When I started my practice, patients found me through the Yellow Pages. “I recognized your address,” they said, or “You were convenient.” It seemed a little impersonal, but what could I expect? I was new.
Later, patients found me on HMO lists. Their physicians referred them because I was the only dermatologist on the rosters at the time, my older colleagues having refused to join. I dutifully sent referral letters to physicians I didn't know: “Dear Doctor: Thank you for referring Jane. I am treating her acne with such-and-such.” Perhaps they read them.
As my fame and reputation grew, I began getting referrals from doctors' receptionists. “They gave me a list,” patients would say.” 'Here are the three dermatologists we use.' The lady at the front desk suggested you.” An article I once wrote for a medical magazine was titled, “My Doctor's Receptionist's Hairdresser Sent Me Over.”
I understood all this. Even before our field became synonymous in the public mind with Botox and cosmetic fluff, nondermatologists thought of skin diseases as something exotic and superficial (“It's one of those skin things. Go see a skin guy.”), if not alien and frightening (“Lordy, it's one of those skin things! Go see a skin guy!”).
I could be wrong, but I can't imagine similar referrals to other specialties. (“Your ticker is tocking. Go see a heart guy.”) In any case, even when patients have come from other physicians, I have rarely felt a sense of the real collegiality I imagine takes place in hospital corridors and cafeterias. Once in a great while over the years, I've gotten an urgent call from a doctor in my own building eager to send down a patient with a dramatic rash, and I've even gone upstairs myself while the patient was still with the internist or surgeon. Such occasions have been uniquely satisfying, though rare enough that I can actually remember them.
Now that I've been around for a long time, many of the doctors who used to refer patients to me, one way or another, have retired, slowed down, or gone concierge. Also, more people have PPOs that don't require physician referral. As a result, when I ask, “Who referred you to me?” I'm apt to hear, “I looked you up online on my insurer's Web site, and I recognized your address. You were convenient.” Higher tech, but familiar.
Sometimes people are referred by other people. “I got your name from a friend,” they'll say.
“Neat. Which friend?”
“Uhhh … actually, I think it was my mother-in-law's friend.”
Then of course there's Google. “I did an Internet search,” a new patient says.
“No kidding,” I reply. “What did you search for?”
“Dermatologists in Brookline.”
Makes you feel warm and fuzzy all over, doesn't it?
One patient was more flattering. “I Googled 'Top Dermatologists, Brookline.'”
Wow, I thought. I've been optimized.
I Googled that myself, and what came up first was an Internet Yellow Pages site with a list called “Featured Advertisers: Dermatology” on top, the first of which was an animal hospital, with an offer to “get coupon for pet's first visit!” Next to that was a listing for a (human) dermatologist in a town 20 miles north. Scrolling down past more advertisers and a long paragraph of skin-related keywords, I found actual dermatologists in Brookline. I came in second, with an incorrect address.
Just for fun, I Googled “Bottom Dermatologist Brookline.” The top listing for that was an answer on a medical Web site that I wrote in 2005 to a worried questioner who had pimples on his bottom. Bottom's up!
Not long ago, I saw a patient who identified herself as a “health writer for the Wall Street Journal.” After I examined her, she asked me for the name of an internist. “I need someone affiliated with a major teaching hospital,” she explained. “In case I get sick, I need access to the most advanced medical care. I'm a sophisticated medical consumer,” she added. “After all, I'm a health writer for the Wall Street Journal.”
I gave her the names of two doctors. “By the way,” I asked her, “how did you find me?”
“The mailman,” she said. “I met him while I was walking by your building, and he told me he hears you're good.”
Well, I am the only dermatologist in the building.