Sydney Zaremba's mother developed a large growth on her neck in
summer 2011, which turned out to be diffuse large B-cell lymphoma.
The 88-year-old woman's primary care physician referred her to an Oakland County specialist for treatment. Helene
Zaremba died that November.
close to two years later, Sydney Zaremba is fraught with questions over
the decisions she made about her mother's care: Did she need so much
chemo? Was she on too many medications?
Zaremba, 58, of Rochester,
Mich., is suspicious of the doctor who oversaw the treatment - a
specialist she didn't vet and instead took at the recommendation of her
mother's primary care physician.
Experts say it's common for
people to rely on the recommendations of others or fail to thoroughly
research doctors, with some studies showing people spent more time
researching a new vehicle purchase than choosing a physician. A bad car
can translate into years of grumbling - but a lousy physician can mean
life or death.
As more people are signing up for health insurance
under the Affordable Care Act, along with increases in referrals to
specialists, experts say it's more important than ever for people to
take an active role in their health care and who provides it.
stakes are higher, and health care is complicated," said Dr. Ardis
Hoven, president of the American Medical Association, which counts
225,000 of the 1 million-plus doctors in the U.S. among its members. "I
wish there was a magic answer to plug in there for you. At the end of
the day, there isn't one, and that's why front-end selection (is
Hoven's advice: Trust your instinct.
got to keep your eyes and ears open and not be afraid to ask questions,"
she said. "People have got to learn it's not like going online to find a
good restaurant to eat. It's a different situation, and you must use
all resources available to you."
Zaremba was treated by Dr. Farid Fata, the hematologist-oncologist and
owner of Michigan Hematology Oncology Centers who is currently awaiting
trial in a $35-million Medicare scheme. Authorities allege he gave
patients medically unnecessary treatments, including chemotherapy, and
misdiagnosed healthy people with cancer to bill for treatments.
"We took the recommendation," Sydney Zaremba said. "I don't know if
we found out anything about him because everyone thought he was great. I
did look him up online and the center because you want to know about
the doctor. It was nothing, just about his education.... I was told he
was good from (her physician, Dr. Bradford Merrelli), and we thought it
was a good place to go."
Merrelli, who has practiced family medicine for 27 years, said he screens the specialists to whom he directs his patients.
had the training. He had the personality, and he was extremely
available," Merrelli said of Fata. "Patients don't just wander into
oncologists' offices. They go there because someone trusted their care.
He obviously convinced a lot of people."
Gina Balaya, spokeswoman for U.S. Attorney Barbara McQuade, declined to comment on how Fata got his referrals.
are going to medical specialists more and more. According to a recent
national study in the journal Archives of Internal Medicine, the
probability of receiving a referral during a doctor's visit increased
from 4.8% to 9.3% between 1999 and 2009.
Wayne State University
health economist Gail Jensen Summers said the increase stems from the
growing number of managed-care plans that have replaced self-referrals
with the primary care physician serving as a gatekeeper, for efficiency
and cost savings. She also noted physician group practices are expanding
to include auxiliary services such as labs and physical therapy, and
many have medical specialists on staff.
Checking on your own
Even if your primary care physician gives you a referral, experts say it's a good idea to do your own checking.
Start by running through state medical boards or licensing divisions, which track license suspensions and revocations.
The American Medical Association's DoctorFinder lists data such as
schooling, residency training and specialty for members; for nonmembers,
it lists just the specialty.
"Part of the challenge patients face
is they wait until they're sick and then try to find a doctor," Crader
said. "That's when it becomes more hastily done."
Some patients turn to websites like www.healthgrades.com or www.vitals.com,
which are the medical equivalents of Yelp. The anonymity of the those
sites can be problematic because anyone can post false information, and
they have a limited number of reviews per physician - so one bad review
out of a sample of four could make a doctor appear to be a poor
"Unfortunately, there's not a grading system out
there right now that in fact does that," Hoven said about evaluating
doctors, adding that the federal government is considering one in the
future, like the Centers for Medicare & Medicaid Services now does
for hospitals. "But that's in a really rudimentary stage right now
because you need to compare apples to apples."
Summers suspects establishing such a system would take at least five years.
doctors are resistant to this. But there's another problem. How do you
measure quality? It's not easy to measure in the case of physicians,"
Doing it differently
If Zaremba had it to
do over, she said she would have sought a second or third opinion and
talked to more people - including her own primary care physician -
before settling on a specialist for her mother's care.
"I'd get a
couple of opinions from friends or relatives, people in general who
might know someone," said Zaremba, a fitness company owner. "If not, we
look online or in the phone book. We don't always go with least
expensive. That's probably what I should've done with my mom, but we
were told aggressive cancer."
Zaremba failed to get a second
opinion herself when she had thyroid cancer 11 years ago. But in that
case, it worked out - her doctor referred her to an endocrinologist she
still praises today.
"I had a fantastic team," she said. "It went well, and I guess we thought it would go well for my mother."