An editorial entitled “Rating your Doctor, Fairly” (The New York Times ([NYT)], December 8, 2007) discussed consumers’ need for reliable sources to rate physician quality. At present, insurers do much of this rating and apparently focus on costs, awarding grades or stars on the basis of expenditures. According to the editorial, physicians who are most “cost-effective” get the top marks. The NYT advocated a more encompassing set of rating criteria that would include measures such as adherence to guidelines or national standards (whatever they are). They also suggested posting physician scorecards on a single Web site to facilitate consumer choices.
The NYT has intelligent and trenchant editorials, but, in this case, I think that the paper has mistakenly oversimplified a complicated and contentious subject. Sure, there is an enormous amount of data on physicians out there, but creating a meaningful consumer guide will be a heroic undertaking, if possible. Furthermore, while a ratings system (a Zagat’s guide, in other words) may work for restaurants or movies, I am far from convinced that it would work for healthcare. After all, restaurants are a matter of taste and deciding that the food is a 26 or 27 has the same precision as deciding who has the prettiest face or the most talent in a beauty pageant.
‘Best’ Is a Matter of Perspective
On a recent flight, I was surprised to see an advertisement for the “Best Plastic Surgeons in America” in the airline magazine. The doctor pictured looked sharp in his crisp white coat and he had the straightest and pearliest teeth you have ever seen (no doubt crafted by his buddy who is one of the “Best Cosmetic Dentists in America”). While the basis for calling any doctor the “best” is questionable, I have to admit that the impression was strong. If I ever need a facelift or tummy tuck, trust me, I am going to fly to the smiley surgeon in that ad.
I have been thinking more about quality ratings in medical care since I have presented cases in this column. As you may remember, in a previous column I wrote about managing a hospitalized patient with gout when all the usual therapeutic options are problematic because of co-morbidities (July 2007 TR, p. 6). I asked readers what they would do, and the responses ranged from intra-articular steroids to intravenous colchicine. As pleased as I was with the enthusiastic response, I was amazed by the diversity of opinion.