And before this new year began, you were perhaps notified of another round of open enrollment for health insurance plans through either an employer or the Affordable Care Act (a.k.a., Obamacare). If you’re lucky, and the insurance companies haven’t narrowly restricted your choices to their preferred networks, you might be in the enviable position of choosing a doctor.
But don’t get your hopes up. What the government and the insurance companies often neglect to tell you in all their promotional efforts is that guaranteed insurance coverage does NOT guarantee you’ll actually be able to see a doctor. And even if you do get to see one, it may not be the one you’re used to seeing or wish to see. Odds are, especially for primary care, but also other specialties like oncology, you’ll be seeing a nurse practitioner or a physician’s assistant in place of an M.D. This is not necessarily a bad thing as there are many well-trained nurses and physician assistants, and you may thank your lucky stars that we have them available because the alternative is no one to care for you at all.
If you do get the chance to choose your own doctor, you will want to know that you’re placing your health in good hands. People choose their doctor for a host of reasons, some logical, some not. In this first of a series of blog posts, I’ll review some points to consider as you make your choice of care provider. We’ll start off with a few ways NOT to choose a doctor.
Don’t choose a care provider (or healthcare facility) based on an ad you see on the side of a bus. For that matter, don’t pick a doctor or facility based on any form of advertisement – billboard, radio spot, or slick marketing brochure. The people who produce these ads aren’t doctors. They’re marketers. And the job of a marketer is to sell you something.
So that full-color, 8-page booklet just released by a specialty group near you – well, don’t believe what you read. Marketing departments have been known to advertise services and abilities that facilities and their employed doctors don’t actually have. For example, in an effort to impress, the facility may claim that its doctors “have been researching and publishing in their field,” which gives the impression of cutting-edge care. Don’t believe it. The deceptive words here are “have been.” ALL doctors were active in clinical research and publishing at one time – it’s a requirement of their training program. Unless they’re currently employed by a teaching hospital (most of which are attached to a university), the greater chances are that they’re no longer researching or publishing. With so many hours spent in patient care and dealing with the increasing medical bureaucracy, it’s the rare doctor who has time to publish and do cutting-edge research.
But it sounds good in a brochure, doesn’t it? Especially if you’re trying to edge out the competition.
The same is true of a hospital or other care facility – don’t pick one based on an ad. The current slogan of the bus ad for the large hospital in my town is “pays attention to detail.” But this slick slogan conveniently omits the detail that a patient died last year on one of their services as a result of chronic understaffing, and the hospital was investigated by the Joint Commission, which accredits and certifies healthcare facilities. It seems that staffing might be an essential detail to pay attention to.
The point is clear: don’t let the marketers pick your doctor.
Don’t pick a doctor based on the ratings of patients on any of the myriad websites such as Healthgrades. These sites are unreliable, as they represent only the voices of people who take time to go online. Thus, the comments posted there do not represent the overall skill and abilities of any particular doctor.
For example, Healthgrades allows patients to rate a doctor with a number of stars, and though the site does make users verify who they are when they post (via email confirmation), it does not allow patients to enter comments, which are critically important in seeing how a patient interprets the interaction with the doctor. And still, on a 5-star scale, Healthgrades often lists a rating of 4 stars as “below the national average,” with no explanation of how that national average was determined. It’s hard to believe that a rating of 4 out of 5 stars indicates below average care.
Other sites like Vitals and RateMDs.com often have erroneous or outdated information about doctors, and allow all users to post as long as they claim to be a patient. But they don’t verify whether a user has actually been a patient of a particular doctor, so anyone can make comments about any doctor they like.
Most of the comments at sites such as these show that the patients either love or hate the doctor, with no in between, but posters who had a change of heart about the doctor’s care later on seldom come back to the site to change their opinion. So the patient who writes off one doctor for not offering a currently trendy treatment, for example, isn’t likely to come back many years later to amend the comments when the treatment failed.
In addition, facilities seeking to promote their doctors against the competition often send patients to these sites in hopes of increasing their ratings. (Remember, it’s all about the image!) And occasionally, a doctor who is under investigation for suspect practices is somehow highly rated by patients. Check out that doctor’s rating on Vitals.com: he earns 3.5 out of 4 stars.
For a keener analysis of the problems with patient satisfaction surveys and online rating systems for doctors (and facilities), go here. The online ratings for any particular doctor might just say more about the poster than they do about the doctor, and no one’s post will reflect your own experience with that doctor.
As the saying goes, “your mileage may vary.” Especially on a bus.
Next time: How NOT to pick a doctor: Part 2 – Referral patterns, bedside manner, and other criteria