Say you have a medical problem and need a doctor. Ideally you’d want a high quality doctor right? So what do you look for to determine a physician’s quality for you?
The simple answer is…you can’t look for anything.
Let’s consider a primary care doctor who has the average 1500 to 2000 patients in their practice. Let’s say the practice has the standard number of diabetics– about 8% of the population has diabetes. Therefore, there are about 140 diabetics in that doctor’s practice. This practice is in let’s say an affluent, mostly white suburban town– or maybe it’s in a predominantly hispanic, inner city neighborhood with a high percentage of Medicaid. We’re trying to answer the question, “does this doctor who theoretically treats all patients according to the latest theories and his/her best judgement, provide high quality diabetic care?” How many patients would be needed in this “real world study” to provide reproducible, statistically significant results that say “yes, this doctor provides higher quality care for diabetics than another doctor.” What would the study look like and how many patients and what kinds of patients would a doctor have to see in order to be considered “higher quality than another doctor” for you?
It’s impossible. The number of patients just like you that that individual doctor would have to see would be thousands over a short period of time…think of how many patients are needed in pharmaceutical studies to provide statistically significant, reproducible results.
We’ll never be able to determine individual doctor quality because doctors simply can’t see enough patients to provide meaningful results. There’s no way to say that Dr. Smith provides, on average, 4% higher level diabetic care than Dr. Jones. Trying to do so would be a very poor scientific study with results that are not statistically significant and therefore, unscientific. And again, we can only talk about an average, not about how Dr. Smith would do in your unique case or if his practice demographics change. There’s no way to determine if the head of Cardiology at Hopkins is a “higher quality doctor” for you than the head of Cardiology at Springfield Hospital in Anywhere, USA.
Only about 20% of the practice of medicine has evidence behind it. And many standards change about every five years. By the time we get done studying some medical therapy doctors think is good, another study comes out saying that a new therapy is 3% better. Standards change. And when standards change, quality changes.
Medicine is more of an art than a science. And it’s more about people having real relationships with their doctors. It’s about being connected to that doctor and their personality and feeling as if that doctor was doing everything they could to help you.
Disclaimer: This dilemma somewhat falls apart when a doctor only does one type of procedure on one type of patient for a long period of time (for example, an orthopedic surgeon who does only hip replacements in dedicated Hip Replacement Hospitals on middle class women over 80). If that’s the case, quality data on an individual physician to an individual patient is much more meaningful.