Hospitals and doctors should still pay attention to word of mouth

The organizations that rate hospitals and doctors have proliferated as the internet has become mainstream over the past 5 years. I’m sure you have seen some of these: U.S. World & News Report, Consumer Reports Health, Health Grades, Leapfrog, Hospital Compare, Americas Best Doctors and 100 Best Hospitals.

My local magazine lists the “top doctors” along with full page paid ads and promos that are very compelling. The questions is, do consumers care? Are these rating agencies really steering people toward top quality in health care?

Each of these agencies and organizations that “rate” have different measurements and criteria for their choices. The top rankings do not necessarily relate to quality outcomes. The Medicare data is two years old. Different treatments and conditions are judged, so a “top” hospital in one area may be a loser in another.

Even the mortality rates for acute myocardial infraction that were in the top 50 hospitals in US News & World Report were misleading. One-third of the ranked hospitals were outside the best performing quartile based on mortality and 4 of them were within the worst performing quartile.

Where can a patient go to find out the outcomes of a hip replacement? What if I want to know the infection rate and the number of hips that require “re-do”? How can I find out information about my surgeon? How many has he/she done? Do they track outcomes one year after surgery?

Believe me, you cannot get this information. Period.

Patients are becoming more savvy about health care choices, but research suggests that rankings have little influence over those choices. “The primary care physician is still the leading source for patients seeing specialist physicians and the opinions of referring physicians remain the leading factor for an individual patient choosing a hospital,” according to a JAMA perspective article.

For that reason, it is important that patients have a choice and have transparent information on their primary care physician. Selecting a physician is done mainly by “word of mouth” and availability. The consumer websites where patients can rate doctors are imperfect, but without better ways to get information, more patients are looking there as they select a doctor.

We still don’t know if the 5 star doctors are just nicer or if they are clinically better.

Tony Brayer is an internal medicine physician who blogs at EverythingHealth.

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  • Michael Kirsch, M.D.

    We’re in the era of measuring medical quality, as if it can be quantified. As Toni points out, it’s not that simple. What really counts in medicine can’t be easily counted. Regrettably, reams of data are being weighed and measured, masquerading as true quality determinants. This is like assessing a work of art by its weight. It’s easy to do, but what does it mean?

  • ninguem

    The big box clinic run by a local hospital. It’s a revolving door, docs come in, get disgusted, and leave in a year or so.

    When they were desperate enough to sign me without a noncompete, I did work for them part-time, though I quit as well, in a few months. The extra income wasn’t worth it.

    Their corporate cheerleader types would e-mail me with their roster of docs I should vote for. Send the votes to our city magazine’s “Best Doctor” issue. Of course, if you’re in their primary care, you couldn’t refer out of their system anyway, if you wanted to keep working there.

    So, they stuffed the ballot box. They got to brag about their “top 5%” ranking. Ever notice, all of America’s hospitals are in the top 5%. They can brag about all the specialists “voted best doctor” by the stuffed ballot box.

    The city magazine then gets to sell expensive advertising space to the dentists and plastic surgeons.

    • jsmith

      If you don’t mind me asking, where are you located? Region or state is ok if you don’t want to name the city. It sounds nasty there. I used to work in Duluth MN, where the oligarchic players were SMDC and St. Luke’s. Same sorts of games there. Corporate to the hilt.

  • Primary Care Internist

    Healthgrades’ methods and tactics are particularly egregious – they have always had me as NOT board-certified, and incorrectly affiliated with the wrong hospitals, etc.

    It seems companies like that compile information from a variety of public and quasi-public resources (e.g. insurance network info that they sell unbeknownst to us once we docs credential with them). Then they sell a “report” about us, true or false, to a misled public. All of this happens without us knowing or benefiting. And it can be indirectly libelous – for patients to pay, to be misled that I’m not board-certified causes harm to my reputation.

    Once I confronted healthgrades about this, and they simply replied “it is your responsibility to know what we publish about you”!?! Needless to say, i was dumbfounded.

    They apparently are protected from lawsuits from people like me (or it’s just not worth it to pursue). But i think we bloggers should make a concerted effort to educate the public about the “garbage-in, garbage-out” nature of these types of reports.

    If anything, at the very least these companies should PAY their sources for this information, ensure accuracy with stiff penalties for failures of such, and at least our reimbursements or licensure fees should be adjusted to our advantage accordingly. Healthgrades just makes money off of OUR BACKS, and we get nothing in return, except for the spread of misinformation.

    Can you imagine if i SOLD reports about congressmen that said they didn’t actually graduate from college? Same sh!+

    • jsmith

      GIGO is right. One of these services says I’m located at a clinic I left in 1995.

  • anna

    In the breast cancer/reconstruction world, women have some amazing forums to hear from their peers about their different experiences with any number of providers – both good and bad – very detailed and names are named. So much so, that some docs have their practice managers log on to solicit business. This is shameful and the posts are removed by the community almost immediately. Recommendations and warnings are made every day.

    It’s only going to get more pervasive. Ignore the trend at your peril.

    • jsmith

      anna, There is such huge shortage in primary care that we can afford to ignore the trend, at least until a lot more docs are trained up, which might never happen. Sad to say, but if you have a pulse, an MD, and a family medicne residency diploma, you will have you pick of well-insured pts, no matter how bad you are. And I’ve seen some pretty bad docs, and worked with quite a few. Things might be different in the lifestyle specialties.

      • anna

        Good point. The dearth of primary care docs makes any rating system irrelevant. Patients are at their mercy. I have a primary care doc in name only. Her office is a central place for my records to be stored. Next time I need primary care I’ll just go to a doc-in-the-box. The primary care experience doesn’t offer a sense of relationship and mutual respect anyway – so may as well see a stranger, since that’s what I am to my doc.

        • jsmith

          Unfortunately your experience is common. We’ve come a long way down from Marcus Welby. We might have a ways to go down yet.
          The only way reason my family could get in with the other family medicine group in my town is because I see the docs at the local hospital staff meeting. Otherwise they’re not taking new pts, even pts with good insurance.

  • Alexey

    Well said Toni! Screw rankings

  • sara

    Could some of these problems be avoided if healthcare providers were transparent in regard to outcomes by voluntarily providing data to the public?

  • Dr. Mary Johnson

    20-30 years of horrible word-of-mouth cannot be erased by great marketing or phony ratings or all the overpaid/overrated suits in the world.

  • Lisa

    I completely ignore doctor ratings. I actually found my allergist through my health insurance company. In a relatively short time my allergies and asthma were controlled with medication and I started allergy shots. The information I obtained through my insurance company was much more useful that the information provided by doctor ratings.

    On the subject of PCPs, there are some good ones…they’re just hard to find. I’m not that old, but I have more issues going on than my mom and maybe even my grandma…heh. It seems like a lot of PCPs address the concern at hand without regard to how it or its treatment could affect your other problems. (Do some of them even look at your medical records or have a clue what other problems you have?) For me, that doesn’t fly…in Donald Trump’s words, “You’re Fired!”

  • Amelia

    The Freakonomics guys say, no, Best Doctor ratings are pointless. Consistent great outcomes can be had by ducking the tough cases and peer selection may be popularity. I’ve only visited one top in his field in the country. They had me watch a 1/2 hour video before talking to him. 8| Of course, I didn’t return.

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