How a Patient Should Choose…

Clear as the vision out my window in a Feb snow...
Clear as the vision out my window in a Feb snow…

Over the years, I have been approached by people asking me who my neurologist is, do I like him/her and how often do I see him/her… I always answer truthfully, and I think I have been lucky to get good doctors. Still, I have to admit that I am likely a poor judge. Upon what can I base my evaluation? Did he do the standard neuro tests or give me information to support my medical decisions? To make this call, I have to already know the very information for which I am going to the doctor to learn. Now, I have had dozens of neurological exams, and I may note when one test is missing or a new one is added, but my experience is dominated by my treatment at one hospital.  This  means many of my doctors may be taught or instructed to do certain routines which says nothing about which routines are good, better or best.

If I am to be a judge on who practices good medicine, I should probably be aware how my perceptions are formed. As a patient, I read some articles with medical information or advice. If I am having a thoughtful day, maybe I take the time to ask how the article reaches its conclusions. However, I fear I am rarely thoughtful enough when it comes to this point, and my recall is even more suspect. I am far more likely to remember the headline of “Caffeine is good for memory” than I am to remember how the conclusion was reached. Will I think to check if the study is a person’s memory or a mouse’s and remember the answer? I am more likely to remember the caffeine is good theme because I want to justify the copious amounts of caffeine I drink.

If you want a sobering look at the reliability of journal articles, press releases and related news, check out the British Medical Journal’s article:

“40% of the press releases contained exaggerated advice, 33% had exaggerated causal claims, and for studies on animals other than humans 36% inferred similar human health implications.”

Maybe I should not rely on what I think I remember an article telling me, but I’m human so it still forms a baseline impression from which my mind starts trying to answer questions.

Hopefully I have convinced any reader that I, as a patient, am poorly equipped to tell you who is the good doctor you should go see. If you still doubt, I will leave you with this press release from The American Board of Internal Medicine talking about the reliability of patient ratings of doctors,

It turns out ratings by patients have no statistically significant association with the quality of care delivered by the doctors. However, the positive ratings were correlated with positive reviews of the doctors’ websites. I guess other web pages rating doctors probably are not good a great route for picking a doctor either.

If I, as a patient, am a poor judge of which doctor is good, and websites gathering consensus of patients are no good, then where else can a patient look for guidance when looking for a doctor? I figure those most likely to have the knowledge to assess a doctor’s competence are other doctors. For years, the Washington Post ran a series on doctors to whom other doctors go for treatment. I do not know if they would be immune to the biases patients face, but at least they may recognize bad treatment.

It would seem better yet to have doctors make up an objective exam to weed out who knows the best treatments from the snake oil of the day. From my early experience with them, it seems this is a job the American Board of Internal Medicine (ABIM) has undertaken for years to discern doctors who know legitimate medicine and practices. Ideally, this knowledge and skill set need to remain current as best practices change with new knowledge. Without continuing education, how would a doctor from the 1970’s know to tell patients smoking causes cancer? Continuing education is vital for an up to date medical profession. As a patient, I readily admit to not knowing what I do not know about my body. Still, I expect my doctors to be up to date and able to tell me the current best practices to treat my maladies. For me as a patient, that is the value of the ABIM certification of a doctor.

I have seen it suggested that patients will be able to tell the good doctors from the bad based on outcomes data which will be available as a result of the Affordable Care Act. I remain doubtful. Even if the data is available, how will I as a patient know which doctor took on more difficult cases resulting in higher costs and/or lower success rates. How will I know which data I need to know to whom I should turn for medical matters? When I started my job, I had a supervisor tell me, “Tell me what you want to prove. I can find the stats to bolster your claim.”

Sadly, I suspect many of us patients do not know if our doctors are current. We trust blindly or worse with the impression of knowledge about their skill set. We simply do not know what we do not know.

In an effort to provide full disclosure, I am a patient representative on ABIM’s Internal Medicine Specialty Board