into how to choose a physician. Some of our clinicians may be a better fit for certain issues. In addition, I have prepared the following table to assist you.