Third Place Health Care

Media reports on misdiagnosis continue to mount.

A recent study on patients with Alzheimer’s found that half had been misdiagnosed.  Half.

Another headline blared “4 out of 10 patients being misdiagnosed.”  The article encouraged patients to “see another doctor” if they are worried about their diagnosis.

You know what it makes me think about?



Because the way Starbucks revolutionized coffee drinking shows a way forward for health care.

Starbucks realized that since our lives focus on two places – home and work – most of us don’t have a “third place” to go.  A place where we can be free of everyday distractions and take care of ourselves.  Starbucks set out to create that “third place,” by making its stores comfortable, inviting places.  It works.  “Third place” makes customers’ lives better – and Starbucks has almost 20,000 stores to prove it.

It’s time for a kind of “third place” in health care.

Health care focuses on two places, too: the doctor’s office and a hospital.  Both places are difficult for patients.  Patients complain of not getting enough time from their over-worked doctors, and studies of things that go wrong in hospitals are equally disturbing.

There really isn’t a “third place” to go to in health care.  Somewhere that you can step outside of the difficult process of being sick.  Somewhere you can get a quiet, clear perspective of what is going on.

Now, some people are lucky and can turn to relatives or friends who are doctors to provide some of that “third place” experience.  But most people cannot.  At Best Doctors, we’re creating the experience of a health care “third place.”  We do it by taking the time to review each case, have doctors think about what’s happening, consult with experts, and share advice.

In 2010, we found incorrect diagnoses in more than 20% of cases of the cases we reviewed.  We found incorrect treatment plans in more than half of cases.  These data match independent studies of misdiagnosis and faulty treatment.

Consider Rosa (not her real name), a 45-year old woman.  She had been having trouble with her thyroid, and after a biopsy came back “inconclusive,” she endured months of treatments that didn’t seem to help.  As part of her benefits package at work, she had Best Doctors and so she called.  She was worried, but mostly she was frustrated that she couldn’t get answers to what was happening to her.

We collected her records, reviewed them, and identified the important issues in her case.  We consulted with an expert in the thyroid problem the doctors thought she had.  He said the “inconclusive” finding on the biopsy and the lack of response to treatment were worrisome signs of cancer.  He recommended she have her thyroid removed.

Roslyn shared this information with her doctor.  The doctor agreed, and she had surgery to remove her thyroid.  It turned out that the thyroid was riddled with cancer.  It was a missed diagnosis that could have threatened her life.  Today, Roslyn is doing very well.

Stories like Roslyn’s are familiar to anyone who has faced illness, and is one of the ironies of modern health care.  We have the best trained most capable doctors in history, and yet it can be harder than ever to get the right care.  The increasing demand for what we do speaks to the need consumers feel to find health care’s “third place.”

Evan Falchuk is President and Chief Strategy Officer of Best Doctors, Inc. Prior to joining Best Doctors, Inc., in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases.

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23 replies »

  1. I have to say to Doc B that the blogs I have read and commented at with regularity has “the choir” and “the challengers”, and I for one always hope and then enjoy when someone who is not a regular joins in. It is what it is.

    And, if you realize that a site that claims it tries to be balanced and fair and then is fairly much just preaching to a choir is just either in denial or hopes it can sell the adage “hear the lie enough and it becomes the truth”.

    When it comes to health care matters, I dispel the lies and hope those that are as impartial and objective can see through the bs. Hence my participation!

  2. Doc B-

    I can’t speak for other posters, but I always think it’s cool if you have the chance to interact with the author of a piece and critique his or her work. Don’t you?


  3. I had no idea when I first started reading THCB, that the article authors and commenters were mostly the same people. Just commenting on one anothers blog posts. Very disappointing.

  4. Misdiagnosis is a big problem partially created by incomplete healthcare info. Individuals need to become actively involved in their own healthcare and those they may care for. Electronic records have major integration, reliability and security issues. A individually maintained Personal Healthcare Record is a great way for the patient to become a single source of truth and help their healthcare providers.

  5. Peter, if you already knew, why ask?

    Our work is focused on helping people implement the advice we give them. That means we spend our time working with the patient, and their doctor, to help them make good decisions.

    It’s not easy to do, and requires that you do an exceedingly thorough job reviewing information, identifying the right issues, consulting with the right expert, getting the right advice, and presenting it in a way that is usable.

    Too often in our system, doctors are not afforded the time they need to do this as effectively as they could. It leads to real and avoidable problems with diagnosis and treatment.


  6. Hi Peter, no we don’t do that.

    People get Best Doctors as one of the benefits of their job. It’s free for them to use, and is independent of their health coverage. Our sole focus is making sure each person be sure they are getting the right diagnosis and treatment.

    Nearly 2/3 of the people who call us are trying to decide among multiple treatment choices. The degree of uncertainty most people face when dealing with an illness is staggering. It is a problem that is otherwise largely unaddressed.


  7. “In this way we avoid a great deal of unnecessary suffering, as well as unnecessary expense and, I’m sure, lawsuits.”

    Will your “Best Doctors” be “Best Witnesses” in the lawsuit the patient brings against the doc that caused, “unnecessary suffering, as well as unnecessary expense”?

  8. Hi DeterminedMD,

    You caught me! I am a lawyer!

    But our business- which covers more than 25 million people – has nothing to do with medical malpractice. Our mission is to help patients and their doctors avoid the problem of misguided care in the first place. In this way we avoid a great deal of unnecessary suffering, as well as unnecessary expense and, I’m sure, lawsuits.


    Evan Falchuk

  9. Maybe Roslyn had cancer, but that doesn’t mean Rosa did too…. Perhaps a third place misdiagnosis?
    I think Starbucks is a great analogy. An overpriced product of so-so quality that nobody really needs, but lots of people were brainwashed into wanting really badly for no good reason (I know because I am one). Very good business strategy.

  10. Simple. Go overseas to have your surgery and a holiday at the same time. Take tylenol for post operative pain relief.

  11. What enabled doctor at third doctor to be better than doctor seen before?
    What if the second or first doctor disagreed with diagnosis?

    What does a patient do when one doctor suggests tylenol, one a surgery and another one a vacation?

  12. I don’t get the connection between ‘third place’ and misdiagnosis. The comparison is misplaced. The author is trying to fit in the problem of misdiagnosis with a concept and term that just does not apply here. It has more to do with better care, multiple consultations and so on.

  13. Now this site is running ads for “Best in Health Care”? Time is running out for my participation at this site.

    Oh, and the piece is written by a lawyer, touting misdiagnosis issues in cases.

    Split offices at this site!?