Finding a great match!

One of my favorite movie scenes is from Miracle on 34th Street, where Kris Kringle let's a customer shopping for Christmas presents know that if they can't find something at Macy, he'd recommend a competitor (this link is grainy at off-sync a bit, but you get the idea).

I think one of the clear messages is no service provider can be all things to everyone, and so if you are not able to provide the service requested, often times the best customer service is no service.

The relationship between a patient and their doctor is first and foremost a relationship.  Much like dating, there are subtleties that make a relationship work, but also times the fit isn't ideal.  When that is the case, it's best to recognize the lack of fit, so that the patient can find someone who fits their needs and style.

Another analogy is the world of burritos. In our area, you can get a great burrito at Chipotle, Baja Fresh, Qdobo, and a myriad of other places.  Chipotle is my personal favorite, but I am glad that I have a choice.  I'd hate to have a system that mandated uniformity.  Variation is good.

In healthcare, that is true as well.  I have some colleagues I respect greatly who have different practice styles.  My practice style could be summarized as a musculoskeletal root-cause analysis, but with dogs in the office, and a graduation ceremony with maracas when you get better.  It's not the right choice for everyone, and I am ok with that.  I don't want to be good for anyone- I want to be great for a subset of patients, and help other people find a great fit with someone who meets their style.

One of the things that helps an efficient market is choice and transparency.  As my partner Garrett Hyman noted, the recently released Medicare billing data doesn't really add transparency- it mostly adds a lot of noise to true signal.  On the other hand, I think this blog provides transparency.  One of the main reasons I like to blog is that it offers patients a free "test drive" to my style and way of thinking.  For example, my personal diagnostic approach is rooted in thinking through a differential diagnosis, and my blog post on Differential Diagnosis explains how I think.

An additional part of this transparency and choice is freedom of choice for referral sources.  As I continue to work with colleagues, they start to develop familiarity with what I do well and what I don't do well, and that can help coordinate a good fit for the patient.

For example, many referral sources like to refer to me because they know I do a very thorough biomechanical assessment, give feedback on exercise, have expertise in diagnostic musculoskeletal ultrasound, and that I am skilled with both ultrasound-guided and fluoroscopically-guided injections.  For patients looking for that approach, I am a great fit.

Conversely, I do not prescribe oral medications for musculoskeletal conditions.  I don't think they work in the long term, and I think their usage gets in the way of more effective treatment approaches.  I have evidence-based and experience-based reasons for this philosophy, and this not a negotiable part of my practice style.  For patients looking for oral medications as part of their treatment, I am a horrible fit.  My preference is that patients understand this as early in the process as possible, preferably before the first encounter even.

Bottom line- great care starts with a great match!  Sometimes that great match is going to Gimbels instead of Macy's.  Patients should have the right to have a choice