Finding a Doctor

Finding the right doctor is a challenge for everyone. Believe it or not, even physicians are challenged.

I love to ask all types of patients and referring doctors how they go about finding a good doctor. After a confused stare and a lot of stammering I get a series of answers. In the case of physicians making a referral it generally boils down to the old tried and true three “A’s”: “Available,” “Affable” and “Ability.” I am embarrassed to acknowledge that this little list describes the thoughts of referring doctors in DESCENDING order of importance! Although “ability” is often judged through the lens of medical education and any prior firsthand results that were witnessed, many (most?) times the final choice is dictated by vague rumors or even gossip. The only exception to this practice is when referring physicians have access to, and opt to actually read, outcome studies published by the potential specialist in question.

Ultimately, if there is a ground truth in the referral business, as exemplified when physicians themselves need a great doctor, the decision is based on peer-reviewed publications. It’s clear that subjecting one’s clinical outcomes to the peer review process remains society’s single best tool for revealing physician competency, and as medicine becomes more specialized, this is ever truer.

How do patients go about this same decision when trying to locate the right specialist for them? Sometimes the choice has, for better or worse, been removed by insurance plan networks or geographical constraints. However, when true life or death decision making is involved, there is oftentimes some flexibility within the system, and in such cases patients are much more determined to find excellence; if the risk of dying or ending up disabled at the hands of one doctor is 2-3X greater than another, only the most desperate or unsophisticated patients would ignore such knowledge. This notion is nice in theory, but where can a patient access such information? When it comes to finding the best doctor, the typical resources that patients can use to make their decision are little better than throwing darts at a dartboard!

Yes, patients can check to see if their physicians have been sued in the malpractice lottery or if the physician has complied with some mindless government-collected quality metrics. Yes, they can rely on rumors, innuendo, ZocDoc, Angie’s list, glossy advertising pages in airline magazines etc., however, do any of these measures reflect the type of competency that truly matters when selecting a doctor, the consequences of which involve life and death? Not from my perspective. In my opinion, the single best tool for assessing a specific doctor’s ability continues to be the same resource used by smart referring physicians: published, peer-reviewed outcome studies.

Historically, patients have not had access to the peer-reviewed medical literature. Fixing this situation is one of the primary rationales for Cureus’ existence. In the modern world of internet connectivity, I would think such validated health information should be a virtual human right. By the same token, I think the onus should be on ALL physicians to contribute to the medical literature, and in doing so, demonstrate their competency within a peer-reviewed environment. If you really are a good specialist, then prove it in some tangible way! Billboards, magazine ads, fancy brochures or websites, broadcast advertising and sundry PR campaigns are not evidence of your competence.

Once upon a time it was not easy to publish in the medical literature, but Cureus is doing its best to remove publication barriers to the greatest extent possible. Therefore, it is time that ALL physicians, (yes, including you guys in private practice), prove some of your skills through a validated process like publishing in journals. Going forward it will be my provocative advice to all patients in need of complex healthcare to trust no physician who has not demonstrated some competency within the peer-reviewed medical literature!! In turn I urge all physicians to use Cureus to demonstrate your hard-earned knowledge to the world, including the lessons imparted to you through patient complications, which will be the topic of a future blog by me.

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