There are tremendous advances taking place in medicine today, but in order to benefit from them, the healthcare consumer must take an active role. The best healthcare will not find you; you have to seek it out.
While the United States offers the highest standard of healthcare in the world, there is still huge treatment variation based on the doctor you see. Bottom line, the doctor you choose will determine the quality of care you will receive. Here is an overview of how to navigate through the healthcare system to find the best doctor for you.
How to find a super-specialist
There are many ways to identify the best specialist within a given area. One place to start is to consult a family practice doctor who addresses your general healthcare needs. This “primary care” doctor will usually know the best super-specialists within a specific region. Also, since this primary care physician may have referred patients to that specialist before, they may have seen firsthand their clinical outcomes after surgery. If these outcomes are poor, the primary doctor will not refer additional patients.
On the downside, this referral process abdicates the selection process to someone else. Also, some physicians refer to other physicians out of habit, or in the hope of reciprocal referrals back. The educated healthcare consumer would do well to perform secondary research to identify the best possible specialists and clinics within a given specialty.
The Internet can provide a wealth of helpful information. The educated consumer can locate information on a doctor’s education, training, clinic and area of specialization.
Cues on physician competence
Fellowship training, the highest level of training in the United States, can be an indicator that the physician has invested an additional year in a specific area of specialization. Note where the physician has trained. Training at a large or prestigious institution would expose the physician to more complex cases, which in turn makes them more proficient in their chosen specialty.
Board certification is another criteria that indicates a physician has met the competency standards within an area of specialization, as judged by the specialty board. Board certification typically requires that a physician has been in practice for several years since graduating from medical school and has passed a rigorous written and oral exam. Younger physicians, however, may be in the process of obtaining board certification by fulfilling the various criteria of time in practice, etc. These physicians are called "board eligible."
Using Internet complaint boards
TripAdvisor is a very successful Internet site that features traveler comments about hotels, resorts and restaurants. But is a person's rating of a hotel meal the same as that person’s ability to understand diagnosis and treatment of complex neurological disorders?
One survey found that 62 percent of patients are using online reviews in complaint boards as their first step in choosing a doctor, and 19 percent use complaint boards like YELP, Vitals, Healthgrades and RateMDs to validate their choice before making an appointment.
Unfortunately, studies are now revealing that such complaint boards are not indicators of physician quality simply because consumers don’t have the data to judge quality of medical care.
A recent 2017 study conducted by ConsumerMedical, a leading health care decision support company, revealed that there may actually be an INVERSE correlation to quality as featured by complaint boards. The ConsumerMedical study found that vast majority of top-rated specialty physicians on YELP, Vitals and Healthgrades are NOT the highest ranked physicians when it comes to examining actual clinical outcome data related to their medical specialty.
In the study, ConsumerMedical identified the top 10 ranked physicians on YELP, Vitals and Healthgrades across five common specialties in New York, Chicago, and Los Angeles. They then compared these complaint board rankings to a list of the 10 physicians with the highest clinical outcome scores in the same cities. The ConsumerMedical clinical ranking was based on more than 5 billion data points that measure physician performance on variables such as: patient readmission rates; surgical infection rates; average length of stay; procedure volume; and functional status outcomes. Only 2 percent of physicians ranked as top 10 by YELP, Vitals and Healthgrades showed up as top performers when examining actual clinical outcomes.
“This research confirms what we have long suspected,” concludes David Hines, CEO of ConsumerMedical. “Online patient reviews tend to reflect a patient’s care experiences, such as the physician’s bedside manner. While these attributes are important, they are simply not the main indicators of a physician’s overall quality; sadly you can have a very kind orthopedic surgeon whose patients have hospital readmission rates that are through the roof.”
So the healthcare consumer needs to be mindful that complaint boards indicate merely the bedside manner of the physician rather than quality of care.
Get a second opinion
Most health insurance plans advise or require that the healthcare consumer receive a second opinion when treatment involves a complex surgical procedure. This is excellent advice. Furthermore, the healthcare consumer should not inform the second provider that their visit relates to a second opinion, since some physicians are reluctant to provide conflicting opinions. If you have received two identical, unbiased opinions related to your diagnosis and recommended treatment, you can proceed accordingly with more confidence that you are pursuing the right approach.
If the two opinions disagree, you should examine the training and qualifications behind each opinion to determine which is most likely the correct recommendation. Another option is to pursue a third opinion, but this can add to your confusion.
The physician visit
The best specialists within a given niche will typically provide all the appropriate nonsurgical and surgical treatment options for your problem, along with the pros and cons of each approach. In some cases, treatment may include watchful waiting. If your doctor is unwilling to answer questions about your diagnosis or treatment, you’re in the wrong place. Go find another doctor.
Be a good patient
After all the searching, if you have found a good doctor, the rest is in your hands. To be a good patient, you must comply with the physician’s recommendations and prescriptions. Too many times, it’s natural to want a magic pill or miracle surgery to provide an easy route back to activity. However, you should always view surgery as the last card to be played, after all nonsurgical options are explored.
For nonsurgical treatment alternatives to work, the patient must often follow physician and therapist prescriptions, which may include a commitment to therapy. For spine and joint problems, this may mean incorporating special strengthening exercises that rebuild supporting muscles, so that surgery is not necessary. While athletes are familiar with the required commitment and pain associated with the exercise gym, others may not. It can be new territory for many people, but it is essential if you are to give nonsurgical options a chance to work.