作者，华裔医生 By PAULINE W. CHEN, M.D.
In Search of a Good Doctor
By PAULINE W. CHEN, M.D.
Published: January 8, 2009
In response to my recent column on patients trusting doctors too much, several readers wrote in about the difficulty of finding or sifting through information on doctors and diseases. Many asked for suggestions, so a couple of weeks ago I contacted several nationally respected leaders in family medicine, pediatrics, internal medicine, oncology, surgery and anesthesia and asked them to share their advice on researching doctors and diseases.
Go to Well »Many of the doctors I spoke to or exchanged e-mail with made commonsense suggestions that were not unexpected. They urged patients to find out which doctors their closest friends really like, to ask a prospective doctor questions like how much experience he or she has with a specific condition or operation, and to make sure that as a patient you feel part of a shared decision-making process and comfortable saying how you feel, or that you don’t understand or that you respectfully disagree.
But many of the physicians also shared links to valuable Web sites, several of which I was unfamiliar with. All the sites are free to the public and accessible to anyone with an Internet connection. When I looked at these sites while writing this column, I became really excited as a patient about the amount of information available. For example, one site from the Department of Health and Human Services called Hospital Compare (www.hospitalcompare.hhs.gov) allows you to select three hospitals within a 25-mile radius of your home. It also lets you compare a wide variety of quality indicators, like the percentage of heart failure patients who were given discharge instructions, the percentage of surgery patients given prophylactic antibiotics at the right time, or the percentage of hospitalized patients who felt that doctors or nurses “always” communicated well (the differences among hospitals surprised me).
And according to several of the doctors I spoke with, the amount of information available to patients will only increase in the future.
Throughout our conversations and e-mail exchanges, every one of the doctors stressed the importance of patients doing research and becoming an active part of the medical team. “This is a shared responsibility between the physician and the patient for the patient’s health,” said Dr. Ted Epperly, president of the American Academy of Family Physicians.
Dr. Lisa V. Rubinstein, president of the Society of General Internal Medicine, said that sharing in decision-making “will help raise the quality of care given by any clinician, because it will sharpen the focus on the key decision points and help the clinician put a plan in place that the patient understands and agrees with.”
Here is a summary of these experts’ advice and the Web sites they use themselves and recommend to patients, friends and family.
Choosing a Doctor
All the doctors I contacted stressed the invaluable contribution of a good primary care doctor in helping patients identify specialists or other physicians. “I cannot emphasize enough how important it is for every patient to have a trustworthy primary care physician who can help them navigate our challenging, but potentially excellent, health care system,” said Dr. David T. Tayloe Jr., president of the American Academy of Pediatrics.
Primary care doctors can identify qualified subspecialists through local and national networks or professional organizations. “Even for a patient in a distant city,” Dr. Rubinstein said, “I can usually find a local respected colleague who knows someone in the general area.”
When a primary care doctor does not have a recommendation or when the patient does not have a primary care physician to turn to, Dr. Rubinstein advised identifying high quality medical groups or hospitals that “carefully monitor the quality of the clinicians affiliated with them” and that provide “decision support, continuous quality improvement and continuing education to keep their clinicians functioning well.”
Data on hospital and medical group quality is more readily available to the public than information on individual physicians, and Dr. Rubinstein offered several Web sites (see below) that patients can use.
One way to help assess the quality of individual physicians is to establish that a doctor is board certified, Dr. Epperly said. To become board certified, doctors must complete a full residency at an accredited training program, pass written and, depending on the specialty, oral examinations, and provide proof that she or he has experience with a defined set of clinical problems and technical procedures. However, cautioned Dr. Roger A. Moore, president of the American Society of Anesthesiologists, “board certification is one indication, but it’s certainly no guarantee.”
作者:admin@医学,生命科学 2011-09-08 05:11