HealthNews from the publishers of the New England Journal of Medicine
Gone are the days, for many of us, of doctors and patients knowing each other—their families, their values—over a lifetime. Instead, the rapid evolution of managed care is bringing some patients into a new plan every few years, leaving them without the continuity of a longstanding patient-physician relationship. Meanwhile, expansive media coverage of individual medical mistakes has created the impression that these occur more frequently than they really do. Add to this the rising tide of consumerism and a general mistrust of all professions. The result, in recent years, is growing public demand for ways to evaluate physicians.
In response, the state of Massachusetts will make available within the next few weeks profiles of every physician in the state—a groundbreaking step because it was proposed by the state's physicians. These will be the most complete descriptions of individual doctors available from a public agency. The profiles include not only education, training, board certification, and length of practice, but also what has been regarded as more sensitive information: malpractice settlements, criminal convictions, and any disciplinary actions taken against a doctor by the state or by a hospital.
The more information we can provide patients, the better. But it turns out that evaluating physicians is no simple matter. Being a doctor is part art, part science—and gauging the results of medicine defies simplistic evaluations.
Other states and health organizations are learning this as they attempt to meet consumer demand for yardsticks by which to measure their physicians. Already HMOs are gathering data on cost-effectiveness for individual physicians. Health statisticians are struggling to make this information useful in other respects, such as trying to show which doctors have the best results and greatest patient satisfaction. These efforts are known as physician "report cards." But a significant problem is that there are no standard rating systems or measures of quality. And in presenting data to the public, health care providers may include only categories in which they score well.
One approach—using data on treatment outcomes or mortality—doesn't take into account the patient's health and complications at the outset. New York's experience of ranking cardiac surgeons by mortality rate has prompted concern that the potential for poor rankings could have a chilling effect on physicians' willingness to take on complicated, high-risk cases.
Alternatively, a measure like "patient satisfaction" may be based on questions about parking availability and politeness of the desk staff—significant, perhaps, but no substitute for the larger questions: Was the diagnosis correct? Was the treatment correct? Did you get better?
Researching on Your Own
While these tools are being refined, there are many resources available to research a doctor, but patients should be aware of the limitations.
State medical boards license and govern doctors in each state. Most can tell you by phone or in writing whether a physician is licensed in that state, is certified in a specialty, and has been the subject of disciplinary action.
Such disciplinary action, meaning a doctor has fallen short in the eyes of his or her peers, is more significant than malpractice claims, which insurance companies sometimes settle simply to avoid the cost of litigation.
Professional liability claims that go through the court system and result in a jury award generally are public record and accessible at your local courthouse. Records of out-of-court settlements may be available from the state medical board. But just because a physician has claims against him or her, or has paid a settlement, does not mean he or she is a bad doctor. Physicians in high-risk specialties and those who take on more difficult cases have predictably lower success rates and a greater likelihood of being sued. To take this into account, Massachusetts physician profiles compare liability claims of each physician with other doctors in the same specialty. But this is controversial. The American Medical Association and some doctors object to systematic disclosure of malpractice settlements, saying they provide inadequate information for patient decision making.
The American Board of Medical Specialties Certification Line (800-776-2378) can tell you if a physician is certified in a specialty. Some so-called boards with impressive titles may not, in fact, require the rigorous training (such as many years in a residency program) of those listed with this organization. Local medical societies and hospital physician referral services also usually can supply the basic information on education, specialty, and location. The American Medical Association recently launched a Web site that attempts to list all US physicians in good standing, noting each doctor's address, board certification, and education (http://www.ama-assn.org). This is useful to find a specialist in a sparsely populated area or to confirm a doctor's license or board certification. But don't automatically rule out a physician whom you can't find on the site; the listings are new and far from complete.
Charts, ratings, and physician profiles, no matter how good, show only a fraction of what makes a good doctor and what makes a physician right for you. To learn more about a physician, consider:
People react to the chemistry between doctor and patient more than to any column of numbers or list of awards—and that's probably best for everyone involved. Remember, physician measurements are only as good as the data they are based on and the people who interpret them. Don't risk turning away from a good doctor because of a single malpractice settlement. The effort to make public more information about doctors comes from our insatiable desire for data. Whether it proves truly useful or not remains to be seen.