How Doctors Choose a Doctor

It stands to reason that a doctor should show greater expertise than the average man in picking a doctor for himself. Not so, says Sociologist Herbert Bynder of the University of Colorado. Doctors like to think that they choose their own physicians on the basis of qualifications and competence, but in most cases they are deceiving themselves.

As Bynder sees it, the chief factor involved when a doctor picks his own doctor is his inability to give up his superior role. "Doctors don't want to be dependent," he says. "They can't stand the thought of losing rank and of being subordinate, even to another physician. All their training and background in medicine are against it. Their role in practicing medicine is always that of a superior, an authoritarian who gives the orders."

For a run-of-the-mine illness, even if it includes hospitalization, the physician tries hard to retain that role. By choosing someone his own age, to whom he has referred patients and who in turn has referred patients to him, he achieves a cozy sense of equality. If he knows the other physician socially, so much the better. If he has to be hospitalized, he shuns strange institutions where he would be just another patient and addressed as "Mr." rather than "Dr." He tries hard to obtain admission to his own hospital.

Talking Down. Among Bynder's criteria for rating the doctors chosen by other doctors are: 1) whether they have university appointments and if so, what rank, 2) their standing in professional societies, and 3) whether they are board-certified specialists. According to these standards, doctors choose a topnotch doctor in only 33% of the cases involving a minor illness. With a more serious illness, they are more likely to seek the most expert care. But Bynder found it "particularly striking" that even in such instances, they buy the best in only 55% of the cases.

With all this savvy, Bynder should be an expert in picking a doctor. He sorrowfully admits that when he applied his own rules--selecting a doctor by his educational and training qualifications--it turned out badly on his first two tries. He felt that both doctors talked down to him, when they condescended to talk at all, and treated him impersonally. After Bynder moved to Colorado, he got his doctor the way most people do--by asking a neighbor for a recommendation. This doctor is roughly 15 years older than Bynder, whereas the first two were close to his own age--and therefore might have been trying to maintain their authority by keeping their distance. Most important, says Bynder, his present Colorado doctor "takes the time and effort to explain things to me. He doesn't talk down to me. So I have confidence in him."

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