The Comfort of Good Care
Prioritizing your needs—both practical and emotional—and spending some time engaged in high-quality research will help you find the right physician.
By John Leifer
Beyond family, there are few relationships more important than those we share with our doctors. We entrust physicians with our most precious asset—our health and well-being. Yet despite the importance of our medical relationships, many of us don’t seek out objective information to guide our search for those doctors who can best meet our needs. Instead we often rely on blind trust.
Why do Americans, who are arguably the most discerning consumers on the planet, fail to invest more effort in exploring their healthcare options? The answer is twofold.
First, many of us hold the erroneous belief that there is little variation among physicians. Beyond their chosen specialties, we tend to act as if all doctors are created equal.
In truth, doctors vary dramatically in the depth of their education and training; their clinical discernment, technical competency, and clinical outcomes; as well as their values and communication skills and myriad other factors that may affect care. Though we may wish that our doctors were superhuman and impervious to human foibles, they are as mortal as the rest of us.
Second, even if we accept the premise that an appropriate level of due diligence is wise before selecting a physician, we may not know how or where to begin a search. It takes time to find actionable and trustworthy information that will lead to an informed decision.
Before you set out on a quest to discover the right physician for you or your family, take a few minutes to define the features that you believe constitute a great doctor. That means asking yourself the relative importance of such things as his or her clinical skills, knowledge, bedside manner, and hospital affiliation. Once you have your list, order the items from most important to least important. When you’ve completed that step, you are ready to roll up your sleeves and become a data sleuth.
Below are my criteria—what I consider important when evaluating a physician—along with tips directing you to reputable sources of information. I hope this helps you get started.
- Accepts my insurance. Whether your physician is included in your insurance network can make a tremendous difference in your out-of-pocket costs. Your insurer can provide a list of physicians who are in-network, as well as an explanation of the costs for going out-of-network. It is wise to also check with your physician’s office to further validate this information.
- Hospital affiliation. Just as physicians vary in quality, so too do the hospitals with which they are affiliated. As such, the depth, breadth, and quality of a hospital’s services, as well as it aligned medical staff, should be an important consideration—particularly when selecting a primary care physician. Chances are your primary care physician will first turn to affiliated physicians when making a specialty referral. Bear in mind that the quality of the hospital is no guarantee of the “quality” of the physician.
Start your assessment of hospital quality at the US Centers for Medicare & Medicaid Services (CMS) website, which provides objective, comparative hospital information: medicare.gov/hospitalcompare/search.html. Another, more subjective view of hospital quality can be found on the U.S. News & World Report site: health.usnews.com/best-hospitals/rankings.
- Education and certifications. The depth and rigor of a physician’s training can have a major influence on the doctor they become. As a bare minimum, you should know where your physician completed their education, the extent of that training, and whether the doctor is board certified or board eligible (a minimum quality standard you should expect with every physician). Your physician’s office can provide this information, or it can be found on consumer websites such as Healthgrades.com:
- If we believe Malcolm Gladwell’s assertion that mastery of any skill or art requires at least 10,000 hours, having a physician with significant time in the field can prove highly beneficial. It should be easy to ascertain a physician’s years in practice simply by asking.
- Volume and outcomes. There is a clear correlation between the volume of procedures performed by a specialist and the specialist’s clinical outcomes. For that reason, before undergoing a procedure it is wise to inquire how many comparable procedures the specialist has performed in the past year, as well as their outcomes. Your objective is to eliminate the possibility of having a marginal provider with high complication rates—things like unscheduled returns to the operating room, post-surgery infections, and unexpected deaths.
One place to begin your investigation is with the ProPublica database (bearing in mind that it is limited to surgeons and a small number of procedures): projects.propublica.org/surgeons. This is where my wife, a physician, turned before selecting a surgeon for a total knee replacement.
- Loyalty to patients. A physician’s first loyalty should always be to the patient. Yet as an employee of a healthcare system, your doctor may be pressured to make recommendations that are not always in your best interest. You need to have confidence that your doctor is always looking out for you, not the financial interests of the health system.
It is easy to determine whether your physician is employed by the health system. You will have to ask, however, regarding their philosophy of referring patients to doctors outside their health system.
- Lifelong learner. Medical knowledge becomes dated quickly. Without a commitment to lifelong learning, doctors can find themselves woefully out of touch with contemporary practices. One simple measure of this can be a physician’s participation in case conferences, tumor boards, and similar learning venues. Don’t hesitate to ask a physician how they stay current on the myriad developments in medicine.
- Emotional intelligence. For many patients a physician’s compassion, empathy, communication skills, and awareness are every bit as important as their clinical skills. You should not have to forgo one for the other.
One indicator of emotional intelligence may be patient satisfaction. Healthgrades attempts to provide such information, however the numbers of patients contributing reviews is often so small as to render the information of questionable validity. Another method is to actively engage the physician in dialogue, paying close attention to how they respond to your questions. How you feel at the end of the interaction with this particular doctor may reveal a great deal about your comfort level going forward.
- Service orientation. Service is not the sole province of the physician. It is determined equally by the office staff. Some clear measures of service include the relative ease of scheduling an appointment, waiting times for the doctor, clarity of instructions regarding your care, and the kindness and compassion evidenced by the staff.
- No red flags. Just as it is important to know what to look for in a doctor, it is every bit as essential to know what to avoid. One such red flag is financial arrangements that may compromise the integrity of your care, such as when a doctor receives payments from a pharmaceutical or medical device manufacturer. Thanks to a law passed in 2014, consumers now have easy access to information about any such payments made to doctors: propublica.org/docdollars.
Another red flag may be legal or punitive actions against the physician for purportedly inappropriate care. There are two websites that can be helpful in discovering this information: projects.propublica.org/graphics/investigating-doctors and consumersunion.org/wp-content/uploads/2016/03/Final-report-for-posting-3-28-16-6PM-ET.pdf.
If you do your homework, you can gather considerable data about any physician, but your final decision requires more than a linear analysis of the data. It requires a degree of intuition. That may sound remarkably unscientific, yet the field of cognitive neuroscience is proving that there’s a tremendous amount of cognitive processing that underlies intuition. Your “gut instinct” therefore plays a very important role. If you are trying to decide between two doctors after doing your formal assessment, let your gut be your guide.
Finally, remember that you are not marrying your doctor. If things do not work out as planned, find a new physician. It’s important that you feel comfortable with the care you and your family receive.
John Leifer has spent more than 30 years immersed in the healthcare industry as a senior healthcare executive, consultant, academician, and writer. An outspoken advocate for patients’ rights, he has published widely on the need for patients to receive appropriate, safe, effective care, including two recent books: The Myths of Modern Medicine: The Alarming Truth about American Health Care and After You Hear It’s Cancer: A Guide to Surviving the Difficult Journey Ahead. Leifer is the founder and chief executive officer of My Cancer Advocate, a not-for-profit organization committed to empowering patients with the right information and resources needed to participate actively in their cancer care. For more information visit afteryouhearitscancer.com or e-mail firstname.lastname@example.org.