A hidden way to measure quality when finding a doctor

Choosing a new doctor is never easy. You need to know about convenience factors, such as office location, available appointment times, and accepted insurance plans. You will probably also consider background information, such as education, board certifications, and licenses. But the most important question you likely have involves results: Is this doctor any good?

Unfortunately, there just isn’t a single, perfect way to measure the quality of individual doctors. No matter how we approach the issue, we will always be looking at just one slice of overall physician performance. To see what I mean, let’s examine some ways to think about evaluating quality.

Health outcomes

In a perfect world, the health outcomes of other patients would show us which doctors are best. Better doctors have healthier patients, right?

However, it’s not that simple. To accurately detect trends, you need a lot of data. Because physicians handle so many different types of problems, getting enough of one kind of data to compare is nearly impossible. Not even specialists, who have a narrowed focus, see enough similar cases to detect statistically-valid trends. Hospitals are bigger, so they can at least measure how groups of doctors do on the whole, but this still doesn’t help in evaluating an individual doctor’s quality.

Guideline compliance

Since it’s not practical to choose based on health outcomes, how else might we compare physicians? The next most obvious potential solution is guideline compliance.

In almost every medical situation, there are guidelines – essentially checklists –that doctors should follow. We could grade doctors based on how strictly they follow these rules. Better doctors would be better at following rules, right?

Again, it’s unfortunately not that simple. A sloppy surgeon might leave every patient with a dangerous infection, yet still get a perfect compliance score, because she always performs the recommended procedure in the recommended way at the recommended time. In other words, a static set of guidelines is never complex enough for real-world medicine. It just can’t help us understand who the highest quality doctor may be.

Patient adherence

It’s not all bad news, though. There is a hidden, underreported way to measure quality when finding a doctor: the human factor.

As a young neurologist, I worked in a headache clinic. Many of my new patients came to me addicted to the pain medications originally prescribed to treat their headaches. When they stopped taking the medicine, they would get withdrawal headaches. It was a vicious circle. To help them, I needed them to ride out the difficult withdrawal process until they were “clean.” In my experience, the most effective way to make this happen was to build a great rapport with them. It was a struggle, but the power of our emotional connection was enough to help many patients break the addiction cycle.

Think of your own experiences as a patient. Imagine if a doctor you didn’t like told you to exercise three times a week, or wear a certain SPF daily, or take a specific medication weekly. Would you trust or respect that physician’s recommendation enough to do so? Would you even schedule a basic follow-up appointment?

This is a critical issue in medicine. For physicians, the ability to build great relationships with patients isn’t just good manners; it also has an effect on adherence. Adherence, in medical terms, is simply how well a patient follows medical advice. If patients don’t stick to the plan, it is much harder to help them get well (and stay that way), which is of course your doctor’s primary job. This is reflected in the trend toward physicians utilizing motivational interviewing techniques.

This is especially true for office appointments (versus a surgery), where results depend on how well patients follow prescriptions and recommended behavior modifications. That’s why, everything else being equal, adherence is very important to good health.

How to measure patient adherence

This is where things get interesting. Since good relationships mean better health outcomes, one of the best ways to measure a physician’s quality is to look at their patient reviews in categories like “bedside manner.” You can ensure that reviews are authentic by using closed-loop review systems, which I discussed in more detail here.

But isn’t every rating subjective? What if a patient was just having a bad day when he left a scathing review? Yes, that is a concern. And that’s exactly why we should look at ratings in large numbers. The more reviews a doctor has, the more fair and representative they become, and the more they can tell you about that doctor.

Of course, as I mentioned earlier, there is no perfect way to judge doctor quality. But that’s why it’s so fortunate that health care consumers have these new tools at our disposal. Closed-loop review systems are currently one of the most powerful ways to discern doctor quality. And best of all, the power to create reviews, share them, and utilize them is right where it belongs — in patients’ hands.

Oliver Kharraz is chief operating officer and founder, ZocDoc. He blogs at The Doctor Blog.

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  • VKA

    Unfortunately, high patient satisfaction scores have not proven to correlate with outcomes- in fact, they correlate negatively with them in some instances. As a doctor in “How Doctors Think” by Dr. Groopman put it, there are doctors in every hospital whose patients love them, who always communicate wonderfully, but they are technically incompetent. Satisfaction scores are not a good way to measure doctors.

    • rbthe4th2

      Yes and no. I couldn’t give a doc who I had problems with anything but ok scores because otherwise there would be retaliation. Denying care, dropping care, and I got told if I didn’t do what he said (take a medical test), he’d put it in my record ‘and all the other docs who can see it will wonder why’.
      I believe that patients and nurses calling him “Dr. Dreamy” would have something to do with his scores also. I didn’t see him as cute, and worship his ego, which is a main reason why we didn’t get along. I wanted medical answers, not just “trust me”. I did that and got months of pain because he didn’t correct a surgical issue.
      RB

  • http://twitter.com/GoldCareInMed The Gold Foundation

    Nobody wants a doctor who is kind but incompetent. But both components must be present in order to receive the best healthcare. The Arnold P. Gold Foundation works to humanize healthcare by advocating for compassionate care coupled with scientific excellence. Our goal is to improve healing and healthcare outcomes by restoring the balance between high tech and high touch. Satisfaction scores are definitely a subjective measure, but perhaps patient experience is a better measure. Determining if a doctor asked about your family circumstance, if you had any questions about what was discussed, what concerns you most about your condition, etc. may be a fairer measure than how satisfied a particular patient was with the doctor.

  • meyati

    I’d rather have a competent Dr. Grouchy than an incompetent Dr. Smiley. One must look at the criteria given for feed back online and in a health system. Did you have a long wait B4 seeing the Dr.? Did they advise U of any delay? Did the Dr talk to U with words that U understand, etc? I haven’t been asked if I was talked to like I was a 5 year old, or if the Dr. listened to me, or even let me talk. Some friends and I were talking, and we decided that you pick the Dr. with the lowest scores, because all of the high score Drs were quacks. Charming, but incompetent. My low-score Dr. Grouchy saved my infected arm last week-hospitalized me–Why? I met a high score Dr. Smiley that didn’t follow protocol for dog bite victims that have cancer. I was there in 10 minutes after the bite.

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