Patients should be informed and the process should be open and honest. And also, any physician who would balk at a 2nd opinion is not confident in his or her own course of action.

That said, it's very easy to get caught up in a situation that is over your head:

http://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect

I can tell you that it took 3 years of medical school (not to mention my heavy science undergrad) to begin to critically appraise basic scientific literature. Medical textbooks are excellent but you have to understand the jargon.

As far as how to choose the 'right' physician, I think I will write a more extensive post about this because it's something that even I struggle with... believe me, physicians and their families know (and are victims of!) the problems in Medicine all too often. But basically, it is hard. I would say, if you have a common illness... almost anyone can help you. If you have an uncommon to rare illness, you should go to a large academic hospital and read about each of the physicians in the relevant department, then make an appointment with that person. Surgery is something else entirely... if you go to a large, academic center, you will only be seen by surgeons that specialize in that procedure. There will be a breast surgeon, a 'gut' surgeon, etc. If you go to a small regional hospital, they will likely only have general surgeons who do common cases and hopefully will refer you to a larger center.

I really agree with almost all of what you said and especially the spirit of it. Just remember that it's all a numbers game and even if your physician is knowledgeable, your surgeon is skilled, etc. there will always be chance events that occur... not medical errors, just random outcomes. There is sadly never a guarantee of health.

I completely agree that finding the "right" doctor can be very difficult. The large academic hospitals are often a good bet, but there are also, depending on what ails you, specialist hospitals that can be much better, as they tend to see many more of the specific case. You may very well be sent to the resident expert at that hospital, but that expert may be far from expert when compared to other facilities.

In one case I am familiar with, someone with an acoustic neuroma was offered treatment at a few very well known, large, academic hospitals, but those hospitals only treated about 25 or so of these cases a year. It was amazing to me that a general neurosurgeon would offer treatment when they only had ever done 20 of the relevant surgeries in their career, and not mention that there were facilities with vastly more experience. Going with a specialist hospital, the patient found a team that did a few hundred of the relevant surgeries each year and achieved a good outcome.

This leads me to think that neuro and other surgery might be better off following the regional heart hospital model so that expertise gets concentrated.

Yes, specialty hospital seems to be a great model. Atul Gawande talks a lot about this type of practice in his "Complications" book; a great read if you haven't seen it.