Americans consider insurance and a good bedside manner in choosing a doctor, but will that doctor provide high-quality care? A new poll shows that people don't know how to determine that.
Being licensed and likable doesn't necessarily mean a doctor is up to date on best practices. But consumers aren't sure how to uncover much more. Just 22 percent of those questioned are confident they can find information to compare the quality of local doctors, according to the poll by The Associated Press-NORC Center for Public Affairs Research.
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Today, 6 in 10 people say they trust doctor recommendations from friends or family, and nearly half value referrals from their regular physician. The poll found far fewer trust quality information from online patient reviews, health insurers, ratings web sites, the media, even the government.
"I usually go on references from somebody else, because it's hard to track them any other way," said Kenneth Murks, 58, of Lexington, Alabama. His mother suggested a bone and joint specialist after a car accident.
"I guess you can do some Internet searches now," he added, but questions the accuracy of online reviews.
The United States spends more on health care than most developed nations, yet Americans don't have better health to show for it. A recent government report found we miss out on 30 percent of the care recommended to prevent or treat common conditions. At the same time, we undergo lots of unneeded medical testing and outmoded or inappropriate therapies.
Yet people rarely see a problem. In the poll, only 4 percent said they receive poor quality care.
About half believe better care is more expensive, even as the government, insurers and health specialists are pushing for new systems to improve quality while holding down costs.
It's hard to imagine buying a car without checking rankings, but checking out a doctor is much more difficult. Many specialists say standardized measures of health outcomes are key, though very little is available.
Doctors who listen are important, but "some of the nicest doctors are the least competent," cautioned Dr. Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice. Higher-quality care actually tends to be less expensive, by keeping people healthy and out of the hospital, and avoiding errors and the complications of unneeded care, he said.
It's getting a little easier to compare multi-physician offices, if not individual doctors. Online report cards in a few states have begun offering some information on quality outcomes from group practices.
In Minnesota, for example, consumers can compare how many people have diabetes, high blood pressure and some other chronic conditions under control in different practices, plus how satisfied patients are. Report cards in California and Massachusetts add how well certain group practices follow guidelines on cancer screening and avoiding unneeded X-rays and MRIs for back pain.
By year's end, Medicare plans to have released quality measurements for more than 160 large group practices, with more information on smaller clinics set for 2015. Called Physician Compare, the online star ratings also will include patient feedback.
The goal is to spur better care as doctors check out the competition.
The arrival of large amounts of quality information "is a big deal. It's a huge shift in terms of transparency and driving quality improvement," Dr. Patrick Conway, Medicare's chief medical officer, told the AP.
Consumers think it would help. More than 7 in 10 say quality would improve if doctors had to publicly report their patients' health outcomes and how satisfied they are.
The AP-NORC Center poll found about 1 in 5 Americans recall seeing information comparing the quality of health providers in the last year. Nearly half aren't confident they even could learn if their doctor had been disciplined. (Some state licensing boards offer free online searches; the Federation of State Medical Boards provides reports for a fee.)
In choosing a doctor, not surprisingly the top factor is insurance coverage, the poll found. For the uninsured, it's cost.
Eight in 10 look for the doctor's experience with a specific procedure. A nearly equal number say bedside manner - their impression after a face-to-face meeting and how much time is spent with a patient - is crucial. About three-quarters say a helpful office staff and how long it takes to get an appointment are important. A majority, 62 percent, also factor how long they sat in the waiting room.
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Asked the characteristics of a high-quality doctor, a good listener is by far the top answer. Others value the right diagnosis, a caring attitude, a good bedside manner and knowledge, in that order.
"Some don't even give you the time of day. They just look at you and write you a prescription," said Vince Jimenez, 51, of Albuquerque, New Mexico.
When his primary care physician retired, Jimenez got a reference for a new doctor but checked online for complaints. "You can't believe one person, but if there's a bunch of people, if there's a lot of complaints," he said he'd pay attention.
Dartmouth's Fisher said consumers should ask how the office - the doctor's team - supports safe and effective care: Are patient outcomes tracked? Do they check on patients with chronic diseases between visits? Does the person taking after-hours calls know what medications you take?
"We tend to think, `Oh our friend had a great experience with this doctor.' But I'd encourage people to think about the systems around that as well," he said.
The AP-NORC Center survey was conducted with funding from the Robert Wood Johnson Foundation, which has financed projects to publicly report data on care quality.
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It was conducted by telephone May 27 to June 18 among a random national sample of 1,002 adults. Results for the full survey have a margin of sampling error of plus or minus 4.0 percentage points. It is larger for subgroups.
Referrals from another physician or family and friends are a first step in choosing a doctor, but specialists advise doing some research to finalize your choice.
- The insured typically look in-network. Some insurers are starting to score their providers on certain quality and cost measures. Ask what your plan's listing means.
- Check if the doctor is board-certified, which indicates particular expertise in an area such as internal medicine, gynecology, allergy and immunology. You don't want plastic surgery from a primary care physician, said Doris Peter, director of Consumer Reports' Health Ratings Center.
- Check if a doctor has been disciplined by the state licensing agency. The Federation of State Medical Boards has a directory of state boards, plus a license search service for a fee.
- If you need surgery or a specific procedure performed, ask how often the doctor provides that treatment to patients like you. Studies show volume makes a difference.
- Interview the doctor. Do you want someone who discusses the pros and cons of tests and treatments upfront? Avoid physicians who discourage seeking a second opinion, said Dr. Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice. Also, ask if the doctor has any financial relationships with drugmakers or device manufacturers, said Consumer Reports' Peter.
- Ask about specific health conditions. What percent of their diabetic patients have their blood sugar under control? Do they follow national guidelines on cancer screenings? That's the kind of information many quality programs are seeking. Fisher said physicians can't work to improve patients' outcomes if they don't track them.
- Team-based care makes a difference, he said. Is there a nutritionist to help diabetics control blood sugar? Someone who calls to tell the blood pressure patient he's overdue for a check?
- Ask how a primary care physician and specialist will coordinate care, perhaps via electronic medical records, so you're not prescribed conflicting medications or duplicative tests.
- Ask about after-hours care. Will the person who answers the phone have access to your medical record?
- Check if your state has any report cards to track health care quality. The nonprofit National Committee for Quality Assurance publishes online directories of doctors recognized for providing high-quality care for certain diseases or who are affiliated with "patient-centered medical homes," practices it recognizes as meeting certain requirements for coordinated care.
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