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Choosing Your Doctor Carefully Is the Best Medicine

October 12, 1998|DR. ARNOLD MILSTEIN

In this article, Milstein writes about medical quality as he would in a letter to his mother.

Dear Mom,

I'm sorry I can't be with you this year when you pick a health insurance plan or doctor--and especially if you get sick and need help deciding on the best hospital or treatment. Since I can't be at your side, I am sending you some advice that I have given to others.


Why It's Important to Seek Quality Medical Care

The average quality of American care is not dependable. Here are two important numbers to remember when you think about problems in average quality: 3% and 11%. Three percent was the number of hospital patients who suffered avoidable injury or death due to errors, according to a detailed study of U.S. hospital care by researchers at the Harvard School of Public Health.

Eleven percent was the number of Americans living at home with a common chronic illness (such as high blood pressure or asthma) who were suffering an avoidable medical problem because their doctors were not meeting standards for good quality of care. The second study was by health policy experts at RAND, a research center in Santa Monica.

To put these numbers in perspective, one of the Harvard researchers used his findings to estimate that 180,000 Americans die each year from injuries caused from hospital care. He then estimated how many fully loaded jumbo jets would need to crash each year to cause the same number of deaths. If you don't count deaths that were unavoidable (such as someone dying because of a severe medication allergy that no one could have known about), the number of avoidable hospital deaths would equal one jumbo jet crash a day. This does not mean doctors and hospitals are not trying to do their best. It means that meeting standards for high quality is difficult and will require major changes in how care is provided and managed.


How to Get Better Quality of Care

Fortunately, health insurers, doctors, hospitals, employers, unions, consumer groups, government and researchers have been working on solutions. As a result, there are good things you can do. For one thing, you can pick a better quality medical plan. Fortunately, we do have quality-of-care ratings for some health insurance plans. In California, the state has teamed up with a respected quality-review organization and the California Medical Assn. to try to ensure that minimum standards for quality are met by all California HMOs. In addition, many HMOs voluntarily seek performance reviews by the National Committee on Quality Assurance, a national organization that tests HMOs not only for minimum acceptability but also for excellence.

The committee has also developed a quality "report card" for HMOs called HEDIS, which most California HMOs voluntarily report to the public every September. This report includes performance scores on patient satisfaction, preventive services and treatment for several diseases. In addition, the U.S. government makes available to the public other performance information on HMOs offered to Medicare patients.

Unfortunately, for most health insurance plans that are not HMOs, we do not have quality-of-care ratings. Are you better off picking an HMO or a non-HMO insurance plan? Leading researchers conclude that there seems to be no overall differences for a person in average health--no matter which type of plan he or she chooses. There is evidence that some very sick people may be better off avoiding an average HMO. My belief is that quality of care in some HMOs is better, and in other HMOs is worse, than average care outside of HMOs. For example, the 1998 HEDIS report shows quality scores for follow-up care after heart attacks by many California HMOs are much better than scores found in research on non-HMO care.


Choosing a Doctor

My advice is to pick a doctor based on what physician group they join, advice from other doctors or nurses, their qualifications and your own experience.

Report cards on individual doctors are not available yet, but there are several things you can do to increase your chances of selecting a good doctor. First, find out whether your doctor is a member of one of the physician groups who volunteer to participate in "Physician Value Check," a public performance report on physician quality.

A doctor who is in one of those groups is willing to have his or her quality scores measured and publicly compared. In addition, if more than one of these physician groups is in your area, consider picking a doctor from the group with higher scores. Second, if you know doctors or nurses, ask them which doctor they would pick for your medical problems. If several doctors or nurses suggest the same physician, that doctor is likely to be better. Lean toward selecting a doctor who is board certified and has hospital privileges, something you can usually find out by asking the doctor's receptionist or the doctor.

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