Today I’ll add more to a theme from last week - the massive difference between seeing an average doctor and one of the best doctors in the world for your question, and why it’s worth it to find the best doctors.
Last week we established that insurance companies and health systems have their own interests that keep them from finding the best specialists for you. This week we’ll talk about how you can find the best specialists for yourself – without relying on them.
✅DO USE: Reviews
For all the hand-wringing from doctors that negative patients post disproportionately (they do), it remains that exceptional doctors tend to have higher reviews and many more people who took the time to sing their praises online.
☝️Caveats: Focus on the reviews with narratives and read what they’re saying. You can usually tell if the reviewer’s praise or criticism should carry weight to you. Carte pays little attention to reviews with no words, which could easily come from internet trolls. Specialties that have a subset of patients with notoriously unrealistic expectations (OB/gyn, dermatology, plastic surgery) can be especially difficult reviews to interpret.
💡Final Thoughts: Doctors will say reviews unfairly reward the doctors who practice good “customer service.” To which I say, the job actually is about making patients happy. In my experience, doctors with a spine who have difficult discussions with patients don’t get all the negative reviews, nor do schmoozy doctors who give out antibiotics and opiates like candy get all the great reviews. Patients can feel integrity: reviews reflect this. Does a charlatan slip through with great reviews every once in a while? Absolutely, which is why this list doesn’t stop with reviews.
✅DO USE: Surgeons’ peers, nurses, and trainees
When it comes to scenarios like surgery and procedures, where technical skills matter and bedside manner and communication skills simply aren’t enough, you want to know how your doctor’s skills “behind the curtain” measure up as assessed by people who have seen many cases and can compare across different operators.
The three groups of people who can shed light on this question are other doctors in the same specialty, nurses and techs in the operating room with surgeons, and trainees. Each group comes with their own blind spots from their vantage point, but impressions quickly emerge on who is slow but careful, who is tempestuous, and who the true virtuosos are.
☝️Caveats: There are always disgruntled people with an axe to grind, even against excellent surgeons. If all the data points towards a surgeon or proceduralist’s competency except for one person on the inside, take their opinion with a grain of salt.
💡Final Thoughts: To see what a difference these can make, read one of my favorite quotes we gathered from a resident for a colorectal surgeon on our list: “I can’t say enough good things about Dr. [_name removed_]. He’s extremely kind and caring. I’ve worked with him a ton and he’s consistently a technical wizard. He does basically everything robotic and gets patients home quickly. He’s who I would send my own family members to if they needed something like this. He’s truly the best.”
✅DO USE: Impressions from office staff, ancillary team
This is another controversial opinion. But I will maintain that your experience as a patient is shaped by the entire team, not just the doctor – so you should judge your doctor by the company he or she keeps. Office staff are often who you rely on to get last minute appointments, to access prescriptions, to demystify insurance and billing issues. The list goes on and on.
☝️Caveats: Independent offices will almost always have less bureaucracy than large academic medical centers. That shouldn’t necessarily be held against the large centers, which have other advantages that come with scale.
💡Final Thoughts: If the office staff is weak and communication to the doctor is weak, your care suffers. If your doctor is an excellent leader and staff have clear SOPs and work seamlessly together, your care benefits. Whether doctors feel it’s part of their job description or not, leading a great team is part of delivering great medical results.
✅DO USE: Claims and registry data on negative outcomes
There’s a balance to be struck between data and anecdote when answering any question, and much of medicine is an art betrayed by the ways it is measured today. With that said, we still have found benefit in the birds-eye view afforded from reviewing the raw count of surgeries or diagnoses doctors had, how many complications occurred, and how those numbers compared to peers.
☝️Caveats: Case selection bias is real: some of the most talented surgeons may take on the highest risk cases, which will result in higher absolute complication rates even if those rates are lower than their peers would have under the same complexity.
💡Final Thoughts: Statistics are only as good as the underlying data. If the sample is all Medicare patients and you’re 35, or if all the cases are through insurance and your case is cash-pay, keep the generalizability of the numbers you checked in perspective.
This list is getting pretty long so I’ll be more brief on the modes not to use:
❌DON’T USE: Top doctor lists
Here is how top doctor lists are made: either doctors vote for one another, in which case affinity groups form voting blocs where they promise to vote for each other not on the basis of merit but to up their own chances of making the list, or doctors flat-out self nominate themselves and pay “application fees.” In my opinion, these lists are not worth much more than the paper they’re printed on.
❌DON’T USE: Costs (in either direction)
Carte’s objective isn’t to get you the cheapest medical care possible: we want to get you the best care possible. Often that means avoiding expensive surgeries or unnecessary tests, but sometimes it also means using the very expensive biologic or new therapy. Cost should be taken into account in your decision, but the doctor who spends the least (or the most) is not inherently best.
❌DON’T USE: Pedigree
Training at a prestigious place affords you access to cutting edge research and often puts you in the mentorship of great physicians and scientists, but we have seen our fair share of doctors with exceptional pedigree who were truly bottom of the barrel. Similarly, we have DOs and graduates from the Caribbean on our list of top doctors in the country. Part of becoming a great doctor is your training. A bigger part is what you do afterwards.
❌DON’T USE: Your Primary Care Provider (sorry PCPs!)
I mean no offense to most PCP offices. And I will say some PCPs have impeccable taste in specialists and have found all the gems in their area. If you have a PCP like this, by all means, listen to their advice on referrals. But most of us see a primary care doctor who is drowning in work and doesn’t have the bandwidth to do more than simply say the name of which specialty we need to see and click the first name that shows up on the dropdown of their EMR. PCPs aren’t incentivized to ace your referrals, and until they have something more to gain (or lose) in the process, most PCPs most of the time will just keep phoning it in.
