Barely a week goes by that a friend or relative doesn’t ask me the same question: “Do know a good family doctor, or good orthopedic surgeon, or (just fill in the blank for any medical specialty)?” In truth, as a practicing physician, I do have some insight about the quality of other physicians with whom I work. However, the general public vastly over rates this “insider” knowledge.
You see my opinion of a quality physician is often as subjective as a layperson. There is sparse quality data for rating physicians and surgeons. One person’s view of “quality” can be quite different from another. For example, an internist who spends lots of time with his patients and refuses to use nurses or physician assistants, (commonly known as “physician-extenders”), may have not kept up in his field, may order too few — or too many — tests, and be a poor diagnostician. Yet, for many patients, he is considered a good doctor. Thus the “quality” of medical care can be very difficult to measure. It certainly isn’t for lack of trying. Adherence to medical protocols simply means you can follow orders and directions well. It doesn’t mean that you can think critically about solving a patient’s unique problems.
HealthGrades is another attempt to grade doctors, but since it relies primarily upon self-reporting, it too is limited. With a recent foot problem, I tried to find a good podiatrist. All I could discover was other physician’s recommendations, and these were often based upon the foot surgeon being a personal friend! A well-known national “list” of consumer services, including doctors, is limited by small numbers and therefore little better than anecdotal. The closest thing to an objective opinion I found was by chatting with anesthesiologists over the lunch table at the hospital, since they get to observe the surgeon in action.
Nowhere is this more frustrating than in my field of choosing a cardiac surgeon. Presently there are only four states where doctors’ heart surgery outcomes are mandated as public information by law. Florida is not one of them. I may “think” I know who the best heart surgeon is, but I have absolutely no objective data with which to support this opinion. Thus, even as a doctor who is responsible for referring my patient’s to one of the most important operations they will ever face, I am blocked from this information by hospitals and heart surgeons alike.
This needs to change. One of my personal goals is to have Florida adopt a public heart surgery outcome database by physician, and not just the hospital, as is the present arrangement.
In the meantime, ask as many questions as you can and research as much as you can. There is no shame in seeking second, and even third opinions.
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