Yale cardiologist Harlan Krumholz has an important piece in the Washington Post, "Which Docs Measure Up?" (alternatively headlined online as "We Need A Consumer Reports for Doctors.") Excerpt:
"Need a new hip? A hernia repair? You're out of luck if you want to look at a doctor's track record or an institution's success rates. Results vary by surgeon and by hospital; you just have no way of knowing which one is best. And often, neither do they."
He frames the article, though, around the story of a patient who turned to him (a cardiologist) for advice after being diagnosed with prostate cancer.
"This patient had nowhere to turn to figure out which doctors and hospitals had the best results and the lowest risk of these complications. His dilemma is the same one that virtually every patient -- and the entire health-care system -- is facing: How can you measure quality in an area in which your life may be at stake?"
Of course what Krumholz didn't address was the fact that maybe this man's life wasn't at stake. A diagnosis of prostate cancer may not mean a death sentence. It may mean that you've been labeled with a "cancer" that wouldn't have killed you and that you really didn't need to know about.
What happened to the guy? Krumholz concludes:
"He went to a doctor his internist recommended. He heard that the doctor used a fancy new robotic surgery device and assumed that this meant that he was good. Six months later, he occasionally loses control of his bladder, and his sexual function is not what it was. He is left wondering whether he made the right choice. Meanwhile his experience is not being tracked to help the next person choose or the surgeon and the hospital improve."
Ah, the robot. I've found newspaper headlines that promote it in a cheerleading fashion:
• Robot doctor - surgery of tomorrow• Da Vinci puts magical touch on the prostate
• Cancer survivors meet lifesaving surgical robot
• Robotic surgeon's hands never tremble
• Da Vinci is code for faster recovery
• Surgical Maestro
• DA VINCI ROBOT IS SURGERY WORK OF ART
• Hospital hopes robot surgery will lure patients
The last one may come closest to the truth.
And, as Krumholz points out in his Post article, how are patients to be guided? The headlines about "which docs measure up" or "we need a Consumer Reports for doctors" do not do justice to the broader discussion of quality measurement, inexplicable variations in health care across the US, and profound uncertainties that exist in much of the underlying medical science.
But Krumholz didn't write the headline, and he should be applauded for his important article - and the Post should be applauded for publishing it.
I agree the idea of a "Consumer Reports for doctors" does not convey the full spectrum of quality measurement and reporting that Dr. Krumholz was driving at. Consumer Reports is very good at testing washing machines and booster seats and the like. They also send questionaires to their readers asking for their opinions and experience with various products. The latter kind of survey is already available for doctors in the Washington/Baltimore area via The Washingtonian magazine and the nonprofit group Consumer Checkbook. The Washingtonian publishes an annual list of "best doctors" by specialty based on surveys of physicians who practice in the Washington/Baltimore region. Consumer Checkbook surveys consumers about their experiences with doctors and dentists. Both of these sources are of limited use in determining which doctor to go to.