Is My Doctor Any Good?

As readers know, the unifying theme of this blog is medical quality.  Indeed, the role of a whistleblower should be to raise the performance level of a profession or organization.  One need only scan this blog's category list for evidence of the blog's purpose.  Feel free to sample a post or two.

The medical procedure that is fundamental to the practice of gastroenterology is colonoscopy.  I have performed north of 50,000 of these procedures on some very lucky inhabitants of northeast Ohio.  This will be my professional legacy, not quite a true gift to humanity such as music, art or literature.  I’ve been in practice long enough that there are patients whom I’ve performed more than 10 colonoscopies on.  Patients prefer to remain with a doctor whom they are comfortable with.  Long term relationships with patients is one of the joys of medicine.

I also routinely perform colonoscopies on patients whom I have not met previously.  They are referred for the procedure by their primary care professionals (PCP) or others for colon cancer screening or to evaluate symptoms.   What do these patients know about me?  Generally, nothing.  They assume that that I have the technical skill and the medical knowledge to deliver a high-quality experience to them.  Interestingly, many of these folks, I suspect, exert more due diligence before purchasing an appliance or selecting a restaurant.   

More important than your doctor?

If a physician refers you to a surgeon, should you assume the surgeon is qualified or should you do your own research?  Theoretically, I would strongly urge the public to research potential medical professionals before making appointments or consenting to operations. 

Here is the conundrum.  How can ordinary patients assess the quality of doctors they don’t know?  Is this task even possible?  I’m not sure that it is.  After more than 30 years of practicing medicine, I do not have reliable recommendations to offer patients on how they can measure physician quality.  Medical professionals struggle with the same issue. Should patients rely upon published reviews?  We all know how fraught this process can be?  Is a reputation for competence tantamount to actual quality?    How much weight should patients give to where the doctor attended medical school and professional training?  (Hint:  Not much.)   If a doctor’s schedule is booked out for months, does this mean this physician must be excellent as evidenced by the high demand?  If a patient highly recommends his doctor, can we rely upon this?   We’ve all had the experience of a mediocre restaurant meal even though a friend gave it rave reviews.

I have a strong sense of which of my medical colleagues are performing at a high professional level.  But keep in mind that I have never seen most of them take a medical history, palpate an abdomen or deliver hard news to a patient and his family.  But over time, doctors do become familiar with the quality of work that our colleagues do. 

Here’s my advice.  Your best source of intel on doctor quality is from your own physician whom you know and trust.  If you don’t have such a physician, this is one of many reasons for you to find one.  Otherwise, you will be left to your own devices and I don’t think you have the necessary tools to get the job done.   Give this task at least the same attention as you do when buying a new washing machine.