Over the weekend I began to worry if I have been unfair. Just last week in a webcast about the latest comprehensive treatments for brain cancer I urged patients to seek treatment, or at least a consultation, at an academic medical center where they have sub-specialists in neuro-oncology and related specialties. I do believe that is good advice.

Beyond that, I find that I remain a "fan" of academic medicine for a variety of reasons, not the least of which is that my participation in a single, university center clinical trial may have saved or lengthen my life as a leukemia patient.

But what about all those physicians who were trained at university medical centers and then ventured, as most do, into private practice? Are they not qualified? Are they only motivated by growing their business or preserving it, in tough times, at last year's level? Are they the ones who always order unnecessary tests or rush to perform surgery because there are bills to pay? Let's be fair: there are many, many physicians in private practice who are extremely dedicated to the best interests of their patients above and beyond what's good for the health of their practice. These providers walk an economic and ethical tightrope and, I believe, for the most part they make sound decisions.

For example, I think of Dr. Hank Kaplan, an oncologist at Swedish Medical Center here in Seattle. No one could be more devoted and hardworking. Or my friend Dr. Alan Goldsobel an allergist in Palo Alto - the same level of dedication in his case. I know many other men and women just like them who do not have the fulltime title of "professor."

As with so much in healthcare, there are few blacks and whites – mostly gray areas. University medical centers have research, staff physicians, a lot of clinical trials, and usually are quite large. Private practices are more "homey" but may be more reliant only on standard treatments or sometimes get caught up in new technology gizmos that may or may not be the right comprehensive answer for you.

How do you navigate all this, getting the best from a private practice doc who may be closest to home and who you may really like and "kibitz" (my favorite Yiddish word meaning "friendly banter") with, while still assuring yourself that the smartest, most up-to-date approach for your illness are considered?

SECOND OPINIONS!!!!

Yes, you've heard it all before. Unless you are at the emergency room or at death's door, if you have time on your side, I believe it is wise to bundle up your records and respectfully tell your private practice doctor, you want to match his or her "smarts" about your case with that of a university specialist who, day-in-day-out focuses on people with your condition. Then you get the best of both worlds, the academic medical center and your hometown clinic. But you have to drive that. For cancer patients and people with other serious, chronic conditions I think this makes a lot of sense.

Okay, hopefully now I can sleep better at night as I have set the record straight. Private practice doctors can absolutely be "good guys," as other doctors say about people they respect. But as the private practice physicians fight to keep their heads above water in tough times for healthcare, it is up to you to get the best they have to offer and get the best medicine as a whole has to offer by going the extra mile.

I always welcome your comments.

Here's wishing you and your family the best of health!

Andrew