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Posted by Ishani Ganguli June 22, 2012 07:00 AM
My friend Matt and his wife recently settled in Boston and were looking for primary care doctors. They had joined Blue Cross Blue Shield and had been invited to choose from thousands of providers (because who doesn’t love choice?). Overwhelmed, Matt emailed me for a recommendation, so I did what many residents had done before me: emailed the MGH internal medicine resident list-serve with a plea to take on the couple as patients. They went to the first bidder, one of three interns who responded within 20 minutes. He also happened to be a friend and someone whose clinical judgment I respect.
When I moved to Manhattan right out of college, I chose a doctor solely based on proximity (the cut-off was two street blocks) and name brand credentials. Since then, my growing foothold in the medical profession has afforded me the privilege of co-workers' recommendations. On the most recent go-around, I picked a female doctor billed as smart, thorough, and (still importantly) close by, though this time I liberalized my radius to a ten minute walk.
The process of picking a primary care physician (PCP) – the person who sees you undressed, grills you on your smoking habits, and prevents or treats what ails you – is a critical one, particularly as we move closer to models of health care (ACO, PCMH, you name it) that center around the PCP - patient relationship. Yet there’s little information out there to help us make the decision, especially for those of us without Friends-With-Doctor-Friends-Who-Are-Accepting-New-Patients. As any physician who self-googles can tell you, the now plentiful Yelp-like online doctor review sites that use anonymous comments and star ratings offer only random, often emotionally driven glimpses into a doctor’s merits and faults.
Enter Consumer Reports. In its July 2012 edition, the product review magazine will publish a guide to primary care practices in Massachusetts, allowing us to shop for doctors the same way we do laptops and lawn mowers. The data, collected in Spring 2011, come courtesy of the Massachusetts Health Quality Partners (MHQP). The group surveyed 67,353 adults and 16,530 parents of children on their experiences with their doctors: How often did your doctor explain things clearly or listen to you closely? How well did he or she coordinate care? How well does he or she know you as a person?
Though there’s only so much you can make of the subtle percentage point differences between practices in the survey, the results capture more patients’ experiences and are more rigorously collected than on most online sites. To be sure, the MHQP survey is not the first effort to capture patient experience – the CAHPS Clinician & Group Surveys have been used nationally for more than a decade to rate practice and physician performance in this arena and is available to patients and providers alike. But publishing such information in Consumer Reports sends a strong message: that patients ought to evaluate their doctors with metrics of some sort, and that doctors have a responsibility to improve on them.
Of course, patient experience of care is far from the only variable that matters in finding a doctor. A recent study even shows, pretty convincingly, that greater patient satisfaction may be associated with more hospitalizations and higher mortality rates. And a few studies suggest that we often ignore ratings altogether in favor of recommendations from friends and relatives. Unfortunately, we have a ways to go in allowing patients to choose based on easily-understandable, publicly available PCP or clinic-specific data on true health outcomes – and this of course is Fraught with Implications. In the end, choosing a doctor is a highly individualized pursuit, one that – like the practice of medicine itself- is best shaped by data, anecdote, and maybe a touch of luck.
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