Know how your doctor ranks
By Kenneth R. Peelle, M.D.
Special to Reminder Publications
Much like consumer products, physicians are now being ranked, graded and rated on a host of criteria, part of the growing trend of "transparency" in health care.
The assumptions underlying these efforts are that they will improve physician practices, help patients find better doctors, give consumers information to make informed decisions about their care, and, ultimately, reduce health care costs.
Whether grading physicians will help to achieve those goals certainly all desirable remains an open question. But a recent survey by the state's largest health insurer suggested that consumers want more information about doctors and hospitals to make better decisions, but that existing information is sparse and generally unreliable.
Well, not exactly.
Consumers can today easily find lots of information on physicians, how to choose them, and how to interact with them. From the annual 'top doctors' and 'top hospitals' issues of local and national magazines, to publications like Consumer Reports, to the websites of state agencies, nonprofit organizations, hospitals, medical associations, and commercial enterprises, the supply of information about doctors and patient care continues to expand across all kinds of media.
Surf the internet, for example, and depending on where you land, you'll find physician rating systems using stars (one to four); smiling (good), neutral (average) and frowning (poor) faces; tiers (one and two); numerical grades (up to 100); checkmarks (one to five); and scales (one to ten).
The critical question for patients is how to determine the quality and usefulness of the information.
Some rankings may indeed raise questions. Some may use dated and non-clinical data, and others may just include subjective judgments of those doing the grading. Further, consistency and uniformity could be better. Some organizations rate individual physicians; others evaluate only group practices, and criteria for judgment may vary widely.
Also, not all doctors appear on all lists. On some websites, physicians are ranked only because a visitor to the site chose to include a doctor in the ratings. Often, the same physician may be graded differently by different organizations, and some physicians have received lower grades because no data was available to assess them.
Present efforts, therefore, to measure quality and rank physicians are still new and untested works in progress. To date, no universally accepted standards for rating physicians have been developed.
Not surprisingly, then, physician perspective on rankings is mixed, with many averse to such grading efforts as presently created. Everyone agrees that having more information available to patients is a good thing, and physicians are ready to welcome an accurate, reliable and clinically-relevant system of performance measurement that will help them improve patient care.
But we may not be there just yet. Physicians remain concerned about current methods of measurement, possible misinterpretation and confusion among patients, and the potential impact on the doctor-patient relationship that such grading systems will have.
So how should patients interpret such rankings?
Proceed with caution and do some homework. Begin by distinguishing among the sources of the information. The accuracy, relevance, and reliability of the information may vary widely among nonprofit, governmental, commercial, or educational sources.
When reviewing the data, ask questions: Does the information seem up-to-date, accurate, and reliable? Does the ranking system appear fair and objective? What criteria does it use and how relevant are they? Can you find clear explanations of how the rankings were made and who made them? Are the rankings "risk-adjusted" to account for wide variations in the conditions of patients?
Finally, determine how the information is relevant to your particular situation. A Commonwealth of Massachusetts website, for example, lists surgeons and the number of operations they have performed a useful piece of information to get a sense of a surgeon's experience with a particular procedure. Patient satisfaction surveys, tracking such factors as how well doctors communicate with patients, coordinate care, and know their patients, if done by established, experienced healthcare organizations, can also be helpful.
If you have questions about how your physician ranks on any list, start a conversation. Patients should feel comfortable and confident with their physicians - be they primary care or specialist. A good doctor-patient relationship is critical to good medical care, and that relationship usually improves with open and honest communication.
Kenneth R. Peelle, M.D., a practicing radiologist at Saints Medical Center in Lowell, is 2006-2007 president of the Massachusetts Medical Society. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.
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