Do you really know how to choose a good doctor?

So you need a new doctor.  You go online and the list is seemingly endless.  You browse your insurance provider’s list and the information all looks the same.  With so many options, how can you really choose the best doctor for you?

Although this topic has been written about before, many people still find it difficult to determine a good fit.  And when they do, this fit often comes simply by chance.  To assure that you are choosing the right physician for whatever ails you, there are a few steps you need to take proactively to find that perfect fit.

Let’s begin with the basics.  First of all, make sure you know your doctor’s education and background.  In today’s world, these lines are blurring and many physicians are practicing in areas in which they may have received very little to no actual training purely in response to economic pressures.    Ask your potential physician what their residency training was in and any additional training programs they may have participated in since.  Next, be comfortable with their degree of experience.  Let’s face it.   We all have to start somewhere.  But if you’re looking for someone to treat an incredibly rare cancer (for example), my confidence would be on the practitioner who has treated enough patients to know which pitfalls to avoid and basics about this illness which can be gained from experience alone.  On the other hand, you also want someone young enough to be current with the latest cutting edge advancements.

Next, ask to speak with their patients.  In Plastic Surgery this is commonplace and generally encouraged.  In other fields (such as oncology), it may not be.  If this is an option available to you, I would wholeheartedly recommend you exercise it.  Getting a firsthand account before actually moving forward may save you the heartache of a bad outcome in the long run.

Ask your physician about their success rate but understand that this area may be difficult to gauge since some of the more talented physicians may take on the more challenging cases.

If you have access to local nurses or other medical professions, ask their opinion.  Ask them who they would go to and you’ll generally get a very honest reply.

Okay, so those are the standard recommendations that everyone would suggest in looking for a good physician.  But in today’s world are they really as relevant?  Not really.  Times have changed and so has medicine and how it is practiced.  Keep in mind that the medicine is increasingly more enhanced (or encumbered depending upon who you talk to) by technology and what worked 20 years ago may not be cutting edge today.  That being said, for the most basic of workups, you don’t always need cutting edge.  So what should you look for?

As a relatively young physician, I see the benefits of experience but I also recognize the value of youth.  For those of us who entered the world of private practice, our everyday lives can often be isolating (as compared to the comradery of residency) and less in contact with the day to day changes around us.  And so we rely on meetings and other educational events to keep us up to date.  But are these really that effective?  Not always.  So many physicians find themselves practicing medicine in a new age armed with old age tools and information.  In this case, younger physicians have a huge advantage since their information was gleaned from a more current source and, what they lack in experience, they potentially make up for in innovation.

As a patient, it is critical to know just how up to date your physician is with current advances and how they are getting this information.  If they are simply attending industry-funded dinners, then they may not be getting a well-rounded viewpoint.  And if they rely solely on the traditional yearly society meetings, they also may not be getting the latest and greatest if the speakers are still using the same slide decks over and over and over.  So how do you know how to gauge their level of medical fitness?  Ask them.  Find out not only how they have maintained their level of competency but also if they themselves have participated in Focus Groups or if they are considered to be Key Opinion Leader in any specific area.  If you are looking for someone well versed in a certain area, why not go to the person who is actually considered to be an Expert in this area.

And what about online reviews?  Are they really valid and how much weight should you really be placing in them?  In my opinion:  none!  Think about the last time you visited a restaurant.  If you were happy, did you really go online and rave about your soup?  Probably not.  But if the waiter was rude, the wait was long, or the food was cold you better believe that you let ‘em know!  And that’s often what happens with medical reviews.  I find it incredibly hard to get my happy patients to write anything online.  Why?  Because they are happy!  They had their surgery, they had a good outcome, and now they have simply moved on.  And so it is with many online reviews.  Keep in mind that there are people who simply are not happy people.  They are not happy now and they never will be and they certainly will never be satisfied with their care no matter how good it is.  And, unfortunately, many of these people know how to post online and they do so.  And physicians have absolutely no recourse when they do.  For the most part, we cannot even respond because of privacy laws.  And so these unhappy people describe their horrible experience (and often do so in painstaking detail), and the doctor has little to no options for giving their side of the story.  As such, when looking at reviews keep the following in mind:

  • Be wary of physicians with all positive reviews.  In a real world, you simply cannot please everyone.  And even though we all love positive feedback, we also expect that some patients will have one or two comments that are less than positive.  But these comments, if directed appropriately, can actually help us improve the overall care we provide to patients and grow out practices over time in a very positive way.
  • If there is a negative review, pay close attention to why the review was negative.  Was the patient upset because of an apparent lack of bedside manner or were they upset because the care was expensive or it took too long to get an appointment.  All reviews, negative or positive, are not equal and should each be judged on their own merits.
  • And if all else fails, ask to speak with former patients.  I always offer this option and never coach my patients on what to say and what not to say.  I feel that this is an excellent way for a potential client to identify the strengths and potential weaknesses of me and my practice prior to them even booking an appointment.

Going forward, I encourage you to keep these suggestions in mind when looking for a physician of any specialty.  After all, this is your health and there is no reason to leave the outcome to the results of a Yellow Page search or some other search that is equally as random.  Optimal outcomes are no accident and are the results of several factors.  And if you can control one of the most important variables—who it is that is actually delivering your care—then you are simply taking charge of one of the most decisions in your life.

Gregory A. Buford is a plastic surgeon and blogs at be for living.

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  • http://www.twitter.com/alicearobertson Alice Robertson

    This is very pragmatic!  I used to browse the patient advocate sites and I would see the “list”:)  I would review and do a self examination of our decisions in choosing our doctors.  We are at Cleveland Clinic, so one would assume the list was well-covered (they do try to offer “World Class” care….but….).  Ultimately, it seemed the counsel didn’t fit…finding *thee* doctor feels a bit like the glass slipper fairytale fiasco:)…..yeah…we found our Prince…he quit the Clinic and moved to a new kingdom.  A legend he is!  

    Your suggestions…..it seems as long as the human element remains as the foundation and the cure….it’s a bit Holy Grailish!   Well…….most of the time….sometimes you just hit the jackpot!

    • http://www.facebook.com/gregory.buford Gregory A. Buford

      Alice~
      It’s definitely a small world!  I am actually a graduate of the Cleveland Clinic (General Surgery + Plastic Surgery) and so I realize what a great resource it can be.  But that doesn’t mean that every MD is a good fit for everyone. 

      That being said, I strongly urge my patients and others to post comments about their doctors and to be specific as to why they did or did not have a good experience.  I also emphasize that the comments be fair. 

      • http://www.twitter.com/alicearobertson Alice Robertson

        I am sorry….I did not see this reply until just now.  Specific?  I have no problem with transparency, nor giving names.  A doctor (Dr. Ball an ENT) at the Cleveland Clinic messed up badly….twice….his delay in treatment caused cancer to spread in my teenage daughter.  He was cited by the Ombudsman for it and his Chair tried to cover for him, but ultimately, said the doctor wasn’t spending enough with patients.  Right….he didn’t read the lab notes twice…the lab notes that said the biopsy sample had arrived to dry to actually test well.  We lost eight months because we believed him twice when he sent us home and said the lab result was benign….he said we had nothing to worry about that.  Since then my daughter has had two major operations and radiation.  He was not just a bad choice….his negligence caused me nightmares.

        So…..while it is not hard for me to discuss this….I consider it a public service….it means my experience has left me fearful of doctors….even when promised World Class Care.  Now that said….an employee of the Cleveland Clinic peeked at my daughter’s records and told us a mistake had been made (he quit, but this type of employee may have saved our daughter’s life….a tech, not a doctor)….our next ENT was wonderful…he is now teaching and the head of Plastics elsewhere.  This doctor was a great choice…even in his empathy though there were mistakes….but we loved that guy….Dr. Knott.

        But this information you asked for clarity about, basically, isn’t that helpful….just a warning….very little on the patient advocacy sites helps you.   We each react differently to adversity….it really does feel like finding who your particular glass slipper fits, and not everyone’s slipper is the same size.

  • Casey Williams

    Great advice. I found it easier to find a good specialist, however, than a good internist. There are just so many general practitioners out there, the only way I knew how to narrow it down was to ask work colleagues (who I knew were in my network). And that didn’t net out anyone who was taking on new patients! Online was a bust because not enough people are posting reviews about their experiences with doctors – good or bad. So I did what I think most people do – scanned the list of physicians at an office near me and chose one based on the fact she was female, younger (because I figured they were more likely to have openings in their practice, as well as having a ‘newer’ approach to medicine), and had attended decent schools. Fortunately, I really like her.  Maybe I should write a review of her to help others… ;-)

    • http://www.facebook.com/gregory.buford Gregory A. Buford

      Casey~
      If you had a good experience with her, you should definitely write a positive review.  Too often, the only reviews that are posted are negative and may not even be helpful.  If you had a good experience, spread the news and help others locate such a good doctor!

      • Elizabeth Keyser

        “Too often, the only reviews that are posted are negative”

        This study by several MDs suggests, for at least ratings, that isn’t the case:

        Analysis of 4999 Online Physician Ratings Indicates That Most Patients Give Physicians a Favorable Rating
        http://www.jmir.org/2011/4/e95/

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Internists are not general practitioners. GPs are folks who only completed one year of internship. IM and Family Medicine are specialities with varying procedural skill sets and specific areas of expertise. 

      • http://www.facebook.com/gregory.buford Gregory A. Buford

        Good point.

  • http://makethislookawesome.blogspot.com/ PamC

    Question: how am I supposed to find a former patient? Aren’t those lists generally confidential? It’s there some liability issues involved there?

    • http://www.facebook.com/gregory.buford Gregory A. Buford

      Pam~
      Good point.  Most practices will not openly share patient information but will, instead, have a patient call you to discuss their experience.  That is how we do it at my practice.  For those patients who are unwilling to share their experience, they simply don’t make this list. 

      I personally think that this is a great way to determine good fit of a practice before moving forward.  But it is only part of the puzzle. 

      Thanks for your feedback!

  • Anonymous

    Beyond verifying the physician’s credentials (especially board certification status), finding a physician is a daunting task. As a retired physician who spent a significant number of years in quality assessment and health management, I chose a primary provider in the form of a nearby Family Practice residency program. Since I am unfamiliar with the local medical persons, I ask for recommendations from the FPs I see.

    More important than choosing a physician is deciding whether to continue seeing the physician you have chosen. My criteria of quality in health care is that the care be comprehensive, competent, courteous, and compassionate. All four of these are needed for quality care. When the care is discourteous and cold (no compassion), I would seek a new provider. I have not yet had occasion to do so despite a couple significant challenges. In addition, should I “fire” my physician, I will write him/her to advise of the reasons for that action on my part. I have written the hospital in which I received what I found to be excellent care and commented on the specifics of how I assessed their care.

    • http://www.facebook.com/gregory.buford Gregory A. Buford

      Great comments! 

      I completely agree with giving feedback when great quality care has not been achieved.  To often, someone will have a negative experience but will never go back to that practice and share this information. The only way that we improve what we are doing is to know what we are doing right and what we are not. 

      Thanks!

  • Anonymous

    As I was reading this post I thought, this sounds like it was written by a plastic surgeon.  Then at the bottom of the page I’m correct.  What other field of medicine is concerned that people are practicing within it’s scope without residency training?  Certainly not pediatrics.  I understand, you want your money.

    I think knowing the medical school and residency of a physician is less important than the care I receive as a patient.  I agree with asking other physicians and nurses who they recommend.  I don’t think it would be appropriate in any other specialty to have potential patients calling previous or current patients.  Overall this post seems useful if you’re looking for a plastic surgeon, but for other specialties, about 35% of the content seems poignant.

    • http://www.facebook.com/gregory.buford Gregory A. Buford

      Justin~ 
      While I agree with a few of your comments, I have to point out where I disagree.  The field of medicine has changed dramatically over time and fields which previously did not have to necessarily rely on promoting themselves through “quality patient care” or “top notch customer service” are now finding themselves having to do so.  You are absolutely correct that this pertains strongly to the world of Plastic Surgery but I would point out that it is now becoming more universally applicable to other fields, as well.

      In support of this, I actually wrote and published a book last year entitled, “Beauty and the Business”.  This book discusses how to establish and grow a customer-centric medical practice.  And while I wrote this predominantly for the aesthetic specialties, I am surprised how much positive feedback I have received from many others outside of mine.  As such, this tells me that solid customer care is a universal need and that simply treating our patients is not the answer.  We need to provide good care but we also need to go above and beyond that.  And the growing practices are doing just that.

      As far as contacting other patients, you are correct that this is more akin to Plastic Surgery but I am hearing about fields outside of mind offering this option, as well.  Keep in mind that many patients who have had a great experience want to share this experience with other potential patients.  And while they may not wish to share every detail of their care, many of them want to promote the doctors and medical staff who made a positive difference in their treatments.

      I greatly appreciate your feedback!

      Warmest regards,
      Gregory A. Buford, MD FACS
      http://www.beautybybybuford.com
      http://www.beforliving.com

  • Anonymous

    One way you could decide upon choosing a good doctor is to simply sit in the waiting room and watch who comes through the front door. If you see someone with a briefcase and dressed to the nines, that’s usually a drug company representative. If you see that happening, you can usually be assured that the doctor is taking payoffs to push certain brands and the generic medicines that help you save some money are avoided there. Your best bet is to run out of that office like you just saw a ghost.
     

  • http://www.facebook.com/gregory.buford Gregory A. Buford

    I would say from personal experience and from speaking on this several times last year at major national meetings that it is challenging to get your cheerleaders to rave about you but easy to get those who are not satisfied to post. 

    And while online ratings are certainly not going away, they can be a perpetual thorn in the side for a physician who receives a negative review but finds themselves with little to no recourse in either addressing or ultimately removing it. 

  • http://twitter.com/SocialDentalNet SocialDentalNetwork

    A patient’s search for a doctor has certainly changed over the years, and stayed the same. We still reply on the word of mouth referral from those we know and trust.

    Good points on questions to ask a prospective doctor, and exercising caution with online reviews. But isn’t it a bit narrow to think your patients are NOT happy to spread the positive digital word of mouth…especially within the chosen field of medicine?

    Online reviews should be taken for what they are, not
    marginalized and not singular – rather a developing way for consumers to form
    their own opinion. Nurturing dwom should be a regular ingredient in the practice (not doctor)/patient communications pipeline.

    People are happy to spread the word, but we need to be asked to do so – the end result is a beneficial genuine window into a professional, cutting-edge, patient-friendly practice.

    Understandable on the long time axiom reference about negativity spreading faster, but the digital landscape should be facilitating connections, not alienating either doctors nor patients.

    These digital connections are bridges to the face to face interaction (where real medicine takes place) - use them for the communication tools they are.

    We need more engaging doctor to patient exchange of information like you’ve presented here – it helps us as patients learn more about your point of view, and improves overall communication.

    The more we can communicate, isn’t that good for doctors and good for patients…its a Patients are from Mars, Doctors are from Venus type thing!