Tuesday, December 04, 2007

On Picking a Doctor

Riding home to Massachusetts from Iowa the other day, I was thumbing through Sky, the Delta Airlines magazine, and came across a page titled The Best Doctors in New York.

It reminded me of the common – if no longer necessarily valid - notion that the way to be assured of the best medical care is to pick the best doctor

It also reminded me of my last job, which was at Methodist Hospital in Houston – home base of the famous heart surgeon, Michael DeBakey. It occurred to me while working there that while we all believed that Dr. DeBakey was a good heart surgeon – even the best - we had no data to support that conclusion. It was entirely possible that some heart surgeon working in obscurity somewhere had better outcomes, but there was no evidence for that, either.

That is changing now that data on safety and outcomes are becoming available. To a large extent that data relates to hospitals, although there is also information about individual physicians.

The other factor to consider is the growing evidence showing that the quality of modern health care depends less and less on individuals and more and more on systems and processes that depend upon institutional support.

In light of all that, my own view is that the best way to be assured of good care is to first pick a good hospital and then get the hospital to recommend a doctor from its staff. For one thing, the hospital will know more about the doctor than can ever be learned from published data. For another, the hospital, by making a recommendation, assumes some responsibility for certifying the doctor’s competence.

That is what our household did the last two times a surgeon was needed and it worked for us.

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