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.
You'll find out, in sum, whether you can trust her and whether she treats you as an intelligent human being who acknowledges the doctor's expertise and experience but has her own views. And if not, try someone else.
4. Ask good questions, insist on good answers. Blind obedience is out. Finding good specialty care is less of a challenge, if still daunting. We'll look at an example—a patient who stands for millions of individuals a year who face the prospect of surgery. In this case, it is heart bypass surgery.
Let's say you've been having chest pain when you exert yourself. After looking at the electrical patterns generated by your heart on an ECG test, your PCP sends you to a cardiologist, who orders up an angiogram that displays dye-outlined X-ray images of your heart in motion. The pictures reveal extensive blockages in several of the coronary arteries that feed the heart. The cardiologist points out one blockage that nearly closes off the first section of the left anterior descending, or LAD, a big vessel the surgeons dub the "Widowmaker." You're lucky, she says. If that section shuts down completely, your family might learn the reason for the nickname.
You ask: "What are my options, and what are the pros and cons of each one?" She explains that because you have serious heart disease in three arteries and one of those is the LAD, your best option is heart bypass surgery. It's possible to avoid surgery, she says. The vessels could be opened up by guiding balloons inside the blockages, blowing them up, and inserting mesh tubes called stents to keep blood flowing. But the latest guidelines from heart experts advise against that when three vessels are involved, especially when one is the LAD. The chances of a lasting fix aren't good enough. Bypass surgery is a better bet. You scribble a note to yourself to check this out.
"Where would you recommend I have the procedure?" you ask. She names a local hospital. "Why there?" The doctor is briefly startled—not many patients want to know her reasons—and assures you the hospital does a large number of bypass surgeries. She suggests a particular surgeon. You scribble more reminders.
5. Be your own researcher. Back home, you head for Medline Plus, the National Institutes of Health consumer page, to learn more about stenting vs. bypass surgery. You follow suggested links and confirm her endorsement of surgery. You move to the recommended hospital's Web page but can't find volume or results-related statistics. Nor does the state health department's Web page turn up that information. (Only a handful of states, including California, Maryland, New York, and Pennsylvania, give residents performance data on individual hospitals.)
You see if the hospital is mentioned on the Cardiology & Heart Surgery Web pages of U.S. News's Best Hospitals, which looks at Medicare data for the sickest patients in 16 specialties. The hospital is not among the ranked facilities in the top 50, nor is it a "high performer" among the top 25 percent of all hospitals evaluated. Finally, you look up the name of the recommended surgeon on U.S. News's Top Doctors page. It's not there.
You do more homework and discover that the Leapfrog Group, a business-supported standards-setting organization, puts the minimum recommended annual number of bypass surgeries at 450 for a hospital and 100 for individual surgeons. Armed with this information, you call the cardiologist and ask that she suggest a different hospital and surgeon. She does. You call the surgeon's office and ask for his bypass death and complication rates for the latest 12 months. Both are in the low single digits, which is reassuring. You decide to go ahead.
You and your doctor have just collaborated in an informed decision. She did not dictate and you did not blindly accept. The odds of good results have been tilted in your favor. It will be just a matter of time before you're back to pulling weeds in the garden or playing catch with your kids. A long life lies ahead.
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