Competence and high ethics - Marcus Welby, M.D., is a doctor's doctor
Have you wondered how doctors go about selecting a doctor for themselves and their family? How doctors determine if the treatment recommended to them is a valid one? Or how many opinions doctors seek before deciding to proceed with treatment? The answer to these questions is simple – doctors select physicians whose results are the best. Unless a treatment is controversial, doctors rarely seek a second opinion. If a doctor wants to research the efficacy of a treatment, they use certain data analysis skills they acquired during their medical training. These skills can be learned and utilized by any one. No medical school required.
Sources that doctors use to find a physician for themselves and their family:
Although internet review sites such as yelp.com, citysearch.com, craigslist.com are commonly used by non-physicians to look for a physician, doctors rarely use these sites, if at all. The reason is that these sites describe mostly the experience of going to a doctor, rather than the actual results. If the results are described, they are subjective, rather than objective and are limited to that particular individual, rather than to a group of patients with a similar condition. Since there is variability in how different patients respond to the same treatment, individual success is not necessarily a predictor of how successful the treatment by this physician will be in you. A statistically significant sample size is required to determine if the doctor achieves successful outcome in patients with your condition.
There are many variables that make up the experience of going to a medical office, such as how difficult it was to find parking, how long the wait was to see the doctor, how much the staff smiled, how fresh the flowers were, how hot the coffee was, and whether or not they gave you free samples of the medications when you left. Although it is nice when the experience is pleasant, the experience itself says nothing of the result that will be achieved in treating the particular condition you came to the doctor with.
How do you know then, what kind of medical results the doctor gets? Patient testimonials from other patients on patient review sites are subjective and not statistically relevant. Will asking friends, family, and co-workers produce a referral to a doctor who gets the best results? Chances are most people you ask will have a good result wherever they went. This is because FDA-approved treatments generally result in good outcomes. Typically, more than 50% of patients benefit from the approved treatment. If you want results better than average, if you want a doctor with the best outcomes, you’ll have to look for one the same way doctors do.
The most trusted referral source is the recommendation by another health care professional. This is how doctors find their doctors and medical professionals, and how you can too:
• Ask a physician – this is the most common method for a doctor to find a doctor. The physician source is typically a respected and established member of the medical community who has been in practice for a number of years. They may have served on hospital boards or other hospital committees where they have been exposed to outcomes data from many patients by different physicians. They may be a member of the medical society, are familiar with the reputation and successes of physicians in various specialties. Typically, a physician knows the reputation of another physician within their specialty the most. Asking an orthopedist for a recommendation to a specialist with the best outcomes in arthroscopic knee surgery will, therefore, yield the best reference. If a trusted physician source is not in the same specialty as what one is looking for, they may ask their colleagues within that specialty to recommend who is the best for the treatment of a specific condition of interest. Specialists know the outcomes of their colleagues. Their knowledge comes from seeing their patients, seeing their publications, and hearing them present their work at medical meetings.
• Ask a nurse or a physician’s assistant– these professionals often have first hand knowledge of doctors’ results since they see patients come through the clinics or the operating rooms. They have medical knowledge and are able to assess the outcomes such as how well the problem was treated, the speed of recovery, any complications, and how they were dealt with. They see a large enough sample size from the doctor to formulate an opinion about the quality of their work.
• If you have several recommendations, select the physician who publishes their work and presents at medical meetings – If the physician publishes their research and data, they continuously scrutinize it for peer review process and are driven to keep improving their results. They are also at the forefront of scientific knowledge; the latest procedures, treatments, and techniques. Whatever treatment is recommended to you will, therefore, be the most up-to-date.
Ways to determine if the treatment recommended is the right one for you:
• Ask your doctor to explain why they recommend a particular treatment – resist the urge to go home and look up things on the internet rather than engage your doctor in a conversation about their recommendation. Experiences, accounts, and results described on the web don’t necessarily apply to your particular situation. Only your doctor knows what’s going on with you and why a specific treatment will or will not work on you.
• Ask your doctor for references in the peer reviewed literature
• Ask your doctor for their own outcomes data
• Analyze studies from peer-reviewed journals
Tips on analyzing medical studies:
• Look only at studies published in peer-reviewed literature – anything can be published in non-peer reviewed magazines and on the internet, including opinion pieces, poorly designed studies, studies with sample sizes too small, studies that are not well controlled, or completely fabricated stories. Peer-reviewed journals subject submissions to rigorous process by several specialists in the field that ascertain the scientific rigor of study set up, data collection, and data analysis. Only a fraction of submissions gets accepted for publication.
• Read the entire article – the article will include industry affiliation of the authors as well as any financial interest they may have in the treatment described. You can then be the judge of whether or not you trust the result published by an author with financial interest in the products or treatments described.
• Pay attention to statistics – if treatment A is compared to treatment B, make sure that patients were randomized into the two treatment groups, the number of participants is similar in each group, the sample sizes are statistically significant to detect differences in treatment outcomes, and the characteristics of the participants are similar as well, including the severity of the condition treated. For example, if condition is less severe in group A compared to group B, these patients are likely to experience better outcomes regardless what type of treatment is administered. Successful result in these patients may simply reflect how mild their condition was rather than a successful treatment strategy.
Do’s and don’ts of taking charge of your health care the right way:
• Do ask a medical professional for a recommendation
• Do maximize your interaction with your doctor – ask them questions, ask them for literature references, ask them for their outcomes data
• Do take internet referral sites with a grain of salt.
• Don’t jump from doctor to doctor. Find a physician whose results you trust and stay with them.
FDA www.fda.gov
American Medical Association www.ama.org
Pacific Vision Institute www.pacificvision.org
American Association of Physicians Assistants www.aapa.org
American Nurses Association www.nursingworld.org
Association of Technical Personnel in Ophthalmology www.atpo.org
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