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It's the dirty secret every doctor knows. The doctors who pull in the big bucks and who have patients clamoring to see them often are practitioners who ignore some concept of evidence-based medicine.

I have a personal story about going to the top doctor the likes of which you probably won't see somewhere else.

Four years ago I hiked 15 miles and ran out of water. This was in Texas. It was summer. I became dehydrated.

When you get dehydrated, you don't have as much blood flowing in your arteries and veins. If you happen to have atherosclerosis, and despite having had a calcium scan that led the doctor to tell my my arteries were "100% open," and you don't have as much plasma in your blood, and you have an undiagnosed clotting disorder, all of which I did, even if you are healthy enough to hike 15 miles you just might have a heart attack. I did. It was the so-called widowmaker heart attack.

Because I was unusually fit, but it was to be determined much later I had an essentially 100% blockage of my LAD (don't believe everything they tell you about a negative calcium scan), the doctors didn't know quite what to do. It took two more heart attacks and finding myself at death's door before I could get a surgeon who would operate on me.

This surgeon, however, was very sure that he understood his surgical tools better than anyone else. He gave all of his patients a "wonder drug" for preventing new blood clots, even when the manufacturer warned not to give it to patients like me. They could die. He also used a kind of hardware that was not supposed to be used on patients like, but that was a little ($300) cheaper for the hospital. The manufacturer warned that it could cause patients to die.

I died.

Fortunately, I died at the exact moment three nurses were coming into my room, another, competent surgeon was walking down the hall, and another operating room was open. I woke up to the doctor's saying, 12 minutes later, "360, no detectible pulse." After emergency intervention, I was resuscitated just in time for a second surgery.  I am told I am not brain dead. (I suppose my readers could make an assessment of that.) But the hospital "lost" the records of that day. People are still sure my first surgeon is terrific.

One of the dirty secrets of medicine is that some doctors are cowboys. Or as they prefer to regard themselves, they are eminent. They become so sure of their abilities that they practice eminence-based medicine, based on their wonderful results, rather than evidence-based medicine, based on the collective experience of the medical profession.

These amazing providers of medical awesomeness are only too happy to share their experiences. They usually present a barrage of data and data analysis to prove how wonderful they are. Their logic is flawless. It may serve to illustrate their genius. They can cite papers in the published medical literature that prove just how awesomely awesome they actually are. Usually they will have written these papers. Sometimes they will have even published them, in a few cases setting up the publication that publishes them.

But even the most eminent doctors are human, and you don't want to be the case they never talk about. What can you do?

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