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Who is the best doctor?

I recently spoke to Dr. Jorge Mestman about the issue of finding a good doctor. I asked him if consumer ratings of physicians would help patients find their way to better care and he responded with a resounding “no.” I was somewhat taken aback and asked why he felt that way. What he said was surprising (this is not actually a direct quote, I’m summarizing):

“The best doctor is YOUR doctor. Over time a physician develops a relationship with a patient and an understanding of their issues that is very valuable. The problem with seeing a specialist is that they have no baseline to compare you to – they may make recommendations based on their best analysis of the situation at that point in time. But they can be wrong.

Also, physicians – like any human being – have different skills and styles. Some are great listeners and excel in empathy, others have a ‘tough love’ approach, still others are research oriented and like to delve into the ‘nitty gritty.’ How can one person’s rating capture all of that? Most physicians are good people with good clinical skills. The right one is the one that you like. Also, it’s simply not possible for a few highly rated physicians to care for vast numbers of patients. If people limited themselves to only seeing certain physicians (who got high ratings), they’d be turned away due to the over-demand.”

What do you think of Dr. Mestman’s analysis?

Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.

This post originally appeared on Dr. Val’s blog at

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5 Responses to “Who is the best doctor?”

  1. Anonymous says:

    I have mixed feelings about the discussion. As a psychologist, it’s clear to me that my approach works well with some people and is not helpful for others. If the rating is a simple popularity poll, it can be quite misleading and even destructive to other consumers and to treaters. But if consumers provide considered feedback, based on what they liked or didn’t like about a particular treater, this might be helpful. It probably depends on the tenor of the discussion.

    My view is impacted by my experiences as an oncology patient. I found my first oncologist to be unpredictable in her behavior — cold one day and friendly the next. She was rude to a friend who accompanied me to an appointment. She rarely let me finish a sentence. She boasted complete mastery of side effects, and I felt very discouraged that my side effects eluded her. I was so depleted when I began chemo that I hesitated to change, and I also had observed that she was very bright. One cancer support group leader minimized my discomfort — “You shouldn’t expect support from your oncologist! You get that from a therapist!” But friends supported my wish to change. Because I live in a community where good oncologists are available, I realized that there was no reason to settle for someone with whom I felt so uneasy. I changed to a doctor who listened to me, provided good care, and gave me more options for handling side effects. Later I met someone who had interviewed the first oncologist and decided not to use her because of her difficult personality. I wish I had had access to ratings when I felt unhappy with my doctor, because they might have validated my perspective and encouraged me to change more quickly.

  2. StevePocetaMD says:

    Obviously it is hard to judge quality in medicine, or of an individual doctor, or of how a doctor and patient will interact for the benefit of the patient. I agree that there is no single good way to do this. On the other hand, many patients love their doctor, just like they love their chiropractor, herbalist, remote healer, and auto mechanic, and really have no idea what they are really getting. So I disagree with the idea that the doctor patient relationship is the best measure also. Here in San Diego, we have the “top doc” awards in our city magazine each year, and the method of selecting the top docs has changed a few time, but the voting has been from other docs, not the community. Unfortunately, with each method, the biases are obvious and I do not think the ratings really help an individual patient know what is best for them. Maybe the most informative ratings would include both a “professional rating” and a “patient perspective.” Eventually, as Dr. Scherger suggests, the well educated patient will know the best.

  3. JamesHerndonMD says:

    Consumer ratings in my opinion are an early attempt to rate physicians for the consumer, but do not have enough data to be accurate. The consumer needs more information–information about a physicians’ outcomes in treating patients. This is not a new idea. Earnest Codman, MD , a surgeon at the Massachusetts General Hospital proposed this idea in 1917. Today the consumer and the payers are increasingly demanding such information and physicians and their professional organizations are beginning to develop standards of care and assessment tools to measure outcomes of care. Some states have already begun publicly reporting outcomes after heart surgery and more recently after hip and knee replacement surgery. I believe this is the correct approach and believe more information is needed and as it becomes available it will help patients make appropiate caregiver choices. James Herndon, MD

  4. Italianscallion says:

    There are some dangers involved in consumer-generated endorsements of a doctor’s skill. Here are my biggest reservations about such a system:

    1. It favors the articulate physician who may not always be the smartest physician. While I have found it to be resoundlingly true throughout my career that the very smartest people are often able to explain medical conditions to their patients, regardless of the patient’s level of medical knowledge, in a coherent and meaningful way (and this is an ideal to which I aspire), it’s not always the case that the best doctor gives you the best story. There are even charlatans out there who give FABULOUS sound bites to the media but are really espousing bad, outdated or frankly dangerous medical practices. So what feels right may in fact be wrong.

    2. Consumer endorsements may be useful for doctors who practice in areas that contain well-educated patients who are influential people and who can vouch for them. However, what about the excellent physician who is practicing in an underserved area where the patients do not speak his or her primary language? Such a person may be providing outstanding service, but it will never be recognized and may even be considered inferior if this person is evaluated through consumer assessments that do not take the assessors into account (in terms of language, literacy and other potential confounders to ratings).

    3. In an era of ‘pay for performance’ medicine, using patient endorsements to assess physician quality may unintentionally create a very unfair reward system that favors doctors who care for the healthiest and best informed people–in other words, those who need the least help. Doctors who only take care of well informed, health-conscious people will get the best ratings and appear to have the best outcomes.

    In case I sound like a total sourpuss, let’s just walk though this:

    Doctor A practices in a wealthy suburb and refuses to see patients who won’t take good care of themselves. He refers diabetics out of his practice if they refuse to do the work necessary to maintain a hemoglobin A1c level less than 6%. He’s a great communicator, has diabetes himself, which he obsessively manages with an insulin pump, and tolerates nothing less from his own patients. A terrific role model, to be sure, and his patients adore him. His outcomes are also spectacular.

    Doctor B lives across town from Doctor A and takes all forms of health insurance. He also takes all the hard luck cases and the folks who just don’t have the wherewithal to maintain their glycemic control in an optimal fashion. There is a large Latino population in his practice area, and although Doctor B tries to provide appropriate dietary recommendations to his Spanish-speaking patients by working with his local community, he’s got quite an uphill battle to fight to improve outcomes. Oh yeah, and he also takes all the patients Doctor A refuses to see because he doesn’t feel that these people should be without a doctor, after all.

    So now we get the results of patient performance surveys and practice outcomes on both doctors. Doctor A’s highly articulate patients rave on about him and his outcome measure–hemoglobin A1c, is the best anyone has ever seen. Doctor B’s surveys have only a 60% response rate, the comments are brief and his outcome measure is below the national average.

    Doctor A gets the pay for performance dollars, which are doled out geographically, and Doctor B gets a ‘disincentive’ or even gets dropped by some health insurance carriers as ‘punishment’ for his practice’s mediocre performance! If this material is published on a public database, Doctor B may even get hate mail!

    So while the concept is a totally innocent one and I certainly agree with some of the other postings from patients who want to have good chemistry with their doctor, I think we are not in a good place to systematically evaluate physicians in a way that is fair. We need to be well aware of the limitations of such a tool.

  5. OlajideWilliamsMD says:

    This is a difficult issue steeped in potential bias and confounders. There are many views through which one can assess the quality of an individual physician – through the eyes of his patients (or consumers), through the eyes of his students, through the eyes of his professional colleagues, and by analyzing his practice-based outcomes. A panoramic view emerges if we are able to collate the above although this is easier said than done.
    Consumer-based ratings in isolation is fraught with potential error. Rather, just like our patients who often require a multidisciplinary approach, multple perspectives will give our consumers the most informed choice when deciding on us.

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