Recently I decided to change primary care doctors. I was seeing a male doctor and just felt I wanted to have a female doctor. I was immediately confronted with the very important question, What is the best way to find and choose a new doctor? Do you ask a friend? Do you google doctors in your area? What websites give you useful information about a doctor, and what are the characteristics of a good doctor anyway?
One way to find a doctor is to ask friends who their doctor is. But after you identify a few names, what are you really asking them? On what do they base their recommendation? Do they know if their doctor has any malpractice claims against them? Is it important whether the office staff treat patients with respect? I find that friends will say things like, “Well, she listens well” or “She has a good bedside manner.” I rarely hear “My doctor’s credentials are excellent. She graduated from the best schools,” even though that might be an important thing to know.
Let’s start with how well a doctor listens, because that is a key skill. If a doctor doesn’t really listen to you, then she will never understand your issue and miss a diagnosis. Many, if not all, doctors these days talk to you while writing on their laptop. While that can be disconcerting, you can evaluate the proportion of time the doctor looks at her laptop vs. looks at you, and if it is 80/20 (laptop to you), she may not be the listener you need. The best doctors are almost always the best listeners, although there are certain specialties that seem to attract the type of doctor who really does think they know everything and don’t want to be bothered by your opinion.
Dr. Abraham Verghese, has spent his career understanding and communicating the importance of the patient-physician relationship and educating young doctors about bedside manner. He explains that good bedside manner is not just nodding and smiling; it means really seeing the patient. Nothing beats just looking at your patient — not fancy imaging or blood tests. Most of the time you can see a lot in a patient’s eyes, their body movement, their silences as well as their questions. In the time of the pandemic, most of us have not had any physical contact with a doctor. At best we may have had a teleconference or phone call. Hopefully, as we all get vaccinated, we can go back to the in-person contact that is so essential in medicine, since it is an art, not a science.
Other ways to evaluate a doctor are to look at patient reviews on their website or Yelp. This turns out to be about as helpful as a restaurant review. The most negative reviews can be hard to evaluate. If there is only one bad review among a bundle of good ones, you might assume that person had a bad day. But patient reviews will usually address issues like bedside manner or the behavior of front office staff. How a doctor trains her office staff is actually an important key to the overall respect that doctor has for you, the patient. Does the staff look up when you come up to the counter or do they continue what they are doing and make you wait? It is fairly common for office staff to ignore patients or treat them as distractions, and that is a shame. If they were trained properly, they would understand that we are actually their “boss,” and we should be treated with at least as much respect as the doctor herself.
What about a doctor’s credentials? Is a doctor a “better” doctor if she went to a well known medical school? Is the doctor “worse” if she went to an off-shore medical school or one from a different country? While there is much to improve in medical education in our country and around the world, having graduated from a prestigious institution doesn’t guarantee quality and may only reveal that the doctor was able to memorize details well and is a good test taker. The degree tells you relatively little about how they were trained. “Board certification” is important, but it is just a test to be sure the doctor is up to date on the important facts of their profession. A recent study looked at one million hospitalizations managed by 30,000 physicians and found no correlation between outcomes like patient risk of death and readmission and the medical school their doctor attended. The takeaway here is not to be over-impressed by a Harvard Medical degree or under-impressed by a degree from a lesser known school.
Choosing an internist is different from choosing a surgeon. An internist or primary care doctor is supposed to be the gatekeeper and coordinator of your care. You want them to be Board Certified in Internal Medicine so they have a broad knowledge of your whole body, not just one part. But other than certification and medical school attended, the patient reviews here might be useful. Evaluating a surgeon is easier in some ways. First, you are probably referred to a surgeon by your internist, so you may not even think to investigate further. But there is a way to evaluate a surgeon that you should always use — the number of times that doctor has done the surgery under consideration. The higher the volume, the more likely that doctor has the skill required to do your operation. There is a huge amount of literature linking quality with volume, both for doctors and for hospitals. It may be awkward to ask that question of your doctor or the surgeon being recommended, but it could save your life. If you are only the tenth or eleventh patient whom that doctor has operated on, you might want to look for someone more experienced. This question is supremely important for surgeries like orthopedic (knees, hips) and heart (valves, replacements, etc.). Hospitals are rated in a number of different ways, and it doesn’t take much googling to find your specific hospital’s ranking. In fact, Medicare.gov offers a great resource for finding both doctors and hospitals. It’s a little more difficult to find the ranking of an individual surgeon — but it’s not impossible. This article will help you think about it.
It is not true that all doctors are equally competent. We put our lives in the hands of professionals and when it comes to choosing a doctor or hospital, doing a little research is always worth the effort.