Off the top of my head, the most reliable way would be to ask another senior medical professional—senior as they would tend to have been in the same geographic area for a while and know their colleagues, plus have more direct contact with primary care physicians. Also, rather than asking “who should i see as my primary care physician”, you could ask “who would you send your family to see?”. This might help prevent them from just recommending a friend/someone with whom they have a financial relationship. I note that this would be relatively hard to do unless you already know a senior medical professional.
Another option would be to ask a medical student (if you happen to know any in your area) which primary care physicians teach at their university and they would recommend. Through my medical training I have found that teaching at a medical school to be weak-to-moderate evidence of being above average. Asking a medical student would help add a filter for avoiding some of the less competent ones, strengthening this evidence
I think lay-people’s opinions correlate much more strongly with how approachable and nice their doctor is, as opposed to competence. Doctor rating sites could be used just to select for pleasant ones, if you care about that aspect.
(caveats: opinion based; my experience is limited to the country i trained in; I am junior in experience)
This is a great question, and I’m glad that you asked, since I am interested in hearing what people think about this as well. I suppose that word of mouth is generally superior to, say, just searching for a primary care doctor through your insurance provider’s website, but I don’t have any more specific ideas than that.
Personally, I can, and often have, put off going to the doctor due to akrasia, so I put a bit of extra weight on how nice the doctor is—having a nice doctor lowers the willpower-activation-energy needed for me to make an appointment. I also think that willingness to spend time with patients is important, but I’d be more likely to think this than the average person—I’m pretty shy, so I’ll often tell my doctors that I don’t have any more questions (when I actually do) if they seem like they’re in a hurry, so as to not bother them.
Ask everyone you know; ask for their recommendations, and ask why they make those recommendations. Most of the answers you get will not be worth much, but look for the good answers; you only need one.
The trick here is that while it is nearly impossible to find the perfect doctor through any method, you are only looking for a good doctor. Any reasonable recommendation followed by a quick Google search (Google allows reviews on doctors, and most established doctors in larger cities will have at least one or two) to weed out the bad apples will do. This is one of those situations where the perfect is the enemy of productivity.
I don’t assume much of a reliable correlation; but it doesn’t require much. Once you have found a likely few doctors, it is worth finding out if a lot of people hate one of them—particularly if they explain why. It’s basically a very cheap way to filter out potential problems. If I felt that there was a strong correlation, I would have recommended starting with the Google reviews—after all, Googling is much more time expedient than talking to people.
For context, of the few doctors I sampled on Google review, I found none of them to have anything significant posted in their review. The worst I saw was “receptionist was very rude!”
Given two or more okay choices of doctors given by friends and acquaintances, I think that it is fair to apply this sort of filter, even if you have weak evidence that it is effective. The worst that will happen is that you make the other good choice, rather than the good choice you would have made. The best that might happen is that you avoid an unpleasant experience (well, the best is that you lower your chances of dying through physician error). This calculation may change if you have only one doctor under consideration.
The best that might happen is that you avoid an unpleasant experience
If a doctor tells you the straight truth about what you have to change in your life that can be unpleasant. I think it can lead to bad reviews. I don’t know whether it’s useful to avoid those doctors on the other hand.
Defensive medicine doesn’t seem to be something to strive for.
Yes, but if you are reading the reviews, you will be able to determine if they are useful to you. Many will not be. You should certainly be applying the same critical thinking skills that you used when hearing recommendations from your friends in the first place.
I am assuming that there are useful negative comments, although I haven’t seen any yet. (My interpretation was that this was because I was only looking at good doctors to start with). If you have a useful comment on any doctor you have seen, please do add it -- it could save someone some trouble.
Just like everyone else, doctors vary in how good they are. Unfortunately, there is a popular meme (actively promulgated by the doctors guild) that all doctors are sufficiently competent so that any will do. That’s… not true.
Given this, it’s shouldn’t be surprising that finding out the particular doctor’s competency ex ante is hard to impossible (unless s/he screwed up so hard, s/he ran into trouble with the law or the medical board). Typically you’ll have to rely on proxies (e.g. the reputation of the medical school s/he went to).
Beyond that, things start to depend on what do you need a doctor for. If you have a condition to be treated, you probably want a specialist in that (even primary care physicians have specializations). If you want to run a lot of tests on yourself, you want a doctor who’s amenable to ordering whatever tests you ask him for. Etc., etc.
I don’t have any surefire methods that don’t require a very basic working knowledge of medicine, but a general rule of thumb is the physician’s opinion of the algorithmic approach to medical decision making. If it is clearly negative, I’d be willing to bet that the physician is bad. Not quite the same as finding a good one, but decent for narrowing your search.
Along with this, look for someone who thinks in terms of possibilities rather than certainties in diagnoses.
All assuming you’re looking for a general practitioner, of course. I wouldn’t select surgeons based on this rule of thumb, for instance.
If you’re looking for someone who simply has good tableside manner, then reviews and word of mouth do work.
Standardizing decisions through checklists and decision trees has, in general, shown to be useful if the principles behind those algorithms are based on a reliable map. In medical practice, that’s probably the evidence-based medicine approach to screening, diagnosis, and treatment.
In addition, all this assumes that patient management skills are not a concern, since it’s not something I personally consider important (from the point of view of a patient) when considering a provider of any medical or technical service. If you typically require more from your physician (and many people do see physicians as societal pillars and someone to talk to their non-medical problems about) than medical evaluation and treatment, then it is something to keep in mind.
Anecdotally, every medical provider I’ve encountered who was a vocal opponent of clinical decision support systems had a tendency to jump to dramatic conclusions that were later proven wrong.
This is one of the few studies on the subject that isn’t behind a paywall.
What makes a good primary care physician and how do I go about finding one?
Off the top of my head, the most reliable way would be to ask another senior medical professional—senior as they would tend to have been in the same geographic area for a while and know their colleagues, plus have more direct contact with primary care physicians. Also, rather than asking “who should i see as my primary care physician”, you could ask “who would you send your family to see?”. This might help prevent them from just recommending a friend/someone with whom they have a financial relationship. I note that this would be relatively hard to do unless you already know a senior medical professional.
Another option would be to ask a medical student (if you happen to know any in your area) which primary care physicians teach at their university and they would recommend. Through my medical training I have found that teaching at a medical school to be weak-to-moderate evidence of being above average. Asking a medical student would help add a filter for avoiding some of the less competent ones, strengthening this evidence
I think lay-people’s opinions correlate much more strongly with how approachable and nice their doctor is, as opposed to competence. Doctor rating sites could be used just to select for pleasant ones, if you care about that aspect.
(caveats: opinion based; my experience is limited to the country i trained in; I am junior in experience)
This is a great question, and I’m glad that you asked, since I am interested in hearing what people think about this as well. I suppose that word of mouth is generally superior to, say, just searching for a primary care doctor through your insurance provider’s website, but I don’t have any more specific ideas than that.
Personally, I can, and often have, put off going to the doctor due to akrasia, so I put a bit of extra weight on how nice the doctor is—having a nice doctor lowers the willpower-activation-energy needed for me to make an appointment. I also think that willingness to spend time with patients is important, but I’d be more likely to think this than the average person—I’m pretty shy, so I’ll often tell my doctors that I don’t have any more questions (when I actually do) if they seem like they’re in a hurry, so as to not bother them.
Ask everyone you know; ask for their recommendations, and ask why they make those recommendations. Most of the answers you get will not be worth much, but look for the good answers; you only need one.
The trick here is that while it is nearly impossible to find the perfect doctor through any method, you are only looking for a good doctor. Any reasonable recommendation followed by a quick Google search (Google allows reviews on doctors, and most established doctors in larger cities will have at least one or two) to weed out the bad apples will do. This is one of those situations where the perfect is the enemy of productivity.
On what basis do you belief that publically posted reviews of doctors correlate with the quality of the medical ability of the doctor?
I don’t assume much of a reliable correlation; but it doesn’t require much. Once you have found a likely few doctors, it is worth finding out if a lot of people hate one of them—particularly if they explain why. It’s basically a very cheap way to filter out potential problems. If I felt that there was a strong correlation, I would have recommended starting with the Google reviews—after all, Googling is much more time expedient than talking to people.
For context, of the few doctors I sampled on Google review, I found none of them to have anything significant posted in their review. The worst I saw was “receptionist was very rude!”
Given two or more okay choices of doctors given by friends and acquaintances, I think that it is fair to apply this sort of filter, even if you have weak evidence that it is effective. The worst that will happen is that you make the other good choice, rather than the good choice you would have made. The best that might happen is that you avoid an unpleasant experience (well, the best is that you lower your chances of dying through physician error). This calculation may change if you have only one doctor under consideration.
If a doctor tells you the straight truth about what you have to change in your life that can be unpleasant. I think it can lead to bad reviews. I don’t know whether it’s useful to avoid those doctors on the other hand. Defensive medicine doesn’t seem to be something to strive for.
Yes, but if you are reading the reviews, you will be able to determine if they are useful to you. Many will not be. You should certainly be applying the same critical thinking skills that you used when hearing recommendations from your friends in the first place.
I am assuming that there are useful negative comments, although I haven’t seen any yet. (My interpretation was that this was because I was only looking at good doctors to start with). If you have a useful comment on any doctor you have seen, please do add it -- it could save someone some trouble.
First of all, competence and skill.
Just like everyone else, doctors vary in how good they are. Unfortunately, there is a popular meme (actively promulgated by the doctors guild) that all doctors are sufficiently competent so that any will do. That’s… not true.
Given this, it’s shouldn’t be surprising that finding out the particular doctor’s competency ex ante is hard to impossible (unless s/he screwed up so hard, s/he ran into trouble with the law or the medical board). Typically you’ll have to rely on proxies (e.g. the reputation of the medical school s/he went to).
Beyond that, things start to depend on what do you need a doctor for. If you have a condition to be treated, you probably want a specialist in that (even primary care physicians have specializations). If you want to run a lot of tests on yourself, you want a doctor who’s amenable to ordering whatever tests you ask him for. Etc., etc.
I don’t have any surefire methods that don’t require a very basic working knowledge of medicine, but a general rule of thumb is the physician’s opinion of the algorithmic approach to medical decision making. If it is clearly negative, I’d be willing to bet that the physician is bad. Not quite the same as finding a good one, but decent for narrowing your search.
Along with this, look for someone who thinks in terms of possibilities rather than certainties in diagnoses.
All assuming you’re looking for a general practitioner, of course. I wouldn’t select surgeons based on this rule of thumb, for instance.
If you’re looking for someone who simply has good tableside manner, then reviews and word of mouth do work.
Any particular evidence in favor of this approach, anecdotal or otherwise?
Late reply, I know!
Standardizing decisions through checklists and decision trees has, in general, shown to be useful if the principles behind those algorithms are based on a reliable map. In medical practice, that’s probably the evidence-based medicine approach to screening, diagnosis, and treatment.
In addition, all this assumes that patient management skills are not a concern, since it’s not something I personally consider important (from the point of view of a patient) when considering a provider of any medical or technical service. If you typically require more from your physician (and many people do see physicians as societal pillars and someone to talk to their non-medical problems about) than medical evaluation and treatment, then it is something to keep in mind.
Anecdotally, every medical provider I’ve encountered who was a vocal opponent of clinical decision support systems had a tendency to jump to dramatic conclusions that were later proven wrong.
This is one of the few studies on the subject that isn’t behind a paywall.