The baseball world elected Ken Griffey Jr. to the Hall of Fame with the highest percentage of votes ever. Without doubt he is one of the best to play the game, deserving of all the honors he won over the course of his career. Yet for all his success at the plate, he got a hit less than 1/3 of the time he was at bat.
I started to think about how other professions rank their members – athletes by statistics, business people by profit margins, attorneys by cases won, pilots by safety records, etc. But how are doctors ranked? Everyone dies eventually, so survival is not specific enough. Ask anyone for a doctor recommendation and they will say theirs is “the best”. After all, who would go to a sub par doctor (or any professional)? We may not want to acknowledge it, but everyone can’t be the best – its statistically impossible! As the punchline says, “What do you call the person who graduated last in their med school class? Doctor”
How are doctors ranked?
Since there is no medical hall of fame, the first question to ask about a ranking is who is doing the ranking and what perspective are they coming from. Insurers rank by “cost and efficiency.” Doctors rank other doctors on reputation, technical skill and experience. Patients rank us on their own experiences and expectations.
If you are a patient, you can look at multiple online or magazine sources for “Top Doctors” rankings and opinions. But just as I’ve hated movies and restaurants that got great reviews (and vice-versa), if what you need isn’t what the doctor you see provides, it’s not the right fit.
Insurers and Medicare rank doctors on how they perform on cost and utilization – they look for doctors that don’t deviate from the norm – not doing too much or too little. In other words – those that do average things.
Employers have a different perspective – they want a doctor that fills a need – either specific skills or ability to see patients in a way that improves the reputation and revenues of their system.
How do you research a doctor?
When researching a doctor, you can check basic credentials – license, board certification, medical board sanctions are bare minimums. Your first question should be – what are you seeing them for? If you are looking for a diagnostician, such as an Internist, your needs are very different than if you are having heart surgery. What you need will determine what you are willing to accept. In your Internist, you want someone who listens to you, is empathetic and helps answer questions about your symptoms. In a Cardio-thoracic surgeon you may care less about their bedside manner and more about their technical skills. The length of your relationship is different as well – I’ve known many of my patients for over a decade, whereas an orthopedic surgeon who fixes your knee may only be part of your life for a few months until you are healed.
Most surveys of what patients say make a good doctor have little to do with training, malpractice complaints or cost and efficiency. It is mostly a subjective assessment – personality, listening, empathy – the things we call bedside manner. Studies bear this out as well – even when the outcome of care does not end well, doctors with good bedside manner and communication skills are sued less than those who are less liked by their patients.
I like to think I’ve got a good bedside manner – but also recognize that I’d have a lot of empty space in my schedule if I was wrong in 2 out of every 3 diagnoses! The funny part is listening and using my “soft skills”makes getting the diagnosis right much easier – 90% of diagnoses are made by history.
I don’t expect to see my name on ESPN any time soon, I’m quite content when patients leave the office feeling heard, with a plan to move towards health.
The path to wellness begins with a proper diagnosis
Teachers are another profession without a hall of fame – but what if they had their own network?