When meeting a new patient, I often break the ice by asking, “How did you get to me?” Aside from the occasional wise guy who says “By taxi,” the most common reply I get these days is “You’re in my health plan.” Well, how should you choose a doctor, someone with whom you’ll be sharing some of your most personal information and entrusting with life-and-death decisions?
To get the easiest part out of the way first, yes, unless you’re made of money, the doctor really does need to participate in your health plan. Don’t rely solely on the insurer’s online provider directory to make this clear because it might be out of date; check with whoever is in charge of claims and billing at the practice you’re interested in. Beyond that, though, you’re going to have to cobble together information from a variety of sources to make your pick. Here’s what I think of all of those sources, and how useful and/or reliable they are.
If people rate restaurants or health clubs, why not doctors? Sites such as Healthgrades.com, RateMDs.com, and Vitals.com allow people to anonymously rate doctors on bedside manner, availability, office facilities, and staff friendliness. Those are all important. Consumer Reports’ surveys consistently show that patients who think that their doctor treats them with respect and understanding are more satisfied. But there’s no way to know whether those submitting ratings are a representative sample of a doctor’s practice.
Other problems were uncovered by a study reported in the June 2013 edition of the Journal of Urology, which looked at online reviews of a random sample of 500 urologists. The main problem was that the average rating was based on 2.4 reviews, far too few to draw any statistical conclusions. Moreover, almost 9 in 10 doctors were rated positively, making it difficult to make any comparisons.
Your health plan is another source of online information. Many have special designations for doctors who have met standards of quality. And the National Committee for Quality Assurance, a nonprofit group that rates and accredits health plans and medical practices, has a directory of primary-care practices that have been accredited as “patient-centered medical homes” offering such patient-friendly services as after-hours care and extra help managing chronic conditions.
The day probably isn’t far off when people will be able to get reliable doctor ratings online. Consumer Reports has already published them for practices in Massachusetts, Minnesota, and Wisconsin, and for heart-surgeon groups nationwide. Medicare is setting up a system that will measure doctors on 144 quality standards and report the results to the public—possibly within the next two to three years. But we’re not there yet.
Anyone with a medical degree, be it from an Ivy League or off-shore medical school, can practice any type of medicine—from family practice to complex surgery. To make sure your doctor is trained in the specialty you’re interested in, look for certification by one or more of the 24 boards belonging to the American Board of Medical Specialties. Your health plan’s list of doctors may also include that information.
Certification means that the doctor has not only received training in a specialty after medical school but has also passed a rigorous examination. In order to keep skills from becoming rusty, most specialties require doctors to be recertified periodically, so that they can be assessed not only for “book knowledge” but also for practice performance and patient care. Other pluses include fellowships in specialty organizations and a medical school faculty appointment.
Don’t neglect the advice of friends and relatives, although such recommendations usually have more to do with “bedside manner” than with documented competence. Of more importance, as a referral source, is a medical professional—a physician friend or a nurse—who has special insight into what makes a good doctor.
When you’ve done your homework and made your choice, visit the office to meet that person. Ask questions relating to your needs, likes, and dislikes. Your final decision could be one of the most important you’ll make. ■
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