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? General 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 are 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 detailed, 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.