The Gulfshore's Best Doctors

In 1999 the Institute of Medicine estimated that up to 98,000 Americans die each year from preventable medical mistakes in hospitals, more than from "highway accidents, breast cancer or AIDS." And while most patients will not be the victims of outright mistakes, who can say how many might have lived longer or returned to health sooner if their doctors had been more astute diagnosticians, more informed about the latest therapies, or just better at explaining things to patients and their families? Choosing the right doctor can save your life. But how can you judge how good a doctor is?

"In an ideal world, your brother or sister is a doctor," quips Dr. C.B. Rebsamen, one of Lee Memorial Hospital's chief medical officers. And that's not only because you want your doctor to care about your health the way a family member would but because doctors know the inside story. They know which doctor has the lowest complication and mortality rates, which surgeon is most meticulous and who is most compassionate in times of crisis. But how do consumers get such information?

Best Doctors, a Boston and Aiken, S.C., company whose primary business is to find, for a fee, the best doctors for customers with serious and complicated medical conditions, bases its research on just that kind of inside information. The company has been assembling lists of the best doctors in America for 10 years. It sends tens of thousands of surveys to doctors all around the country, asking them, "If you or a loved one needed a doctor in your specialty, to whom would you refer them?"

While Best Doctors uses sophisticated software to create surveys and tally results, it's really trying to mimic the informal process doctors use in real life-asking other doctors.

This year, Best Doctors sent out about 35,000 surveys. The doctors who received the surveys were carefully chosen. All were specialists, and most had made the best doctor list the previous year. The company's researchers believe that doctors who have been recognized as tops in their specialty are the logical choice to nominate and vote on other top doctors in that field. Each doctor receives a survey based on his or her specialty-cardiologists vote only on cardiologists, for example. When the surveys come back, Best Doctors tallies the votes and checks to make sure the top vote getters are board certified and have up-to-date licenses. Doctors who are not taking new patients or who are doing only administrative work or research are eliminated. Of the 814,000 doctors in the country, 30,000 made the list this year. Seventy-three of them are in Charlotte, Lee and Collier counties, and Gulfshore Life has been granted the exclusive right to publish this list, which we present on the following pages.

As carefully researched and well respected as the Best Doctors list is, however, it's just one factor to consider in choosing a doctor. "These lists are a starting point," agrees Susan Edgman Levitan, a Harvard Medical School professor who ran the Picker Institute, which collects patient feedback about health care. Informed patients should consider other sources of information as well, she advises.

"We find there's a huge gulf between what doctors think is important and what patients think is important," Levitan points out. Doctors usually cite superior technical skills, and while patients expect those skills, they consider a superior bedside manner just as important.

"For doctors it's an either-or situation," Levitan says. "But patients want both." And she notes that a good bedside manner is not just a touchy-feely thing. "Doctors can't be effective as healers if they can't talk about what's going on."

Health care professionals are starting to understand that bedside manner has a lot to do with how patients fare in the long run. In a landmark paper by the Institute of Medicine, called "Crossing the Quality Chasm: A New Health System for the 21st Century," national health care experts point out that most Americans who are ill suffer from common and chronic diseases such as heart disease, diabetes and asthma. These ailments require a team approach-lots of doctors, therapists and health care settings over a long period of time. A doctor who can't-or won't-communicate with patients about long-term care issues such as nutrition, exercise, therapy and medicines will fail to provide "safe, high-quality care."

Dr. Drew Mikulaschek, a trauma surgeon and the director of trauma services at Lee Memorial Hospital, agrees that technical skill is not enough. "Communication skills can be more important," he says. "Doctors are members of a team. They must be able to communicate in order for patients to get the best care. I don't want a doctor who is difficult to get hold of or who treats patients like they're an imposition."

While patients can learn about a doctor's bedside manner from other patients, evaluating clinical skills is more difficult. Doctors see other doctors in action and hear what that their peers have to say about each other. They also have access to hospital records about each physician's rates of mortality, infection and complications-a "knowledge base patients simply don't have," says Mikulaschek.

But that may change, he notes, as a growing "push for consumerism" spurs doctors and hospitals to become more responsive to patients' desire for information. "It's the biggest driving force right now," says Mikulaschek, one that recently propelled dozens of Fortune 500 companies, including FedEx, AT&T, IBM and Pepsi, to band together in a group called Leapfrog to examine health care quality and accountability.

So how do you find the best doctor? You must take an active role in the process, say the experts. Keep in mind that most of your medical needs can be satisfied locally. But only a few specialists in the world can treat rare and complicated conditions; if you are diagnosed with such a condition, it's essential to do an exhaustive search.

Begin with your primary care physician's recommendation, but don't stop there. The Internet is a godsend, and patients-or their families-can find endless material online about their conditions and the people who treat them. The Internet can also spread misinformation, however, so it's important to consult only reputable sites. Best Doctors has an award-winning Web site to help consumers, but there are others: www.medlineplus.com, which is a National Library of Medicine Web site, gives access to thousands of medical articles, and www.nih.gov is a clearinghouse of information about diseases and clinical trials. Almost every disease has an official association or organization that offers up-to-date information about treatments along with support networks of people who are willing to talk online about their experiences.

After satisfying yourself that the doctor has a solid clinical reputation, you need to evaluate his or her customer services, because those can also significantly affect your well-being.

Talk to people with your condition to find out if the doctor is open and warm or rude and aloof. Then interview the doctors on your list-and be bold. Ask them how many patients they've seen with your condition, how many surgeries they've performed and how many patients have died in surgery. Best Doctors has an online checklist of questions to ask doctors based on your particular condition.

And remember one more thing: Even the best doctor can only do so much.

"Everything doctors do is eventually going to fail," says Rebsamen at Lee Memorial. "We're all going to die some day from something. That's why compassion is so important in the end."

Dr. William M. Miles, Southwest Florida Heart Group, Fort Myers

Dr. William M. Miles likens his specialty to that of an electrician. A down-to-earth physician who spent many years practicing in the Midwest, he deals with heart arrhythmia that can cause cardiac arrest-as opposed to clots that block arteries and cause heart attacks, a "plumbing problem." In his specialty of cardiac electrophysiology, Miles looks for and treats irregular heart rhythms, which can kill suddenly via cardiac arrest or simply show up in symptoms like dizziness, faintness or lack of energy. The leading cause of death in the United States, heart disease in its many forms kills more than 700,000 Americans each year.

"Approximately a third of everybody who dies from heart trouble dies suddenly, and those sudden deaths are usually not heart attacks," says Miles, who got his medical training at the Medical College of Virginia in Richmond and was a professor of medicine for 15 years at the Indiana University School of Medicine in Indianapolis before moving to Fort Myers in 1998. "They're usually cardiac arrest with ventricular fibrillation. We treat people after they've already been rescued from cardiac arrest, but we also try to predict who's likely to be a candidate for having cardiac arrest in the future."