I found this article interesting. I was medical director for clinical informatics at a (now deceased) startup called DoctorQuality that developed systems to rate physicians and hospitals and provide this information to consumers. I think we were way ahead of our time, and there were many issues as you correctly point out with presenting this information to consumers. First, it’s hard enough to explain risk-adjusted mortality rates to our colleagues, let alone consumers. Also, there are many data streams that relate to quality: pt satisfaction, external physician recognition, raw data such as mortality and morbidity rates, etc. If one hospital has a risk-adjusted mortality rate that is 1% and another hospital’s rate is 1.1% but the second hospital performed better than expected and the first one performed worse than expected based on their patient mix, which hospital is better? Does this even have much meaning when the numbers are so close?

One of the biggest issues also relates to physician data. A lot of demographic data on the Web is garbage: one database provider we used had dead doctors, retired doctors, wrong specialties, etc. One very talented doctor was even listed under no less than 11 specialties: the world’s first gynecologist/urologist/chiropractor/orthopedic surgeon…you get the drift. Also, as relates to performance data, it is readily available (at least for MEDPAR) on the Web for most hospitals. However, performance data is very limited for physicians; some scattered data on CABG outcomes and a few other procedures is pretty much all that is out there.

You are correct that there is more than just numbers and quality check lists to rendering good medicine. However, it’s a start, and better than not focusing on quality. There are many things regarding patient safety that need to be improved, and if we don’t start doing it ourselves, it will be imposed upon us. Encouraging a quality-focused, patient-centered approach is better than doing nothing in this regard.

I agree that numbers cannot tell the whole story on what hospital or doctor provides the best care, and I certainly wouldn’t trust just a list of stats. But from the patient perspective, how are you supposed to choose? The information that is out there is really rather skimpy.

You can ask a doctor about his/her qualifications, but you’ll have to pay for the appointment for each doctor you want to check out. I don’t begrudge them the fee, but I can only afford to check out so many doctors. The licensing and professional organizations don’t seem to have a lot of doctors listed or it’s not accessible to the patient, only other doctors. The pay sites have even fewer doctors in their databases.

As for hospitals, you can visit a hospital’s website, but of course that is going to paint the the best possible picture. If you’re lucky, there’s a hospital in your area that’s on some publication’s list of top hospitals, but if you’re in a rural area, then good luck figuring it out.

I’m having major abdominal surgery next month. How did I pick my doctor? A recommendation from a friend who used to work at USC medical school to start with. Then, I went to my appointment armed with questions I developed after reading the experiences of others on a yahoo news group and reading about my condition. The doctor answered the questions consistent with my own research and she listened attentively and explained well. I found very little other info on her through professional organizations besides published papers.

The hospital, I don’t get to choose. She only operates out of one for her private patients.

Don’t get me wrong, I’m confident in my doctor and the hospital has a good reputation, but most of my decision ends up being based on word-of-mouth and a 20-minute interview with the doctor. Some actual stats, even if somewhat skewed, would have been nice.

MM and KateQ-
Thanks for your responses. I believe that we are in a situation in which perfect is the enemy of good. If you are looking at numbers, you may find the best doctor, but you also may find the doctor who is best at managing his numbers by treating only the easy patients. The doctor you want may be the one whose caseload includes the difficult cases, which will result in worse numbers, but it is the hard cases that we learn and improve from. As to the doctor who has a nice informative website, all that proves is that he, or someone he knows/hires, has good web skills. The doctor with a nice website is no more likely to be a superior physician than drinking Bud Lite is to get me a date with the Swedish bikini team. It’s all marketing.

There is no foolproof way to good medical care. The best way is to establish a trusting relationship with a primary physician (internist or family practice doc) when you are healthy, or in stable health. That may take some time and money, but it will be worth it. That way, when you need a referral to a specialist for surgery or other episodic care, you will have the benefit of her experience with other patients who have had simiar problems. It’s not foolproof, but it’s a lot better than waiting for reliable numerical ratings, which is a concept for the future, and always will be. If your problem is serious or urgent, your family doc will call the specialist and make sure he understands your situation. It will get you better care and more attention.

BTW, you can call any doctor’s office and get basic info from the receptionist for free, such as type of training, where she went to med school and residency, board certification, years in practice, etc. If the office receptionist will not give that over the phone, that’s a doc to avoid.

Most hospitals have websites that feature their docs, and give the basic info you will need. I would be surprised if your local hospital does not do this. Getting a referral from your family doc is a much better way to go.