Saturday, January 12, 2008

Doctor shopping in the 21st century

How do you find a good doctor? A good dentist?

You can look in the phone book. You can sign on to one of those bogus websites where doctors pay to have themselves recommended, or where you pay to be provided with information that you can find by yourself for free. You can look in a magazine where local doctors vote each other “top doctor.” All of these choices are inherently unreliable, of course, and provide little or no meaningful system for filtering the wheat from the chaff.

States do have medical boards of examiners that keep track of complaints and malpractice judgments against doctors. This tells you when a doctor screws up in a big way but it tells you little else.

What about a doctor’s bedside manner? Punctuality? Ability to communicate? Ge
neral quality of care?

For answers to those questions, patients have long relied on word of mouth. This is subjective
, of course. My neighbor, who has battled and defeated breast cancer, is a patient of Dr. Lippencot, and likes her. Lippencot was my first CLL doctor, and I fired her. So depending on which door you knock on, you’ll get two different views of the same doctor. Perhaps you would benefit from both, depending on the cancer you need treated.

Word of mouth works on the internet, too. CLL Forum has a section called “Doctors and Centers” in which people ask questions about, and describe their experiences with, doctors who treat CLL. (By and large the comments are complimentary, by the way.) On the ACOR CLL List, someone will occasionally ask “Can anyone recommend a doctor in Gotham?” and several people will reply, both on the list and privately off the list.

This works, sort of, for CLL, because there are specific discussion groups for the disease. But what if you are looking for a local urologist, or gastroenterologist, or orthodontist?

All that patient word of mouth has joined the internet age in a useful website called RateMDs, which contains more than 400,000 patient reviews of doctors and dentists.

Words to the wise, sort of

Personally, I think it’s about time something like this was created. Not that there aren’t pitfalls -- some patients simply aren’t going to be fair in their assessments and some doctors are going to try to game the system by encouraging patients to comment favorably -- but we’re all adults here, and we can more or less separate the reasonable reviews from the BS.

Any system of evaluating doctors is going to be subjective, based upon user impression and experience. To make it work, it needs to be designed intelligently, with some safeguards to insure a reasonable degree of fairness. RateMDs, located in Sunnyvale, CA, lets physicians post rebuttals and removes comments that are libelous. It is, for example, OK to say the doctor “has the bedside manner of an orangutan” but you can’t say “the doctor killed a patient.”

Of course, some doctors are not happy about this regardless. For a long time doctors have existed “above the law,” seldom held responsible in the court of public opinion. But that great equalizer, the internet, is changing things.

The creators of RateMDs offer this simple statement in their FAQ:

“We're just average patients who happen to know how to make websites; we are not doctors and a
re not affiliated with any medical organizations so we don't have any conflicts of interest. Having visited several doctors in the past few years, we became frustrated with the treatment we received, and the lack of comparative information available for choosing a good doctor, so we decided to create this web site to help people who have had similar experiences.”

Or as RateMDs co-founder John Swapceinski told Forbes, "Patients are ultimately the customer, and they're paying for a service, and they can decide whether or not they're satisfied."

RateMDs covers doctors in the US, the UK, Canada, and Australia. American doctors can be sorted by state and profession. Patients are encouraged to rate them on a system of one to five points, five being the highest, in four categories: staff, punctuality, helpfulness, and knowledge. The scores assigned by all patients are then averaged in each category; an “overall quality” rating is assigned based upon the helpfulness and knowledge ratings. Patients are also given space to describe their experiences, and these narratives form the heart of the evaluation.

Before commenting, patients are told: “Please make your comments detai
led, helpful and polite and tell us WHY you rated as you did. Libelous or very short comments will be deleted. Further, this is not the right forum for reporting illegal activity, unless you include a link to a site with supporting evidence. And remember, you are legally responsible for what you write here.”

Spend some time surfing around the site and you will see a reasonably high level of satisfaction, with most of the negative comments concerning the doctor being rude or hurried and paying little attention to detail.

There are some amusing stories. One man visited a dentist and ran into a little problem when he called the dentist “dude.”

“I was scheduled for a root canal after suffering for almost 2 months,” the patient wrote. “I asked a
question, using the word 'dude' at the end of the sentence. He refused to work on me because he said, 'no one calls me dude.' I apologized and explained that I didn't mean anything by it. I left his office in pain and disbelief. I guess when he is charging over $800 for approximately one hour of work, he can afford to be a prima donna. I need a dentist who is more compassionate and can understand that after two months of pain, antibiotics, and pain medication, perhaps a patient could be off their game a little. So, be on your toes, only speak when you are spoken to, and for goodness sake don't call him 'dude.' He has absolutely no sense of humor.”

Avoiding the urologist from hell

Of course, there are more serious issues at stake. I used the site to find a urologist, for example, and ran across some interesting information.

In my town and on my health plan, there is one urologist. My primary care doctor gave me a referral to this guy for a routine prostate exam and I decided to check him out at RateMds.

Based on three reviews, he had a low “overall quality” score of 2.3. One reviewer said this:

“This doctor was hired to repair a recurring hernia and testicle pain. Not only he did not repair the hernia (open surgery without any mash reinforcement) he did cut the blood flow to my testicle which within six months slowly died of starvation. He ignored my complaints for those six months and then he said: "Oh well, it is not a big deal, testicles are like kidneys -- you have another one." The dead testicle was removed last month. I am facing a lifetime of expensive HRT [hormone replacement therapy] and of course the damage done to me and my family life is obvious, and this man will keep doing this until who knows when.”

Hmm. Nothing like the prospect of a dying testicle to get the average man's attention. So then I went to the other place where I check on every new doctor I make an appointment with, the state medical board. (Conveniently, RateMDs provides a link to each state’s board.) The board website provides information about the doctor’s
education, residency, area of medical interest, whether they are board certified in a specialty, and license. It also lists any medical “board investigations and actions” and whether there is any “malpractice/criminal information.”

Sure enough, this doctor had one “board action” in which he received a letter of reprimand in 2004 for “failure to timely repair a damaged ureter that contributed to the death of the patient.” Clicking on a link took me to a 5-page PDF describing the incident in detail.

After reading the RateMDs review and the PDF, I decided to take my prostate elsewhere. Back I went to RateMDs. I expanded my search geographically and matched the names on my health plan against the doctors who had reviews and found one with four reviews and an overall quality rating of 5.0.

Here was a typical comment:

“Superb surgeon and doctor. Treated me for testicular cancer, removed the testicle and did follow-up prosthetic surgery. All healed well and quickly. Very knowledgeable, and extremely empathetic and supportive. I would not hesitate to recommend him. Great bedside manner. A very genuine nice guy, who is extremely highly skilled.”

So I went to see him and found him to be as advertised: professional, knowledgeable, and friendly.

And all this thanks to RateMds, with an assist from the Arizona Medical Board.

I did the same thing when looking for a gastroenterologist and was similarly happy with my choice.

Without RateMDs, I would have been wandering around in the dark, hoping for the best, and not necessarily getting it.

There is a lot riding on the doctors we choose -- our health, our time, our money. “Luck of the draw” and blind referrals are not reliable methods of finding a doctor. As countless CLL patients have discovered, having a medical degree does not always mean a doctor can provide an adequate standard of care. Sites such as RateMDs provide a worthy and valuable service. The ass you save -- or the testicle -- my be your own.


Anonymous said...

Thanks for the tip. I'll check the site out soon, and you're right, this has been a long time coming.

I'll bet the average doc and the average medical association (who cares little or not at all for the patient) will try to shut this site down as soon as possible.

I have comments about people who have treated me and members of my family.

There is one caveat, though. A doctor can have a good record and yet screw up your case good and well.

Anonymous said...

Sites such as this may serve a useful purpose as in your example with the urologist.

Ultimately, however, they depend upon the judgements of the patients or "customers" and at times may be misleading.

I have practiced medicine for over 30 years and have often marveled at how revered some totally incompetent physicians may be, while others, who may be excellent clinicians or especially skilled surgeons have bad reputations because they are socially inept.

The record of malpractice history and state medical board actions may also be misleading, because all such events are recorded, though not necessarily fully described.

The one malpractice case that I had to deal with was a joke (I won) yet it remained on my record for 10 years. I can assure you that I have made other mistakes for which claims and judgements could have been rendered against me, but never were because I have good rapport with my patients and have always been upfront about errors and quick to be as helpful as possible.

One of my friends inadvertently failed to pay his licensure fee to our state after he moved to practice in another state and was cited by my state medical board for this. This would appear as a board action just as much as some gross misconduct.

When seeking medical care learn as much as you can about the competence and humanity of the physician and choose one with whom you can relate well. Ultimately what you want is one who will listen and interact, give you a reasonable amount of time and be honest about the implications of all decisions.

Anonymous said...

My experience dealing with some CLL expert clinicians is that they may be brilliant, but their staff drops the ball frequently. I tended to blame the staff, but then I realized that these problems (lack of contact with the patient, failure to return important phone calls, etc.) persisted through numerous staff changes.

I concluded after many years that the guy at the top either failed to understand how incompetent his staff was, or didn't care, or cultivated this lack of patient care so as to drive away patients so as to maintain a manageable patient load.

What a terrible practice!

K said...

Thanks for the information on how to find good CLL doctor.

We recently wrote an article on finding a good doctor on Brain Blogger. When it comes down to finding a doctor, is communication and accessibility important to you? Does it matter whether your doctor is foreign and has as thick accent or the fact that you can't talk to your doctor through the phone directly, but through a nurse or receptionist?

We would like to read your comments on our article. Thank you.