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'Let's Rate Doctors Too'

May 23, 1985

On the surface, the proposal by Dr. Wolfe that the performance of doctors be made available to the public may sound like a good idea and simple to do. Unfortunately, it isn't so.

The successful outcome of a surgical procedure or treatment of an acute or chronic illness is only partly dependent upon the skill and knowledge of the physician. To hold the physician accountable for the outcome, various other factors that will influence the outcome and are not under the control of the physician must be considered. These include, at the least, age of the patient, severity of the illness, associated conditions, genetic background of the patient, compliance with treatment, environment of the patient and performance of other appropriate members of the health-care team.

It follows then, that in order to obtain a valid comparison of the performance of doctors, only similar types or "mixes" of patients should be compared. It would be wrong to compare apples with oranges, as they say. This requirement poses at least two additional problems. Each physician must treat a large enough number of comparable patients over a reasonably short period of time to allow for valid comparison. But the fact is that most physicians will not individually treat enough truly comparable patients except over a relatively long period of time (during which time the physician's ability and modes of diagnosis and treatment may change).

Another issue is how to deal with the "learning curve" of physicians. Like it or not, physicians and members of other professions and occupations do not emerge from their training periods as fully hatched experts. They all continue to learn and improve over time. Do we then categorize younger physicians as provisionals or juniors and treat them separately so that they can proceed through their learning curve or do we not ever give them a chance to learn and improve?

And a final thought. If we do measure and publish the performance of physicians, shouldn't we also do the same for other service individuals such as auto mechanics, plumbers, TV repairmen, teachers and even lawyers?

SAMUEL O. SAPIN MD

Sherman Oaks

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