What is a good doctor?

Tags: fiesinger, president's letter, family physician, quality

By Troy Fiesinger, M.D.
TAFP President, 2012-2013

Although I missed the blockbuster 2011 Brad Pitt movie Moneyball, I recently read the book by Michael Lewis. Oakland A’s general manager Billy Beane, a promising high school prospect out of California, was drafted by the New York Mets the same year as Darryl Strawberry and Lenny Dykstra. Despite looking like a top prospect to the scouts, Beane’s major league career ended early while Strawberry and Dykstra won the 1986 World Series with the Mets. As the general manager of the Athletics, Beane struggled to define more accurately what makes a baseball player good. This got me thinking: How do I know I’m a good doctor?

I can point to the diplomas on my wall and tell you I went to good schools, but the U.S. News and World Report rankings are little more than opinion surveys with minimal hard data to back up their lists. I can show you a copy of my Texas medical license, but that just means I haven’t broken any laws nor received any complaints to the Texas Medical Board. You could look at my American Board of Family Medicine diploma, know that I have passed a national exam and do annual online education modules, and consequently assume I know something. You do not know, however, if I am better than the doctors across the street.

You could ask my patients. They would tell you I often run behind but they would recommend me to their friends over 90 percent of the time. They might say I am a good listener or helped them through a difficult time, but they will not know what my diabetic patients’ average hemoglobin A1C is. When the Kaiser Family Foundation asked people how they chose a doctor or hospital, the majority said they relied on the advice of friends and neighbors, not on published mortality and quality data.

You could ask Medicare. My Physician Quality Reporting System data says my diabetic patients’ average hemoglobin A1C is better than 75 percent of the doctors in the country, but fewer than half of my patients get their diabetic eye exams. How much of that is my fault and how much occurs because their eye doctors do not send a report back to me? I am still looking for the answer to that one.

You could ask the insurance companies, but their first priority is whether I take care of their customers—my patients—in a cost-effective manner. If I hit their HEDIS quality targets, they are even happier, mainly because they get a higher star rating to put in their marketing material to attract more customers. They value keeping their members out of the hospital and emergency room, and discharging them quickly because that lowers their costs, not because the quality of care is better.

You could ask the hospital where I am on staff. They can tell you if they have achieved their Joint Commission Core Measures, but not what role I play in meeting their targets. They can’t tell you if I have run afoul of their complaint driven quality review process, because that information is privileged. They will maintain that they have only the best doctors on staff, but you have to decide if you believe them.

The answer to the question of whether I am a good doctor depends on who is asking the question. Whether we love or hate the amount of information different entities collect about us, we have to gain control of this data so we can articulate our own definitions of quality and defend them with numbers. We do not have time to react indignantly as though our honor has been grievously insulted when someone questions the quality of our care. We must analyze our own data so we can answer affirmatively: Yes, I am a good doctor, and here is the data to back that up.

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