Much has been written previously about the
importance of choosing your doctor wisely. But honestly, much needs to be written on this topic,
because smart, savvy people continue to make bad choices, despite all the advice
that’s out there.
Just like any other profession, there are
some bad doctors, a lot of reasonably competent doctors, and some excellent
doctors. All are not created equally. But most people don’t know how to discern the
good from the bad. They make their
choices instead based on factors like: proximity to home or work, ease of
finding a parking place nearby the clinic, the interior design of the office or
the variety of magazines in the waiting room.
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Identifying excellent doctors isn't an easy task |
Your choice of doctor
is important in and of itself. It also
is important because it typically dictates the broader health care system and
the hospital that you will be using eventually if and when needed. You might have the best doctor in the world,
but if that doctor is allied with a poor-quality hospital that has unsafe and
unhygienic conditions, then you are in trouble if you ever need to be
hospitalized.
The consequences are significant. More than a decade ago, the Institute of
Medicine estimated that at least
44,000 people, and perhaps as many as 98,000 people, die in United States
hospitals each year as a result of medical errors that could have been
prevented.
Hence the title of
this posting: choosing your health care team.
It is important to choose the right doctor, of course, and that is the
focus of today’s posting. But the broader health care
system in which the doctor works is also crucially important. Even in today’s era of managed care and
preferred providers, most of us have a range of picks at our disposal.
Today, I am listing some basic factors you
can look into before you meet your prospective doctor. In future postings,
I will discuss some of the things you can consider when you meet the doctor
face-to-face; and factors about the broader
health system that can serve as clues to the quality of services you can expect
to receive.
So don your sleuthing hat and start
researching.
Degrees.
In the
United States, two professions are licensed to practice medicine: doctors of
osteopathy (DOs), and medical doctors (MDs).
Other doctoral-level professions that can practice independently are naturopathic
doctors (NDs), doctors of chiropractic (DCs), and my professional group,
psychologists (PhDs). Physician
assistants (PAs) and nurse practitioners (ARNPs) are not technically doctors
but can serve as primary care providers within larger health care clinics. Certainly, excellent practitioners can be
found within each of these professional groups. I will nonetheless offer my
opinion that MDs are typically the most rigorously trained and best prepared
for general health care.
In addition to the degree, I look at
academic reputations of the specific schools and hospitals where the doctor has
trained. This is not a hard and fast indicator, but a clue about the doctor's rigor of training (as well as ability to be accepted into competitive schools or residency programs).
Board
certification. Beyond completing their basic
training, doctors must be licensed by the US States in which they work.
However, being licensed does not indicate whether a doctor has completed
internship and residency, nor whether a doctor is qualified to practice in a
specific medical specialty, such as internal medicine, surgery, or dermatology. One of the best ways to know if your doctor has the qualifications to provide
care in a specialty is to find out if he or she is Board Certified by the
American Board of Medical Specialties. I always look for this certification
before making an appointment.
Licenses
and disciplinary actions. Many US States maintain
online databases where you can verify that a health care provider has an active
license, and confirm that no official disciplinary actions have been taken
against him or her. An inactive license
or a history of disciplinary action is a big red flag. In some cases, disciplinary actions can be
explained by mitigating circumstances but you should do your homework if you
see one on a provider’s file.
Commendations
from peers.
In my city, Seattle, a local magazine conducts an annual “top doc” survey
of thousands of local doctors. Each
doctor is asked: To whom would you send a loved one for medical care? The
doctors who end up on the final ‘top doc’ list have been selected by their
peers as among the very best in their fields.
Most of my doctors have been, or are currently, ‘top docs’. In locations where such a list does not
exist, you can improvise by asking a trusted physician or health care provider in-the-know this same question.
On the other hand, beware of doctor review websites. You’d think they might be a great source of
information. But in reality, most are
unreliable because they are based on only a few reviews, typically from
patients who have had either wonderful or awful experiences. One study showed that only 3% of patients
have ever posted an online review of their doctors. Until these sites are used more widely, they will
continue to be inherently untrustworthy.
There is no single factor or information
source to lead you to the best possible choice.
But many clues are out there, if you take the time to look for
them.
Resources
The website DocFinder contains the
licensing background and disciplinary information of physicians and other
health care practitioners in addition to physician profile information from US
States that have passed physician profile laws.
American Board of Medical Specialties
maintains a database of board-certified physicians.
Seattle Magazine’s Top Doctors 2012.
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