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RATING DOCTORS.
I spent some of the morning running almost random searches to try and remember the name of my doctor. Eventually, I got him. And a bunch of reviews of him. Most of the reviews, to be sure, were good. The consensus appears to be that he's sort of mean to you, but quite thorough. But that's all the reviewers were able to evaluate: Was he courteous? And did he do lots of stuff?
Those are not particularly useful metrics on which to evaluate doctor quality. Etiquette is important, but neither here nor there to diagnosing appendicitis. And "doing stuff" can actually be bad, and needlessly costly. The question is whether the doctor is doing the right stuff. But patients simply don't have the requisite tools to evaluate that question. They can't review doctors like they can review books, or movies, because impressions of the experience aren't terribly relevant, or insofar as they are relevant, they're a second-order concern. There have been some efforts to get insurers to rate doctors, but their incentive, of course, is to rate doctors highly when they're being stingy, and helping the insurer make profits. There are a host of other ideas for rating doctors floating around, but most of them are bedeviled by similar problems. And that's why I'm fairly pessimistic about attempts to heal our medical system by giving the consumer information and power. The doctor-patient relationship is necessarily private, so you're not going to have third-party observers (nor should you), and it's founded on a massive information asymmetry (otherwise, the patient wouldn't be there), neither of which lend themselves to an accurate and reliable consumer information system.
COMMENTS (13)
I don't think that Ezra has a car. If he did, he would know about the auto mechanics problem, which is really the same as the doctors' problem, and points to the solution.
It is easy to get a decent mechanic. Just go to the dealer, and pay through the nose. An indy might be better (and much cheaper), or might be awful.
What you need are relatively large practice groups, with a trade name to protect. I'd trust almost any Kaiser Permanente doctor to be at least decent. For non-HMO docs, look at the hospital at which they have admitting privileges. It's not as good, but it isn't bad.
Trademarks are wonderful things.
Posted by: Joe S. | February 17, 2008 11:02 AM
Why wouldn't something analogous to a secret shopper - a "secret patient" - work? Have doctors (or medical students, or residents, or whoever would have the requisite knowledge and cost the least) act as patients and then write up anonymous evaluations of the doctors they visit. Not only would it provide useful information, it would provide an incentive to doctors to do the best job they could.
Posted by: George Tenet Fangirl | February 17, 2008 11:56 AM
"Etiquette is important, but neither here nor there to diagnosing appendicitis."
Actually, etiquette can affect diagnosis. If a doctor doesn't listen to a patient, or make a patient feel like a hypochondriac, the patient won't tell the doctor symptoms and the doctor will be less able to diagnose.
Take a look at the book How Doctors Think by Jerome Groopman for how a doctor's assumptions about the patient can screw up diagnosis.
Posted by: Cindy | February 17, 2008 12:32 PM
Ezra is touching on a problem that is rife in medicine-- quality is associated with a good bedside manner. This even manifests itself where the likelihood that a doctor will be sued is inversely proportional to his friendly demeanor, rather that being proportional to his likelihood of making mistakes.
Posted by: Tyro | February 17, 2008 12:34 PM
As a physician who was probably regarded as mean but thorough, an excellent diagnostician, fair surgeon;
I hesitate for a moment -but for just that state secret moment- to tell you that your Doctor fits -exactly- into the same service/satisfaction jig as does... your Mechanic.
As a patient/motorist you scarcely ever Know. Your friends and relatives and their individual Outcomes over time tell you.
Your own History with the provider tells you. But you need that history learned personally or provided by others.
Does your relationship with this gal or guy 'work'...are the results generally satisfactory.
[They're never 100%...live with it.]
Does your car run 'good' and do you most usually feel that way too.
Empiric trial and error stuff largely....still, really.
Simple as that.
True, too.
Posted by: has_te | February 17, 2008 2:03 PM
No advice for the policy problem, but for your personal research issue I recommend the Consumers Checkbook guide to top doctors.
Posted by: Antid Oto | February 17, 2008 6:17 PM
As my wife the doctor says, if you want to find out who the good and bad doctors are, ask a nurse.
They watch everything, and are knowledgable enough to make correct evaluations.
Posted by: Zak | February 17, 2008 8:22 PM
Kevin Kelly dig a blog post on this last month.
http://kk.org/ct2/2008/01/how-to-find-a-doctor.php
Posted by: Jason | February 17, 2008 8:31 PM
I've been disappointed by specialist "best" lists. I mentioned this to my regular doctor and he opined that they're pretty worthless; for example somebody might get on a list because of some research he's done, which doesn't say anything about his ability to make diagnoses; or somebody might get on the list because he paid to.
On the other hand I've found very useful discussions patients' experiences with various doctors on forums devoted to the condition I'm dealing with.
Posted by: godoggo | February 17, 2008 9:14 PM
If you want to know the best internist ask a nurse on the regular medical floor.
The best cardiologist- cardiac ICU nurse
OBGyn- Labor and Delivery Nurse
Orthopedic Surgeon- Physical Therapist.
Family Doc- that's tougher maybe a ER doc.
Posted by: jenga | February 17, 2008 9:51 PM
All of which points to what a red herring the "I want to be able to choose my doctor" movement against HMO's really is - people have no idea what criteria to use, in most cases, and the "choice" comes down to the person some family member uses and/or what a co-worker or friend says. If they're "nice" and "helpful" that's supposed to be a decider. You might as well be playing roulette.
Posted by: weboy | February 17, 2008 11:44 PM
I recently broke my right pinky, in a manner requiring surgery to repair. I saw a hand specialist for the operation and have been undergoing physical therapy.
So far, so good, no complaints. But I've never broken a bone before, let alone a finger. I don't really have anything to compare the experience to, let alone a basis to judge the technical competence or quality of the surgical repair.
The upshot here is that many medical events are unusual enough that patients won't have a basis on which to make an adequate evaluation of care, unless the care is truly profoundly bad.
Posted by: Jon H | February 18, 2008 4:25 PM
Each rating source has it's pros and cons.
Patients and consumers are not trained healthcare workers but they can certainly make intelligent opinions which others can base as useful or not.
Industry organizations rating services may be biased due to conflicts of interests in their evaluations but they are professionals in the field and have the expertise to critique properly.
Together both patient and industry ratings paint a complete picture for people to make informed and better decisions for their healthcare needs. The more 'independent' sources the better.
Staff, www.HealthcareReviews.com rate and review your doctor, dentist and hospital.
Posted by: P Fezziwig | March 12, 2008 10:09 AM