Filed under: atencion al paciente, Comunicación y Salud | Etiquetas: "How to survive your Doctor's Care, clientes privados, comunicación, doctor's information, Dr.Right, health information, health's list, healthcare, How to make sure that a doctor is competent, how to select a doctor, information about doctors, information for patients, The Medicare program, THEDOCTORFACTORY
The New York Times
Most people wouldn’t buy a new car without checking consumer ratings, but they still rely largely on word of mouth to select a doctor. Yet with more patients having to choose from a health plan’s list, there is growing demand for information that is more reliable than a friend’s recommendation and goes beyond the rudimentary details available online: a doctor’s hours, educational background and ZIP code.
Unfortunately, it is very hard to get. There are very few good quality measures available to assess individual doctors, so consumers must be prepared to do some research if they want to find a physician they can work with comfortably.
“The truth of the matter is that people are hard pressed to make well-informed decisions when they choose a doctor, and they’re doing it blind,” said Joyce Dubow, a senior adviser in the office of policy and strategy at AARP. “We don’t have objective data, so we use family and friends. And that’s not objective.”
Businesses, health plans and government agencies have developed rating systems for hospitals in recent years, but they have lagged in developing quality measures for doctors.
“We are really in the early days of physician-specific reporting,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “The challenge is to do it well, so that it’s accurate, so that it gives consumers good information about making choices and gives doctors information about how and where to improve.”
One problem, she explained, is figuring out how to compensate for different outcomes from different doctors because they treat different patient populations, not because they provide inadequate care.
For now, patients cannot get their hands on a wealth of information about physicians that is compiled by government agencies but off limits to the public. A national practitioner database compiles reports of health care providers who have been fired, for example, but the list is open only to hospitals and select other groups. The Medicare program recently started a physician quality reporting initiative, but it is in its infancy and the information is not yet public.
And last year, after the nonprofit group Consumers’ Checkbook won a lawsuit granting it access to Medicare’s doctor records, the government appealed the decision. The group wanted to look at the database to see how often doctors perform procedures like knee replacements or prostate surgery, because volume is often associated with proficiency.
The bottom line is that patients who want to make sure their doctor is competent have a lot of work to do. And the work should be done on the front end: experts emphasize that people should find a doctor and establish a relationship while they are in good health, so they don’t have to scramble when they come down with bronchitis or find a suspicious lump.
Studies have found that it is hard to get an appointment at short notice when cold-calling, and that patients with a regular source of care get better care, even when they are uninsured.
First, figure out what your needs are, suggests Dr. Pamela F. Gallin, the author of “How to Survive Your Doctor’s Care” (LifeLine, 2003).
“Do you have special medical needs, such as cardiac problems or rheumatology problems, or do you just need routine checkups?” she asked. “Do you have diabetes? Does your lifestyle put you in a certain category of risk?”
While some internists have additional training in cardiology or rheumatology, she went on, primary care physicians also have a network of trusted specialists for referrals.
Many women choose a gynecologist as their regular doctor, Dr. Gallin said, but should probably have a relationship with an internist as well.
Next, review the list of doctors in your health plan. Consider their location as well as their hospital affiliations. You may want to cross-check your health plan’s list with a top doctors list for your area; these lists (often published in regional magazines like New York and New Jersey Monthly) are usually generated by surveying physicians.
Check with your health plan to see whether it has good information on individual physicians (most don’t, but many are working on it). Good quality measures include National Committee on Quality Assurance accreditation about whether doctors meet criteria for care for specific conditions like back pain or diabetes, and the Healthcare Effectiveness Data Information Set, which focuses on adherence to clinical guidelines, like prescribing a beta blocker after a heart attack. Some health plans also offer networks of high-performing or “honor roll” physicians; ask about the criteria.
Check with your state medical board to make sure the physician’s license is valid, and whether he or she has faced disciplinary action. Those are minimal requirements, however; a higher standard is board certification, which means the doctor has passed a rigorous exam in a specialty like internal or family medicine.
You may also want to check whether the physician is certified in his or her subspecialty, like treating heart disease or arthritis. Some specialties require recertification every six or eight years. You can check on certification status with the American Board of Medical Specialties, the organization that oversees 24 specialty boards (www.abms.org), and at Web sites like HealthGrades.com and Docfinder (docboard.org).
If you’re uninsured, you may be able to negotiate with a doctor and agree on a reduced fee, but remember that you will also be responsible for the cost of lab tests, blood work, X-rays, procedures and medications. These costs are more likely to be covered or charged on a sliding scale at a community health center or hospital clinic. (To find a location, see www.hrsa.gov under “Find Help,” or the Families USA Web site, www .familiesusa.org, under “Resources for Consumers.”)
Other factors to consider are whether the doctor has evening and weekend hours, whether the office leaves time open to schedule same-day appointments for urgent care, whether waiting times are reasonable and whether the doctor is in solo practice or a group practice. (Some experts say that group practices tend to be more efficient and that doctors in groups are more likely to stay up to date on current medical practice.) If the doctor uses electronic records, that’s a plus, some experts say.
On the crucial question of whether you are comfortable with the doctor you’ve chosen, you won’t know that until you meet with the doctor. Pediatricians will usually agree to an interview; busy internists often won’t.
Some physicians are posting video clips of themselves on the HealthGrades Web site, so patients can get a feel for their personal style; Angie’s List (angieslist.com) has started consumer ratings of A to F for doctors; and Consumers’ Checkbook (checkbook.org) provides detailed consumer ratings of physicians in seven metropolitan areas. (All of these sites require payment.)
“Do your research,” said Dr. Samantha Collier, the chief medical officer for HealthGrades. “Don’t assume all physicians are equally skilled. More importantly, they need to be a good match for you. I hear so many patients tell me they really don’t like their doctor or trust their doctor but they keep going back. That is ridiculous. This is one of the most important relationships you’re ever going to have — you need to feel completely comfortable.”
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