Thursday, May 15, 2008

I Have A Good Doctor

I've heard it said that the good doctors are the ones who don't take insurance. The theory is that if a doctor is skilled enough, he or she can fill up their practice with private-pay patients without having to rely on an insurance panel. I'm not sure this holds up in regions where there are so few specialists that anyone could have a full practice without taking insurance. Regardless, it inspired me to think about how to judge the quality of your doctor, particularly when you have no health care training.

Patients aren't the only ones concerned about quality medical care. Professional organizations have ways of ensuring competence and insurance companies are also now taking steps to measure treatment outcomes and other parameters of care. The interesting thing is that each of these three groups use different measures.

Patients look for things like interpersonal skills, communication style, the amount of care and attention given during appointments and recommendations from friends or family. They may also consider things like convenience (appointment availability or location). Since the invention of the Internet patients can also now go to online physician review sites and searchable databases.

Professional organizations encourage people to consider things like physician training and experience, board certification, participation in continuing education and the absence of malpractice settlements or disciplinary actions.

Insurance companies now are starting to institute "pay for performance" indicators of quality: timeliness of appointments, adherence to practice guidelines, treatment outcome measures and patient satisfactions surveys.

So, does any of this stuff actually guarantee you'll get good care?

Of course not. Personal impressions and outcome numbers don't tell the whole story or may be misleading. Doctors with terrific interpersonal skills can give lousy care and still have loyal patients who defend their bad practices. Doctors who kick small dogs and are mean to their spouses could still be good technically. I happen to think my ophthalmologist is the best thing since sliced toast and I'm willing to wait weeks to get an appointment with him, but I can only trust that when he scans they back of my eyeballs he's seeing what he needs to see. I'd be willing to bet that if I had a rare or serious disease I'd want I doc who was the best (or at least great) at dealing with that disease and I wouldn't care if the the insurance company told me that half his patients died---the mortality rate for my weird serious disease could be 80%. He probably wouldn't take insurance anyway.