Are some sources of information better than others?
In another stellar piece, Pauline Chen asks leaders in the field how they would find a primary care doctor or specialist.
Advice included obtaining guidance with the help of a primary care physician, or failing that, “identifying high quality medical groups or hospitals that ‘carefully monitor the quality of the clinicians affiliated with them’ and that provide ‘decision support, continuous quality improvement and continuing education to keep their clinicians functioning well.’”
Arming yourself with the right questions is useful as well, such as asking how many of a specific procedure a surgeon has performed, or if they have a special interest in laparoscopic, or minimally invasive, surgery.
Discussing these more objective measures is especially critical, since bedside manner alone may not be enough. Dr. Chen cites a physician that concurs, saying that “a caring attitude can mask poor quality medicine.”
It’s well worth reading the whole piece, and investigating the websites that the article recommends.
Related posts:
- Do physician quality measures tell patients who’s a good doctor?
- Does good bedside manner mean a better doctor?
- Can bedside manner be taught, or is it something you’re born with?
- How following hospital quality measures can kill patients
- What doctors can learn from patients in the health care reform debate
- Should patients be advised that better care is available elsewhere?
- A doctor bluntly discusses dementia with a patient
{ 6 comments }
“a caring attitude can mask poor quality medicine”
This is nonsense, and reinforces the stereotype that the really brilliant doctors, like tv’s Doctor House, can not be bothered with a caring attitutde.
I spend so much time in my practice being asked to make excuses for these “brilliant” doctors that sometimes I feel I should get a public relations fee. And, yes, I try not to send patients to such doctors but frequently it is out of my control, determined by factors such as few local choices, or the relationship gets started by the ER, or referral patterns are detemined by who is on the patient’s insurance plan.
Fact: a caring attitude IS good quality medicine.
What should a patient look for in a doctor?
For primary care, other than word of mouth, a simple question is how much time is allowed per appointment. If the answer is less than 15 minutes, that doctor is either a genius or sloppy. And there are not many geniuses around and geniuses in medicine tend to be slow anyway.
For specialists, ie surgeons: how many hospitals do they have privileges at? If more than 2 hospitals, I would question their ability to attend to your needs in the event of an emergency.
A family practitioner
The simple answer on how to choose is where the rubber meets the road. You want to find a good OB?talk to several delivery nurses
Good orthopedist talk to local PT
General Surgeon-scrub techs and floor nurses
Internist- ICU nurse
PCP-local ER physicians and so on and so forth.
ER physicians as judges of PCPs? Hmmm…
As much as I love the analogy with the other examples (implying ED docs are our allied professionals), I’m not sure ED folks are in possession of all of the right information.
The best PCP is the one the ED doc has never heard of…because he or she keeps his or her patients out of the ED!
Nobody is going to be a completely objective source in any of those examples, but ER docs do look at medlists and compare them to patient histories and know the availability of the physician. There is little allied health professional interaction with most PCPs. The converse is true as well, a ER doc that has never heard of a local PCP maybe a PCP that gives all of his “complicated” patients to an internist or a partner and is not necessarily keeping them out of the hospital.
To Family Practitioner: If the appointments are 15 minutes long, the doc is either a genius, sloppy, or works for a clinic over whose scheduling he/she has no control. As to asking nurses or PTs who’s the best physician I strongly disagree. They may know who has the best bedside manner and who is the most personable, but their level of training is not high enough to know who is practicing the best medicine. The physician at my practice who is widely popular with the nurses and their families is someone I’m not happy having my patients see even as an urgent care visit.
I read the Times piece and have written a few of my own over the past few years. I am skeptical of the various iterations of quality initiatives that do more to burden physicians than they help living, breathing patients. Everyone wants to maximize medical quality, but there is no reliable way to measure it, despite the government’s many clumsy programs that claim they can do so. As for choosing a ‘quality physician, check out http://mdwhistleblower.blogspot.com/2009/01/measuring-physicians-performance.html. If choosing a good doctor were easy. there wouldn’t be so advice out there on how to do it.
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