A guide to the more than 450 Northeast Ohio doctors chosen by their peers as the best in their fields.

Needles, antibiotics and waiting rooms aren't most people's idea of a good time. Perhaps it's one of the world's great ironies that what can sometimes be so annoying can also contribute to saving your life.

Because our health is so critical, it's important to know where to find a doctor. That's why Cleveland Magazine offers this list of Northeast Ohio's 450 top doctors. The list, compiled by Best Doctors Inc., was derived from a national poll of more than 30,000 doctors in 40 different specialties. It was then pared down to this list of 450 local doctors recommended by other physicians.

While the list is extensive, it should be noted that not all of the area's best are included. For various reasons, such as only recent entry into the profession or narrowness of focus, some great physicians didn't make the list.

Sometimes, the best way to find a good doctor is to simply ask around, according to Dr. Ted Castele, best known as "Dr. Ted" from his 24 years on WEWS NewsChannel 5.

"Get some good ideas of a reputation," he says. "The best way to do that is to ask another doctor."

Doctors know best about other physicians' scientific qualifications. If you're new to town or don't have a doctor yet, Castele recommends calling any large area hospital or the Academy of Medicine for referrals. Then, start asking others about the names you've been given.

Another good way to judge a doctor's skill is through his or her training and education, says Dr. George Kikano, professor and chair of the department of family medicine at the Case Western Reserve University School of Medicine and University Hospitals of Cleveland. For specialists, board certification is an important sign that suggests doctors are actively working to further their education.

Castele says another way to check qualifications is to look at the doctor's educational history and make sure he or she attended a reputable medical school. He warns against putting too much weight on board certification, however. While having it is a good sign, not having it doesn't mean the doctor is bad.

As you search for a doctor, there are a number of common pitfalls to avoid. For example, Kikano says some people think a full waiting room is proof of a doctor's skill.

"It feeds itself," he explains. "[People think] if he's busy, he must be good. That has nothing to do with it."

Both doctors agree that bedside manner is important, but they're quick to note that being nice does not always equate to good medicine.

"You can't go on bedside manner alone," Castele says, adding that picking a doctor is really a subjective process. Someone who may be a good doctor for your neighbor may not be the best fit for you.

We hope our list of the top area professionals gives you a good starting point.

— Jamie Carracher

Dr. Compassion

Dr. Tom Phelps, pediatrician, University Hospitals

Dr. Tom Phelps makes the confession softly.

"Sometimes, I give out my cell phone if I'm really worried about them," he admits.

It's not that he doesn't think his patients will get good service from whichever of the eight other physicians in his Geauga County practice happens to be on call that night. After all, he has personally hired each one of them to build the county's largest pediatric practice, with offices in Chesterland, Willoughby, Chardon and Middlefield.

It's just that he's that kind of a guy: an old-fashioned pediatrician in every way but the house calls.

"Tom exemplifies the kind of pediatrician that every parent would want for their child," says Dr. Michael Nochomovitz, president and chief medical officer of University Primary and Specialty Care Practices. "He gives time to people when they need it — not only patients, but parents and also his colleagues."

Nochomovitz says Phelps has an "endless supply" of physicians who want to work with him. More importantly, adds Dr. Brian Berman, vice chairman of pediatrics for community physician affairs and chief of general academic pediatrics at Rainbow Babies & Children's Hospital, many other physicians bring their own children to Phelps.

Colleagues and patients alike describe him as a "superb pediatrician," who is gentle, caring, understanding and supportive. "Professionally, he really embodies the best of what medicine has to offer," says Berman. "On a personal level, he is a warm, kind, soft-spoken individual. He is a family man of the highest order."

A graduate of The Ohio State University Medical College, Phelps served his residency at University Hospitals' Rainbow Babies & Children's Hospital. After a year practicing out of state, he returned to Chesterland in 1988 to go into private practice.

As a child, he moved frequently because his father worked for General Electric. Those broken attachments left him longing for a sense of community. He calls Chesterland — where he not only practices, but also lives — "a dream come true." When he knows a family in his practice is moving, he shares his firsthand knowledge of what it was like to be an uprooted kid.

During his early days, Phelps worked seven days a week, answering patient calls at all hours. In 1994, he sold the practice to University Hospitals, becoming the physician and practice manager and building one of UH's largest pediatric practices in Greater Cleveland.

It gave him freedom to no longer be on call every night and every weekend. That time became critical when he and his wife, Judy, adopted a trio of siblings about six years ago. They've since adopted a fourth child.

All four children were born to drug-addicted mothers, creating some special challenges in their development. Phelps now tries to work with other parents on the psychosocial issues of adoption. But it's the everyday life of a parent that he says helped him become more compassionate and understanding of the challenges parents face.

"I treat patients as an extension of family in trying to give them personalized care," Phelps says. "So much of being good at pediatric medicine is listening to people, helping them cope, showing that you care and that you're there. You could be the most brilliant doctor, but if you never make that extra call or you never show that extra little bit of compassion, you're not going to get that message through to people."

That's why he sometimes slips patients his cell-phone number.

Seven Days That Shook the Cardiology World

Dr. Steven Nissen, cardiologist, The Cleveland Clinic

Don't tell Dr. Steven Nissen he's a celebrity.

Even with appearances on ABC's "20/20" and in the pages of The New York Times and Wall Street Journal since the startling results of two heart studies late last year, Nissen isn't ready for the spotlight. "I can do without the personal celebrity," says the medical director of The Cleveland Clinic Cardiovascular Coordinating Center. "I do like the fact that we made a contribution here that is recognized around the world as truly pivotal."

That "contribution," as he modestly calls it, may revolutionize cardiac care if it holds up under further, more expansive studies.

In the first study, published Nov. 5 in the Journal of the American Medical Association, Nissen and colleagues at 10 medical centers around the country gave a synthetic form of HDL — commonly called the "good" cholesterol — intravenously to 47 patients, once a week for five weeks. On the sixth week, the plaque in the patients' coronary arteries had decreased by 4.2 percent — 10 times more than any prior drug.

Though drugs have previously slowed the progression of heart disease, this was the first time anyone showed it could be reversed — and done quickly.

Initially, Nissen thought that reversing a chronic disease in such a short time had almost no chance to work. "It's not just that nobody had regressed this disease before," he says, "but to do it in five weeks was unheard of."

This was also the first drug developed from a genetic mutation discovered 30 years ago in a group of about 40 people living in northern Italy. The people, all related to a common ancestor, had inherited a mutation to their HDL. Despite possessing dangerously low levels of HDL, none of them had heart disease.

A company genetically engineered a synthetic version of HDL, called ApoA-1 Milano, and showed that it worked in animals. But countless promising therapies that succeed in animal trials fail on humans. "Humans are more complicated," Nissen says. "A disease takes decades to develop, not weeks or months like [in] a mouse."

Yet the results were astonishing. "I couldn't move from my chair," Nissen recalls. He thought there must be a mistake. "I looked at it over and over again. I looked at the tapes. There was no question about it," he says.

News headlines dubbed it Drano for the heart. Nissen's phone buzzed with media seeking interviews and patients wanting to know where they could buy it. But it's not available yet. Further studies must test if the results improve with extended treatment, if the results last and if there are safety concerns.

Nissen's second study, released Nov. 12 at a meeting of the American Heart Association, revealed that Lipitor, or atorvastatin, was a better cholesterol-lowering drug than Provachol or pravastatin. The atherosclerosis — or plaque buildup — was worse after 18 months in the group taking Provachol, but was stopped in those taking the highest dose of Lipitor.

For the second time in a week, Nissen was in the national spotlight.

His time at The Cleveland Clinic is split between treating critically ill patients in the coronary-care unit and researching ways to prevent the disease. While the two endeavors seem like opposites, Nissen says that seeing ill patients motivates him to fight heart disease. Since joining the Clinic in 1992, he's built the only lab in the world capable of such trials. (Seven others are currently under way.)

Nissen's research is the result of his pioneering work on intravenous ultrasound technology, nicknamed IVUS, which threads a pinhead-sized imaging device, shielded inside a thin plastic catheter, through an artery. When the catheter is slowly pulled back, it takes ultrasound pictures of the artery walls and plaque buildup.

"Dr. Nissen is the most motivated and passionate person I've ever known about intravascular ultrasound," says lab manager Tim Crowe, who has worked with Nissen for nine years.

"He has made extraordinary contributions to advance our understanding and the treatment of atherosclerosis, the No. 1 killer and cause of disability, in our society," adds Dr. Eric Topol, chairman of the Clinic's Cardiovascular Medicine Division and provost of The Cleveland Clinic Lerner College of Medicine. "There is no question that Dr. Nissen in one of the top physicians and cardiologists in the world."

Passion For Teaching, Compassion For Patients

Dr. Margaret McKenzie, obstetrics and gynecology, The Cleveland Clinic

Lisa Ingram of Willoughby says that the day she met Dr. Margaret McKenzie was a "godsend." Otherwise, she might not have her four children.

Ingram didn't know a thing about McKenzie when she first visited. Her sister-in-law went to the same Cleveland Clinic obstetrician/gynecology office in Willoughby Hills, and Ingram chose McKenzie just because she was the only woman in the practice.

"When I met her, she was wonderful right off the bat," Ingram says. "She wasn't the hurry-out-the-door kind of person. She really took the time and sat with me and listened to my history."

Ingram had trouble getting pregnant and then miscarried twice.

"The first time, I was devastated," she says. "The second time, I went in and said, 'What do we need to do to have a baby?' "

McKenzie tested her and prescribed baby aspirin and progesterone. Ingram delivered her first son, Daniel, in 1997.

But then she miscarried again. From that point on, they used the same strategy they had with Daniel. Ingram and her husband, Wayne, then had Hannah, now 4, Matthew, 2, and Andrew, born in December.

But beyond the tests and prescription, Ingram says it was McKenzie's compassion and sensitivity during that difficult time that helped her to cope.

McKenzie says she believes strongly in expressing compassion to patients. But that alone is not enough.

"You have to have good clinical skills and surgical skills," she adds.

That combination is what first attracted McKenzie to the ob/gyn specialty. With a degree from Washington University School of Medicine in St. Louis, she did her residency at University Hospitals.

Now she has gone back to school. In January, she became a Harvard Macy scholar in a leadership program for physicians in academic medicine. She attended an 11-day course in January and will return to Harvard for a week in May.

McKenzie is developing the ob/gyn curriculum for the new Cleveland Clinic Lerner College of Medicine of Case Western Reserve University that opens this summer. In addition, she serves on the new medical college's admissions committee. At the Clinic, she is also director for medical student education and clerkship director.

"It's a way of giving back," she explains. "I like to empower people to become self-directed learners. Once you get out of school and your residency, for the rest of your life you're going to be learning."

"She'll bring a fresh perspective in educating the next generation of young physicians," says Dr. Linda Bradley, director of hysteroscopic surgery at The Cleveland Clinic, who hired McKenzie for her residency and has since become a mentor and friend.

Bradley credits McKenzie's success as a physician to her "compassion, intelligence and no-nonsense, very direct approach to patient care."

Those same qualities are the reason Lisa Ingram referred several friends, her mother, her mother's friends and even her cleaning lady to see McKenzie. "When you see her, it's like seeing an old friend," Ingram says.

Tiny Babies, Big Heart

Dr. Maureen Hack, pediatric specialist, Rainbow Babies & Children's Hospital

Dr. Maureen Hack looks through a stack of Christmas cards. She opens one and the wallet-sized school picture of a smiling 11-year-old blonde girl slips out. Hack picks it up and smiles.

"Look how well she's doing!" she says.

To look at the fifth-grade picture of Kayla Varttelli, you would never know she stopped breathing shortly after she was born on Nov. 24, 1992, weighing a fragile 1 1/2 pounds with almost transparent skin.

Kayla was immediately put up for adoption. For the first three months of her life, she had no parents to help nurture her back to health.

"I brought her home in February at 4 1/2 pounds," says Kayla's adoptive mother, Karen Valore of Cleveland. "I dressed her in doll clothes."

Kayla's father, Mark Varttelli, happened to work in the neonatal unit at Rainbow Babies & Children's Hospital at the time. A social worker in the unit approached Karen and Mark -- who have since divorced -- about adopting Kayla.

But the social worker warned the couple about the problems such a tiny baby could have: cerebral palsy, learning and behavioral issues. There was no way to tell what kind of future the baby girl would have.

That's what Hack, director of high-risk follow-up in the neonatal unit at Rainbow, wanted to know, too. As technology has progressed and allowed smaller and smaller babies to live, Hack asked the question, "But what happens to them as they grow up? Can they live normal, productive lives?"

Armed with grants from the National Institutes of Health, Hack started following babies with birth weights of less than 3 pounds in 1977. Since then, she has followed other groups of children who, like Kayla, weighed less than 2 pounds at birth.

Published in 2002, her groundbreaking study in The New England Journal of Medicine compared 223 premature infants with their peers at the age of 20. While, on average, the preemies had lower IQs and more chronic health problems, they were also less likely to participate in risky behavior such as drug or alcohol abuse.

She hopes to track the same group this year, at age 27, to see how their careers, marital status and health issues (such as diabetes or hypertension) have progressed as adults. Eventually, she wants her research to help parents and physicians know how aggressive they need to be in the delivery room as they try to save tinier and tinier babies.

Neonatology was almost nonexistent when Hack graduated from Pretoria University Medical School in South Africa at 22. Following a pediatric residency and fellowship in Israel, she joined Case Western Reserve University on a research fellowship in the early '70s.

"I imagined myself as a lab scientist," she reflects. "I never thought I'd do clinical work." But as neonatology was expanding, so was Hack's fascination with it.

"She is the most learned, most knowledgeable pediatrician in this area, if not the country, dealing with the longer-term neurodevelopment of sick and premature babies," says Dr. Richard Martin, director of neonatology at Rainbow Babies & Children's Hospital and a professor of pediatrics at Case Western Reserve University. "She has the unique ability to track these infants and assess them in a way that is quite special."

In fact, Martin adds, Child magazine ranked Rainbow's neonatology unit first in the United States due in no small part to Hack's efforts.

Every year, Hack sends Christmas cards to the children she's following. She loves getting cards back and hearing how well children such as Kayla are doing.

When she was younger, Kayla received physical and occupational therapy for mild cerebral palsy that her mother says isn't even noticeable. She gets some extra tutoring, but otherwise attends a regular classroom and takes part in everyday activities. And she's no longer doll-sized.

"It's amazing to me how tiny she was and today I can wear her tennis shoes. And I'm sure next year I won't be able to because she'll be bigger than me," says Valore. "I think Dr. Hack is wonderful. Her work is just phenomenal."

Easing the Issue of Aging

Dr. Maryjo Cleveland, geriatrician, Center for Senior Health at Summa Health System

Dave Richards calls himself a complainer, the kind of guy who doesn't hesitate to take it to the top, frequently writing letters to tell a company CEO exactly what he thinks.

After taking his 83-year-old father, William, to the Center for Senior Health at Summa Health System in Akron, he immediately wrote Summa's CEO Tom Strauss.

But this time, Richards had nothing but praise.

He says that he's rarely had the experience of visiting a physician with as much compassion as Dr. Maryjo Cleveland, director of the center.

"She's just really approachable," he says. "She's very clear. She's very concise. Seldom have I found a physician to be so helpful. She spent all the time we needed and then some."

Cleveland, a geriatrician, diagnosed William Richards with Lewy Body disease, a neurodegenerative disorder that inflicts the body with Parkinson's disease and the mind with dementia.

"It was bad news," Dave Richards says. "But the fact that they were able to diagnose it and give us some direction as to what was going to happen was extremely helpful."

Cleveland made the diagnosis after a three-hour evaluation by her team at the Center for Senior Health. For three years before that, Dave Richards had become frustrated, shuttling his dad between a psychiatrist and primary-care physician with no diagnosis.

"When you pass a lot of bad news along, you worry about the impact that you have on patients," Cleveland says. "But they appreciate the honesty. They appreciate giving them hope, even when it's a difficult situation. So when they say, 'Thanks. You've helped us through a tough time,' I think that's what I'm most proud of."

Cleveland adds that one of the most rewarding aspects of the geriatric specialty is when she can fix problems that patients or other physicians had simply chalked up to old age.

Some things that older adults view as normal aging — such as a weak bladder, side effects from medication or falling — can actually be corrected, she says.

For example, many older adults are taking medications prescribed by several different doctors. "Some are taking two or three medicines for the same problem," she notes. "Some are taking two medicines that are exactly the same but with different names. Some are taking medicines that are causing problems that they're also taking medication for."

She says that geriatrics, which looks at the entire patient, including their financial and caregiver support systems, is not a matter of a patient's age, but of the chronic conditions affecting that patient's life.

Cleveland fell in love with geriatric medicine while working as a nurse's aide in high school. A graduate of Michigan State University College of Human Medicine, she earned a fellowship in geriatric medicine at Case Western Reserve University.

With the aging of the baby-boomer generation, the need for more geriatricians is growing. Cleveland is committed to filling the need. A "masterful" educator, says Dr. Kyle Allen, medical director of Summa's senior health services, Cleveland teaches for the Northeastern Ohio Universities College of Medicine, the Ohio University College of Osteopathic Medicine and The Cleveland Clinic-Summa Health System Geriatric Resident Program.

"To be a geriatrician, you have to be a pioneer," says Allen. "She is dedicated to the vision of improving care for older adults."

And, most of all, she is dedicated to her patients. Just ask Dave Richards. "I'm just completely amazed at the coherence and the clarity and the compassion she's shown our whole family," he says.

Stroke of Genius

Dr. John Chae, physical rehabilitation, MetroHealth Medical Center

August Mendat didn't feel any pain during his stroke three years ago. He was with a friend at a bar when he tried to tip the bartender with his left hand, but it wouldn't move. He got off the barstool and couldn't walk — and he was sure he hadn't had that much to drink.

But the shoulder pain that followed the stroke was excruciating.

"It was like a toothache — just constant," says Mendat, 68. "It never went away. No matter how I'd sit, stand, it just went with me. On a scale of one to 10, it was a 10."

Desperate, Mendat attended a lecture by Dr. John Chae to learn about ways to eliminate his shoulder pain. Chae, of MetroHealth Medical Center, uses a technique called Functional Electrical Stimulation to help relieve pain in stroke patients.

When Mendat qualified for the program, Chae surgically implanted electrodes, which provide intervals of shock for an hour a day, into Mendat's shoulder. Six weeks later, Chae removed the electrodes.

Mendat hasn't experienced any pain since.

A physiatrist, Chae is a physician who specializes in physical medicine and rehabilitation. His time is split about equally between seeing patients and researching ways to help them function better and with less pain after a stroke.

Chae is one of the leading researchers at the Cleveland FES Center, a collaboration between MetroHealth, Case Western Reserve University and the Louis Stokes Veterans Affairs Medical Center. His cutting-edge work with electrical stimulation, funded by grants from the National Institutes of Health, has a direct impact on a patient's quality of life.

"He's a somewhat unusual individual in that he is a superb clinician who is also a very accomplished researcher," says Dr. Gary Clark, medical director of the MetroHealth Center for Rehabilitation. "And he is able to tie those two together very effectively."

Chae, who holds assistant professorships in medicine and engineering at Case Western Reserve University, enjoys molding future scientists. "My goal is to reproduce myself, to ensure that new young physiatrists with a scientific basis are developed," he says.

Originally, he had no plans to enter medicine. With a bachelor's degree in biomedical engineering from Duke University, Chae pursued a master's of engineering at Dartmouth. His desire was to develop a prosthesis that connects to the nervous system.

But while studying engineering, he grew frustrated with his lack of clinical knowledge and entered New Jersey Medical School.

"I wanted to be able to provide holistic care, where I saw the patient as a whole person and not simply an organ system," Chae explains. "I wanted not only to address the medical need of the patients, but also other components that aren't typically included in medicine, such as social issues, emotional issues, spiritual issues."

In fact, Chae says he is one of the few physicians he knows who incorporates spirituality into his practice.

"There's now been a very large amount of data indicating that there's a strong relationship between spirituality and medical outcome," he notes. "I've been able to address the spiritual needs of many of my patients. I ask, 'Would you mind if I pray for you?' I haven't had a single patient say no and about 50 to 60 percent of the patients will cry and say, 'You know, I've never had a doctor pray with me before.' "

Chae won't go so far as to say he's found a correlation between his own patients who pray and those who recover. Rather than wait for miracles, he creates them.

"What he has done for me, I would say is a miracle," Mendat says. "I had constant pain all day long. And when he did [the FES procedure], I have no more pain."