Wednesday, June 03, 2009

Achieving Linearity in a Non-Linear World

Harlan Krumholz, cardiologist and professor of Medicine at Yale University, wants better doctor ratings:
For most patients, the decision of where to seek care comes down to a recommendation based on hearsay. Good reputation plays a role, but unfortunately studies show that just because you have a famous name doesn't mean that you're good.

Even doctors don't know what to do. I broke my collarbone in a bicycle accident a few years ago and had no good way of selecting a surgeon. I picked someone based on advice from colleagues, but neither they nor I had any way of knowing what his past results for this operation — or any operation — had been.

Our health care system has a grasp of the astronomical amounts spent on care, but we have little information about the overall results that we achieve. We lack a trustworthy source of information in most areas of medicine to guide this most critical choice. We don't have a Consumer Reports for doctors and hospitals — at least not yet. For-profit ranking systems, such as the 100-best-doctors-in-your-area feature found in glossy magazines or online, often do not fully reveal their methods or submit their measures to independent peer review. Patients almost always have to make blind choices about where to receive elective care.

The paucity of information about medical performance not only makes it hard for patients to choose care. It also impairs our ability to improve care. If we in the medical profession could measure results, we could weed out bad practices and nurture the good ones — and save more money and lives than we could with virtually any breakthrough procedure or medication we are likely to see in the near future.
I completely agree that even doctors can't figure out who to go to when problems arise. But to suggest this is a simple, resolvable issue that can be posted online misses the point. The issue is not just how many complications a doctor has, but how many procedures has that individual done in their lifetime, what is their diagnostic acumen, interpersonal skills, eye-hand coordination, fund of knowledge based not only on standardized tests, but clinical experience. Are these things simply quantifiable? Furthermore, none of these measures disclose a doctor's availability clinically, or their personality and compatibility with a particular patient. You can have the world's expert in anything, but his clinic is full, then whom do you go to?

Presently, board certification, years of experience, and legal history might be quantifiable entities to use to roughly assess doctors' capabilities. TO some, low complications might be most important, to others, an affable personality. But to suggest that this will EVER be a simple assessment that can be placed online seems ill-conceived since we're attempting to make linear a non-linear algorithm.

To me, it's still better to ask a good nurse you trust whom to see. They've not let me down yet.



Andrew_M_Garland said...

So, assume I need surgery? How do I find a good nurse who I trust?

DrWes said...


If you work in health care, look to your hospital. If not, consider your church or synagogue. Given the breadth of penetration of health care in the marketplace, these suggestions are likely to be fruitful. (There might even be a doc there you could ask, too.)

Remember, even if online resources COULD be developed, they are unlikely to be kept up to date.

Anonymous said...

I asked my pulmonologist to refer someone to fix my deviated septum - excellent recommendation and results. My nurse friends are partial to a certain large urban teaching hospital, so I'd find their recommendations trustworthy. I'd trust Consumer Reports over Angie's List or Healthcare Compare. Forget about HealthGrade,, etc.

Selecting ratings criteria, performing ratings, and keeping them up to date would be a hellacious task. There isn't really a good way to do this online without violating privacy laws somehow.