Dr. Kussin: Choosing a Doctor

September 7th 2012   ·   0 Comments

A quick note to my kind readers: All the links and references herein will add to your knowledge.

Here are some lyrics for you.

“You need understanding
You need a home
All those people so alone. You need understanding
You need a home
You’re looking for love
In all the wrong places.”

Few skills are more important than those that lead you to the right doctors. Most of the resources people use, fail to offer valid help. And that’s bad, because when 15,000 Americans on Medicare die every month from bad care (http://www.washingtonian.com/articles/print/2012/01/27/minor-mistakes-deadly-results.php), it’s clear the wrong choice can be fatal. We live in a country that offers the most unsafe care in the industrialized world, (http://www.commonwealthfund.org/News/News-Releases/2012/Aug/Potentially-Preventable-Deaths.aspx). It’s dangerous out there.

The Feds

When it comes to health care, I like the feds—no one insures it better than Medicare; no one delivers it better than the Veterans Administration (yup, believe it or not); and no one educates and looks out for you better than the Agency for Healthcare Research and Quality (ARHQ). (http://www.ahrq.gov/).

But… when the feds weigh in on how to choose a doctor, (http://archive.ahrq.gov/consumer/qnt/qntdr.htm) the information is useless. They miss the mark on the features you should value most. Brains are a must for physicians; brains and manual dexterity for surgeons. This list doesn’t get you there. Let’s take a look at their list of five ‘doctor-quality’ metrics.

1. Find out if a consumer or other group has rated doctors in the area where you live. Again, you will want to find out how reliable the ratings are.

The rating companies are not reliable. The inaccuracies, conflicts of interest and the doctor-quality metrics they prioritize are deal breakers (http://medicaladvocate.com/?p=392). I studied the free ‘doctor-rating sites’ (http://medicaladvocate.com/?p=400) and the sites that you must pay for (http://medicaladvocate.com/?p=411) in detail.

When it comes to rating hospitals, go right ahead and use these outfits. In fact, when it comes to choosing hospitals, the best places to start are US News & World Report and HealthGrades. Hospitals have stats. Doctors don’t.

Doctors are not like baseball players. When a batter steps up to the plate, the information flashed on the bottom of the screen tells you all you need to know. Go on-line, there are 65 separate stats that can be used to judge a ball player’s abilities.

When Doctor comes into the room, there are no flashing stats appearing on his white coat, no history of errors, home runs or how he hits in a clutch. Rating companies have little or nothing valid to offer. And patient satisfaction is not an indicator or doctor quality. (http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6223)

2. Information on doctors in some States is available on the Internet at http://www.docboard.org. This Web site is run by Administrators in Medicine—a group of State Medical Board Directors.

Take a peek if you wish. You will learn if your current or prospective doctor has been arrested or suspended. But disciplinary actions and malpractice suits directed to doctors are not shown to be helpful. Public Citizen (http://www.citizen.org/Page.aspx?pid=183) is an outfit that’s as nonbiased as it gets. Doctors hate Public Citizen (http://www.thestate.com/2012/05/24/2288009/sc-worst-in-doctor-discipline.html) because the information they publish is often not friendly to us. So, when they say, “ Conflicting conclusions among public reports on physician, discipline and quality raise questions about their methods and validity. State rankings about discipline and quality should be viewed with caution.” ( http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/issues/wmj_v105n8/Roberts.pdf ) you can believe it.

The referenced web site may be be a step up from nothing. Most states offer little information, and no uniform standards of discourse about a doctor’s quality exist across the states. It’s ‘e pluribus anonymous’ for most states.

3. The American Board of Medical Specialties (1-800-733-2267) can tell you if the doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam (board) to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors also may be certified as specialists. You can also check the Web site at http://www.certifacts.org. (While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified.)  But…

I’m sad to inform you that this is useless information. If 85% of test-takers pass the Boards in their selected specialties, then the test is not discriminating enough to point you in the right direction. When everyone passes, no one passes muster. Even lawyers have it tougher than doctors. That’s not right, is it? But the passing rate for all candidates taking the law boards was 69.2%. (http://www.nybarexam.org/press/July2011results_PressRelease.pdf )

The AHRQ also says that if your doctor isn’t board certified, he might be OK. Really? “No Boards? No problem. Go ahead and have a field day in my brain, doc”. NO WAY. “Board Eligible” is also a deal breaker. That means they’ve done all the course work but not taken or have failed the boards several times. Move on.

4. Call the American Medical Association (AMA) at (312) 464-5000 for information on training, specialties, and board certification about many licensed doctors in the United States. This information also can be found in “Physician Select” at AMA’s Web site: http://www.ama-assn.org/aps/amahg.htm. in the United States.

5. Call the American Osteopathic Association at (800) 621-1773 or (312) 202-8000 for information on training, specialties, and board certification for licensed osteopathic physicians (D.O.s) in the United States. Information on locating an osteopathic physician can be found at http://www.osteopathic.org/osteopathic-health/find-a-do/Pages/default.aspx.

Both the AMA and the AOA are lobbies for doctor interests. Even the former editor of the Journal of the American Medical Association calls it “unsalvageable.” (http://www.thedoctorweighsin.com/who-will-speak-for-physicians-and-their-patients/) Only 15% of doctors are members. (Ask the AMA what they think of me: “We found 0 AMA member physicians matching your criteria.”) Also, AMA members must adhere to their Principles of Medical Ethics,” implying that non-members are ethically challenged.

When searching for a steward of you and your family’s care you don’t have the tools you need. Whether you are looking for a family doctor or a specialist this AHRQ guide is not only unhelpful, it’s dangerously off the mark on several points.

By Richard