How to Choose Your Doctor
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It irks economists, marketing professors, government agencies and HMOs that patients do not behave as these experts think they should. Calling them “irrational” and “passive,” health experts would like patients to become “health consumers,” using “quality information” and “examined behaviors” to make “knowledgeable and informed choices.” However, in survey after survey, more than 50 percent of patients rank family and friends as their most important sources of referral for doctors. Newspapers, magazines, yellow pages, radio, brochures and free health seminars are ranked by fewer than 1 percent or 2 percent of patients as their most important sources.
As doctors know from experience, patients are not only smart, but also proactive. In one survey, more than 80 percent of patients have changed, or have thought about changing, their doctors over the past five years. The most common reason was their doctors’ personalities. As one patient put it, patients expect “competence, caring and courtesy” from their doctors. On average, a patient decides within three minutes of meeting a doctor whether or not the doctor cares for her.
Until patients trust statistics over their friends and family, lists such as the one in this issue will remain popular with consumers. On the other hand, hard data might also help to dispel the popular Island belief, that, “If I really sick, I go Mainland.”
Are there good doctors in Honolulu? Cadman, former chief of Yale-New Haven Hospital and director of UCSF Cancer Center, says, “Since I have been here, I have been impressed with the hospitals and the physicians. I think it is more a question of size. For example, Yale has 10 heart surgeons, and here in Honolulu we might have four or five. Yale has 800 beds, and Queen’s about 400.”
The quality of care in Honolulu will certainly improve with the completion of the new UH medical school campus in Kaka‘ako. Of the more than 2,000 doctors in Hawai‘i, more than 1,000 of us are volunteer faculty with the medical school.
How Patients Should Choose Their Doctors
First, you should make sure that the doctor does not have a bad record; and second, that your and the doctor’s personalities are compatible.
You can find out if your doctor is in good standing with the State Professional Licensing Office at www.ehawaii.gov, under Online Services. This Web site will tell you if your doctor is under suspension for any reason and if the doctor has any lawsuits pending against him or her. Because more than 60 percent of doctors will be sued sometime during their careers, having one or two suits on record should not be an automatic strike against the doctor.
You should know that because Honolulu is such a small town, it is hard for a doctor not to have a bad reputation if he or she is incompetent. As an internist, I would not refer a patient to a specialist unless I had confidence in the specialist, because, if things went wrong, I would be named in the lawsuit.
Can “quality information” and statistics really help patients choose doctors and hospitals? Heart surgeon Mark Grattan thinks so. “Unfortunately, here in Hawai‘i patients have no access to quality information, such as mortality rates of surgeons.”
When statistics on heart surgeons were first published, people were quite shocked to see the wide variation among them. “I think the numbers generally improved the overall quality of care. When New York State first published its numbers, several surgeons had to stop operating, because their numbers were just way off the chart.” One can find hard numbers from the National Healthcare Quality Initiative, Health Plan Employer Data and Information Set (HEDIS) and Consumer Assessment of Health Plans (CAHPS). Through Healthgrades.com, one can find if a Honolulu doctor is board certified, where he or she went to medical school and if he or she has been sanctioned by the state or the federal government.
There is a downside to relying on numbers. For example, because heart surgeons are judged according to how many of their patients die during or after operations, they are naturally more reluctant to take on sicker patients. “Does this mean that if your 90-year-old father has a heart attack, and now has a severe heart valve problem and bad heart failure, you will have a hard time finding a surgeon who is willing to operate on him? You bet,” cautions Grattan.
After your doctor’s competence has been vouched for by another doctor and the state licensing board, you should also check if you and the doctor can work well together. This is where your friends and family can be helpful, by letting you know if they have been treated by the doctor and the doctor’s office with courtesy and good service.
The ability for you and your doctor to communicate well is crucial, and you can find this out only by talking to the doctor face to face. When I was in medical school, our professors kept telling us that there is an “art” and a “science” to medicine. Since it has been proven that 90 percent of communication is nonverbal, the “art” of medicine is the verbal and nonverbal interplay between the patient and the doctor. Patients don’t always tell doctors what they really want: a million-dollar work up, a prescription or information and reassurance. Picking up on such subconscious communication is how doctors develop a positive relationship with patients.”
Ultimately, when you choose a doctor, you are choosing someone you can trust. You trust that your doctor is competent. You trust that he genuinely cares for you. You trust that he or she will have the courtesy to see you and return your phone calls promptly. In short, patients deserve competence, caring and courtesy.
Author’s Note: Dr. Robert Yih-jen Shaw is an internist at Straub Clinic and Hospital. He trained at Albany Medical College, the University of Hawai‘i, and Oregon Health Sciences University. His last piece for HONOLULU Magazine was “18 Questions While You’re in the Dentist’s Chair,” February 2004.
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