Orthopedic surgeon Thomas Guastavino often alludes to his “rules of medicine” in the comments. Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are of equal efficacy, choose the safer. If of equal efficacy and safety, choose the cheaper. Cost never trumps efficacy or safety. If you want the fastest, most efficient and cost-effective care, go to the physician with the most experience in dealing with your problem. Go to the physician who has been practice a long time and with the worst personality. That physician is surviving on their skills. Always start with the simplest treatment. Work with what the body wants to do, not against it. Before seeing a patient determine the real reason why they are there to see you. Always have an escape plan, especially in surgery. Never say, “Never” or “Always.” No treatment or test is 100 percent predictable or accurate. Unless the patient is terminal or very, very reliable, no narcotics for chronic pain. Protocols work, until they don’t. The patient/physician relationship is a partnership. The partnership should be terminated if either party is dissatisfied. If your services are considered vital expect to chastised for wanting to get paid. Never take responsibility over that which you have no control. Never get into a fight over a shrinking pie. Never trust anyone whose job it is to find fault with you. Of all the players involved in health care it is the physician who is least motivated by politics or greed and the only one actually licensed to practice medicine. Unless you are willing to put your name to what you say, what you say is worthless. There are six ways to treat: rest and protect, observe, drugs, injections, exercise and surgery. Go to the physician who is familiar with as many as possible. Thomas D. Guastavino is an orthopedic surgeon. Source
