Secrets to Getting the Best Healthcare
These key principles can help lead the way.
At some point, no matter who you are, you'll need good healthcare providers to check you over periodically, fix small problems before they turn serious, and perhaps deal with serious ones that weren't found or couldn't be fixed. It's not that hard to find a primary care provider, and the occasional specialist when necessary. You ask around to see who family members and trusted friends use, check to make sure they're taking new patients (and are in your insurance network), and get specialist recommendations from your regular doctor once you have one.
But the question isn't how to find doctors, but how to find good ones. And that's not so easy. These key principles can help lead you to good healthcare.
1. Accept the information gap. Let's start with the all-important gatekeeper, the primary care doctor who manages your health by keeping you current with immunizations, screening tests, and other preventive care, refers you to specialists when that's indicated, and otherwise manages your health. In all likelihood he or she will be an internist or family doctor, although some women like to use an obstetrician-gynecologist for primary care. Plenty of Websites, like healthgrades.com, show you where and when a prospective primary care doctor went to medical school and did her residency, and perhaps indicate any license suspension or criminal conviction. Trouble is, these facts are not especially helpful. Studies have not demonstrated a meaningful relationship between where doctors are educated and how good they are as primary care practitioners. And while you hardly want a doctor with questionable credentials taking care of you, eliminating physicians with shady pasts doesn't say anything about the competence of those remaining.
In an October 2010 essay in USA Today, internist and blogger Kevin Pho cited an Archives of Internal Medicine study which found that "most publicly available information on individual physicians—such as disciplinary actions, the number of malpractice payments, or years of experience—had little correlation with whether they adhered to the recommended medical guidelines. In other words, there's no easy way to research how well a doctor manages conditions such as heart disease or diabetes. That kind of relevant performance data are hidden from the public."
There's no real alternative to starting by assembling a list of possible candidates whose offices aren't impossibly far from you, then calling to see if they are taking new patients and will accept your insurance.
2. Give opinions the weight they deserve. It is tempting to consult the opinions of patients of doctors you put on your candidate list. You can do that on physician review Websites like RateMDs.com and Vitals.com. There may be some value in taking a look. But the stakes are considerably higher when you select a doctor than when you pick a new movie or pan-Asian restaurant based on Yelp reviews. The value of "crowdsourcing" has a lot to do with the size of the crowd.
A bit of perspective: An average primary care doctor has a "panel," as the number of patients under his care is called, of roughly 2,500. On doctor-rating Websites, 10 comments is unusually high—a few minutes on one of these sites will show that most doctors don't have any comments at all. Taking comments posted by 10 out of 2,500 patients seriously is like asking one student in a class of 250 how he liked the teacher. What's more, the range of views even within a small number of comments can be extreme. The 11 sets of ratings and comments posted on RateMDs.com during the last four years about a particular primary care provider in the Washington, D.C. area, for example, included straight 1s (the lowest mark) and straight 5s (the highest mark) in office staff, punctuality, knowledge, and helpfulness.
3. Test the fit. You'll need to learn over a period of months or even years whether your initial PCP choice was right for you. It's an auditing period, during which you'll discover whether she listens carefully and follows recommended practices, such as making sure to update your medication list every time you visit and to check the pulses in your feet every visit if you're a diabetic. You'll find out, if you go to specialists, whether she reviews their reports. You'll soon know whether she constantly interrupts you, whether she bristles if you mention a study or Web article you've seen, whether she will go to bat for you with your insurance company if necessary, and whether her office staff treats you respectfully.