Qualy #109 - How does one select the right physician as a patient?

**Peter Attia** (0:11)
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**SPEAKER_1** (0:40)
MD Selection, I think you've received this question more than once.
How do I find a good doctor? So what is the best way to find a really good primary care physician? Are there specific telltale questions, labs I should bring up with the perspective of PCP? I think we covered that. But also to see if they've picked up a medical journal in the last 20 years.

**Peter Attia** (1:03)
You know, I sort of actually had this discussion with a patient on Monday who's looking for a concierge, you know, primary care physician, since I'm not a PCP. Many patients come to me already with a PCP, but sometimes they don't and they want to have this question. So, you know, I kind of walked him through my mental model, which is, there's no one size fits all here. You just have to decide what it is you need and want. So I think about availability, availability, affability, ability and advocacy as sort of the four broad pillars that you're looking for in a physician.
And it's pretty much impossible that you'd find all of those in the same person.
So what do I mean by those things? So advocacy is the physician who's connected and knows how to help you navigate through a storm.
When you need to go get a colonoscopy, they know the absolute best endoscopist, and if, God forbid, something comes back with a positive finding, they know exactly the right surgeon and boom, boom, boom. And not only do they have the Rolodex, but they know how to help you get through that.
They will be your advocate in the system. I personally think that's very important. I think many people aren't actually thinking of that, but it's important to ask a doctor explicitly and directly about that.
Ability, to me, is obviously, I just think that that's the single most important thing. I mean, in the end, yeah, bedside manners, great. Affability is important, but I'll never take affability over ability. You'd want both. They're not mutually exclusive, but don't be confused by affability at the expense of ability. So we'll come back to maybe how you can assess ability, but that's important. Affability is like, do you get along with this person? And I think you should be able to get along with your doctor. I mean, I think the days of going to the doctor who talks down to you and is basically preaching a bunch of commandments just doesn't make any sense. You just don't want those kind of people around because yeah, in the end, they might be the expert, but if they can't bring you along, then the relationship probably doesn't fit. And if I have a patient in which I feel like I can't bring them along or I don't connect with them, I certainly say to them, look, maybe this isn't working. And in the end, you maybe need somebody different from me who can communicate in a way that you like to be communicated with.
Availability is basically, or access is like, are you looking for someone that you can call 24-7? And that's, when people are looking for concierge docs, that's generally what they're looking for.
There are lots of non-concierge docs, though, that still have, and within the world of concierge, look, you've got like the $30,000 a year concierge guys, and you've got the $3,000 concierge guys. And so you also have to be able to think about, okay, well, within that, like, what's the difference between those two? What's worth $27,000 more per year? If that's the, and those are literally like, that's probably the range that I see in New York for concierge PCP.
But I guess the person asking this question is probably thinking mostly about ability. I think, you know, the question included something about, have they read a medical journal in the last 20 years? I mean, that's a good question because so much of what we learn in medical school is pretty much irrelevant by the time we're practicing, and the lag between when something becomes a finding and when it becomes mainstream or obvious enough that everybody's doing it. You know, I've seen that number estimated at anywhere from 12 to 20 years. So, yeah, it seems like a pretty inefficient system. So I think there you just wanna talk to your doctor and say, look, how busy are you clinically? How much time do you spend reading literature? And again, I wouldn't use buzzwords like evidence. Do you practice evidence-based medicine? Because what doctor is gonna say no to that question? Like it's sort of a silly question. It's, you know, it's like, so it's mostly just trying to inquire about the curiosity of the person, their passion around learning. Because I think in many ways, if you're not learning quite a bit as a doctor, you're probably not practicing great medicine. If you're not sort of trying to get smarter on diagnostics or advancements in the field, then you're probably stagnant. And it's not to say that a doctor who's stagnant can't do great work on certain things, but for most people, they don't want to have like six doctors in their life. You want to go to one person. So I think that's how I sort of think about that. Unfortunately, I'm not really a fan of a lot of the labels that people put on. Like, well, I practice functional medicine, or I'm part of this organization or that organization. I just, I don't know. I think in the end, you gotta just evaluate the person individually, regardless of those features. And I don't know if that answers the question, but.