Saturday, August 1, 2009

How do you pick a good doctor?

My family and I just moved to Philadelphia where I will start work on Monday at the University of Pennsylvania. My brother in law and his pregnant wife just moved here this last week as well. Between the 4 adults, 2 kids, and one kid in utero, we're looking for primary care doctors (pediatric and adult), a specialist, and an OB. We're also picking benefits such as deciding between PPO insurance vs HMO insurance (which costs at least $300/month more than an HMO insurance). So we have some decisions to make.

The funny thing to me is that the dilemma in picking a good doctor on an individual level is the same dilemma that the federal government has (and all health payers) on a large scale level: how does one determine the quality of a health care provider and whether they are worth the cost?

Most people want to know if their doctor is a "good doctor." Sometimes people mean whether the doctor knows and practices up to date medicine. The problem with that is if you could truly tell if a doctor practiced up to date medicine, then you wouldn't need that doctor. I believe that it is nearly impossible for a non physician (and very difficult even for a physician), to be able to know if a doctor practices up to date medicine.

So what else is there to go by? Here's a list
1. You click with the doctor. Never underestimate the power of a good warm relationship with a physician. The physician will think harder, listen better and care more. You will be more open, more trusting and less fearful. It's a good thing.

2. The office staff is professional. My wife and I took our newborn to a doctor once. One of the worst experiences we ever had. The office staff would unlock the front door at 9:02 for a 9:00 appt. The phones were often not answered. And they were rude. A good doctor will care about the professionalism of his office staff.

3. The doctor is accessible. The Institute on Medicine defines quality medicine as what you need, when you need it and how you need it. If you can't easily get an appointment or talk to the nurse or even the doctor, either the doctor is too busy or has an adversarial relationship with patients. Not a good idea.

4. The doctor answers questions (and is not in a rush). This is the most important for me. A good doctor shouldn't be afraid to answer questions and sometimes say, "I don't know" or "I'll get back to you later." No doctor is omniscient, should not pretend to be omniscient and should be honest. Humility is a key trait. A doctor who takes the time to draw out questions and answers them to the satisfaction of the patient will go a long ways towards building trust. They won't make things up (fellow doctors have done that to me a lot which I hate).

5. The doctor seems to take your concerns as his concerns. This goes along with the last one but makes it more personal. I hate it when a doctor blows off a patients concerns and I see doctors do it all the time. Medicine is serious. There's no room for belittling the concerns of patients and families.

6. The doctor uses an electronic medical record with a disease registry (icing on the cake). For economic reasons and tech reasons, there are plenty of docs who are great but because of a lack of finances (some EMR systems cost hundreds of thousands of dollars), some great docs don't have this. But to take medicine to the next level, you want a doc who audits themselves. This can't be done (very easily) without a disease registry. You don't a want a doc who assumes they are a good doc, but measures themselves to find out reality.

The last note is that there is no such thing as quality by association. A partner of a good doc is not necessarily a good doc. I've noticed a lot of University of Pennsylvania advertisements now that I'm in Philly and starting work there on Monday. They want people to assume that any doc at Penn is an amazing doc. I've been around long enough and in enough places to know that that is wishful thinking.

Anyway, these is not meant to be a comprehensive list, but these are some of the things I'm looking for for my family.

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