Who are the best Doctors?

As a physician, many of my friends ask me to comment on the doctoring skills of my medical colleagues. Admittedly, a positive testimonial from a physician about your private physician is reassuring, but is it reliable? Outside of my specialty of urology, I found it very challenging to assess the competency of my colleagues other than by the three A’s of medical practice, first Availability, second Affability and finally Ability in that order. Yet, each year both Cincinnati and Cincy magazines glibly put forth a list of the Top or Best doctors in the Greater Cincinnati area.

Currently, statistical measures do not differentiate the best from the average also. Web site such as Healthgrades.com may crunch the numbers of millions of medical claims from federal and private sources to rate and rank doctors but their parameters that allegedly factor in experience, complication rates and patient satisfaction are grossly incomplete and subject to arbitrary standards of care.

You might think that primary care physicians and pediatricians (PCPs) would be knowledgably about the quality of medical care rendered by the specialists to whom they refer. But today’s PCPs are generally hospital employees and do not follow their patients in the hospital if they are admitted and thus rarely interact professionally or socially with the specialists. Moreover, the hospital systems (Christ, TreHealth, Mercy Healthcare, UC Health and St. Elizabeth Healthcare) have incentives for their ‘owned’ physicians to refer exclusively to other doctors in the network. The advent of the ‘Hospitalist’ and ‘Intensivist’, new breeds of physician that manages hospital care, has added an additional layer of isolation between the PCP and other physicians.

Moreover, insurance plans often change their panel of physicians and enrollees often change health plans. And when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the physicians covering the practice.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practitioners. Many patients have already received the 3 or 4 page satisfaction surveys after a routine office visit, outpatient surgery or a hospital admission.  The soft data of patient satisfaction does correlate with quality of care, but the response rates to these surveys are much higher in the outliers of either the very satisfied or very dissatisfied. From a physician’s perspective, they do not paint an accurate picture.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. In the hospital setting, possibly, the floor nurses and operating room technicians with whom the doctor works day-over-day give the most reliable testimonials about the behaviors and capabilities of individual physicians.  But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match based upon trust, bedside manner, accessibility and previous treatment outcomes.

And yet the magazine lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, and medical testing facilities goes on and must certainly sell magazines. However, if your doctor or medical facility does not make the cut, don’t get concerned; the lists are very arbitrary and have little correlation with quality of care.


— Richard G. Wendel MD, MBA

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