What is the Best Way to choose your Doctor?

As a physician, many of my friends and acquaintances ask me to comment on the doctoring skills of some of my medical colleagues. Some take it a step farther and ask who the very best doctors are in a given field of medicine. Admittedly, a positive testimonial about the skills, knowledge and abilities from a physician about your private physician or specialist is reassuring.

But even as a physician, it is difficult to judge the competencies of other doctors and how their practices treat patients. Only in my specialty of urology was I confident that I knew with certainty who were the better practitioners. For instance, I knew the number and types of procedures they were performing at the hospital and often took care of some of their complications or patients that were dissatisfied with their care. In addition, I knew them socially and attended the same scientific and medical conferences. As they were competitors, it was unusual for me to refer patients to other urologists.

Judging medical practitioners outside of your medical specialty is very challenging and most often based on subjective and second hand information. Certainly the doctor’s reputation amongst his colleagues is important, but not always accurate because it may relate more to friendship and social skills than ability. However, the opinions voiced by the floor and operating room nurses and staff with whom the doctor works, however, are usually right on target. Other considerations that may or may not influence your decision include malpractice actions and catastrophic medical complications plus any disciplinary actions against the doctor by the State Medical Board or curtailment of privileges by a Hospital.

You might think that primary care physicians and pediatricians (PCPs) would be accurate in their assessments of the quality of medical care rendered by the specialists to whom they refer. But the typical PCP refers only a few patients to any one specialist and rarely has the time to discuss the patient’s experience with that doctor’s practice when he or she returns. Additionally, PCPs today rarely follow their patients when they are admitted to the hospital and in large groups specialty practices the new patients are often assigned a doctor that has openings rather than the doctor the PCP referred the patient to in the first place. Moreover, physicians no longer congregate in the morning in the hospital medical staff lounges to socialize, provide curb stone consults and get to know one another.

Adding to the difficulty in assessing the quality of an individual physician is the very structure of today’s medical marketplace. For starters, insurance plans often change their panel of physicians and enrollees often change health plans. Most physicians are now in large medical groups and when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the numerous partners that happens to be on call. Moreover, the hospital systems are buying medical practices to form large vertically ‘integrated’ healthcare systems and this disrupts traditional referral patterns by the hospital’s insistence that their physicians refer only to other doctors in their system.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practices. In fact, within Obamacare, up to 2 percent of reimbursements will be linked to patient satisfaction in the near future. Many patients have already received the 3 or 4 page satisfaction questionnaire after a medical visit, outpatient surgery or a hospital admission.  Response rates to these extensive surveys are generally low and the majority of patients that complete the survey are either the very satisfied or the very dissatisfied. Thus, from a physician’s point of view, these surveys have limited ability to quantify quality.

New Statistical Ways to Choose a Doctor

In a recent USA TODAY article they talk of a revamped Healthgrades.com website as a new tool to research doctors. This site uses about 500 million claims from federal and private sources to rate and rank doctors. It claims to factor in experience, complication rates and patient satisfaction. Problems arise with selecting a physician in this way because:

1. Some physicians treat sicker patients than other doctors and accordingly might have higher complication rates. No severity of disease adjustment of patient populations is possible.
2. Medical treatment still lacks broad standardized parameters of medical care for all but a few common clinical conditions such coronary artery bypass surgery, diabetes, asthma and pneumonia.
3. The collection of electronic data covering large populations of patients is still in its infancy and the current statistical data is insufficient to evaluate individual physician performance.
4. The geographic, insurance and technical barriers to properly match patient and physician are many.
5. Patient satisfaction statistics may be the only valid indicator because patient satisfaction does correlate with quality and outcomes.

Both Cincinnati and Cincy Magazines rate the ‘best doctors’ in Cincinnati based upon surveys sent to all or some of the 5000 physicians practicing in Hamilton County. The surveys are quite simple, “who would you send your relatives to for care?” With large group practices dotting the medical landscape and hospitals owning a large swath of medical practices, this type survey causes business interests to surface rather than objectivity in physician evaluation. There are few independent physicians in solo practice who ever make the list of best doctors. Moreover, the survey response rates tend to be less than 20 percent and, at best, this exercise becomes a ‘popularity contest.’ In my review spanning many years of these ratings, I have been unable to see any correlation between the survey results and the quality of care administered by those selected.

Lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, medical testing facilities and so on must sell magazines and attract viewers because the numbers of lists in all media just proliferate. In Cincinnati, virtually all major heart, orthopedic and neurosurgical clinics claim to have high national ranking. You must ask how and by whom or just chalk it off to the hospital’s or practice’s aggressive marketing efforts.

In the medical field, physicians and physician specialists all read the same scientific journals, attend the same medical society meetings and, as a consequence, no one has ‘special’ knowledge or revolutionary techniques. Some efficient hospital systems such as the Mayo and Cleveland Clinics have perfected their processes to expedite medical care and achieve a reputation through exemplary patient satisfaction. Additionally, if a surgeon or hospital does 500 open hearts a year, they usually are more proficient than if they do 50-100 per year.

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. 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.. At the end of the day, you, the patient, are the best custodian of your health. A healthy lifestyle has greater survival benefit than selecting the best of the best doctors.

– Dick Wendel MD, MBA