Skip to main content

Is My Doctor Any Good?


Medical quality is like pornography, it's hard to define but we know it when we see it. Every participant in the health care arena - physicians, pharmacists, insurance companies, hospitals, pharmaceutical companies, our government and the public - all support the mission to enhance medical quality. What paralyzes the effort is that no one agrees how to get there or even how to accurately measure medical quality. You can test this yourself. Ask your friends and relatives about the quality of their physicians. You will likely receive glowing testimonials about their 'excellent' physicians. Yet, if you ask the important follow-up question, How do you know your doctor is so good?, then your smooth talking neighbor may start stuttering. Don't be too hard on him. If quality experts can't figure out how to assess medical quality, then I doubt that your neighbor or your Aunt Mathilda can do better.


Here's a sampling of tips from 'experts' on how to select a high quality physician. After each of their recommended questions to ask, I will comment in italics to provide a tincture of skepticism.

Is your doctor is board certified?

While board certification is of some value, in no way does it guarantee that the physician is a high quality practitioner. In addition, most physicians today are board certified anyway as most hospitals and insurance companies require it. If I am a decent physician, it has nothing to do with my board certification status. Nevertheless, many patients like to see certificates on their doctors' walls. Take a closer look at them. From a distance, you might not realize that they are for bowling tournaments, barbecue contests and dance marathons.

What is your doctor's complication rate for the procedure he is proposing?

First of all, he may have no idea what his complication rate is. I certainly don't know what mine is. Additionally, operations can have dozens of complications. Which specific complication would you be referring to? Keep in mind that a higher complication may simply mean the doctor treats sicker patients. A superb surgeon, for example, may have more complications because he accepts critically ill patients who other doctors won't operate on. Complication rates, therefore, can be very misleading. I'd be more suspicious of a physician with a 0% complication rate. This doctor must have very little experience.

How many times has the doctor performed the operation or procedure?

This statistic makes some sense. Numerous medical studies demonstrate that physicians who perform procedures and operations regularly have lower complication rates. It is not clear what volume of procedures is necessary. For example, is a gastroenterologist who performs 2000 colonoscopies yearly better than one who does 500? Not necessarily. In addition, a high volume of cases does not mean that the procedures were appropriate or medically necessary. Who wants to have a gallbladder expertly removed if it should be left alone?


What is the doctor's success rate for the treatment proposed?

Good luck defining success in medicine! Doctors and patients often define success differently. A doctor may feel successful because the high blood pressure is well controlled, but the patient is disappointed because he is still fatigued. In addition, physicians' offices are not research institutions that study their patients' clinical data. Most doctors may have a sense that they practice sound medicine and have favorable outcomes, but most have no scientific basis for this assertion. A doctor's comment, "I've had lots of success with this treatment", may reassure you, but I'd be cautious about assigning too much weight to this optimistic statement.

What is your doctor's medical malpractice history?

Now my blood pressure is rising. Excellent physicians are sued everyday who have done nothing wrong. Many of them settle their lawsuits for business reasons, not because they were negligent. We live in a society where many expect and demand compensation and reward for any injury, even if no one is at fault. I may not be able to unravel the medical quality riddle, but I know for sure that a doctor's medical malpractice history is the wrong tool.

Which medical societies does the doctor belong to?

Society membership means the doctor has sent in a check and has received a certificate to hang on his wall to impress his mother and his patients. While the societies may disagree, I don't think that membership implies medical quality. I belong to 4 professional societies and I doubt that my medical quality is four times better than a doctor who has joined only one.


Is there a fish tank in the waiting room?

Yes, I know this sounds silly, but it may predict quality as accurately as any of the questions above.

Next posting: Whistleblower Quality Tips



Comments

  1. While many doctors don't like being anonymously reviewed or rated, doctor ratings sites provide consumers with a way to gauge doctor's patient customer satisfaction. A doctor may be technically "knowledgable" about his specialty, but been rude or having poor bedside manners may turn off some patients.

    ReplyDelete
  2. wow, great post - I'm not too knowledgeable about how to assess a doctors abilities. Of course, without healthcare, I usually just ask about whether or not s/he has a sliding scale...

    I feel like its even harder to evaluate the work of mental health care providers.

    Here's a post we did about doc shopping, you might get a kick... http://speakhealth.org/doc-shopping

    ~c

    ReplyDelete
  3. i am trustee of 30 year old cancer hospital at Rajkot gujarat in india. I am faced with problem of malpractices by ordinary general surgeons passed their retirement age and having no formal fellowship in cancer field continue diagonising and operating poor patients. I need help of social organisation who will expose this malpractices. In India and in gujarat state regulators are not strict and courtsey medical director this practice is going on since 20 years. any case laws on this kind of practice by general surgeons posing as cancer expert, what remedy? Kishore ghiya india mob +919825217857

    ReplyDelete

Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary