Is My Doctor Any Good?

What is the definition of medical quality?  Perhaps we should take a defining lesson from Justice Potter Stewart who in 1964 offered an iconic definition of pornography -  I know it when I see it.  I think this template works well for doctors also.  Every participant in the health care arena - physicians, pharmacists, insurance companies, hospitals, pharmaceutical companies, our government and the public - all support the mission to deliver medical quality. But what is medical quality and how do you measure it? What stultifies this project is that no one agrees on the definition or even how to accurately measure it. You can test this yourself. Ask a friend about the quality of his or her physician. You may hear a glowing testimonial about the 'excellent' physician, but what does this really mean?  Understandably, patients may equate a good bedside manner with physician quality. I know how important the bedside manner is to patients, but it is not a sufficient measurement of medical quality.  If quality experts can't figure out how to assess medical quality, then I doubt that your friend or your Aunt Mathilda can do so.

Justice Potter Stewart can help us define medical quality.

Here's a sampling of tips on how to select a high quality physician. After each query, 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 a physician is a high quality practitioner. In addition, most physicians today are board certified 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. As a personal aside, my own mother has told me that she would not see a doctor like me since I have never displayed any of my diplomas or other certifications.  Thanks, mom!

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

First of all, the doctor may have no idea what his exact complication rate is. I certainly don't know what my precise complication rate is, although I know they are very rare events. Additionally, surgeries can have a full range 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 or she 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. Keep in mind that 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 have been left alone? This latter point is very difficult to measure.


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 his primary complaint of fatigue persists. An oncologist may be pleased with a treatment response in terms of improved lab and imaging results, but the patient feels the same. In addition, physicians' offices are not research institutions that study and track their patients' clinical data. Most doctors may have a sense that they practice sound medicine and have frequent favorable outcomes, but most have no scientific basis for this belief. 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 scientific weight to this optimistic statement.

What is your doctor's medical malpractice history?

Now my own blood pressure is rising. Excellent physicians have been sued despite having maintained high medial standards. Many of them have settled 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 enigma, but I know for sure that a doctor's medical malpractice history is the wrong tool. My own medical malpractice record remains clean after over 35 years in practice.  Does this mean that I am a better doctor then a colleague who has had a different experience.  Not at all.  It means I have been lucky.

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 the 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 3 professional societies and I doubt that my medical quality is 3 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 above questions .

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