The Insitute of Medicine, on the basis of two large studies (one in N. Y.; another, Utah & Colorado), extrapolated the data nationally and then rounded up the worst rate so as to, in 1999, proclaim that medical errors lead to 100, 000 USA deaths per year. Texting and driving account for 16,000 per year. Importantly, they restated a profound truth in the Alexander Pope quote, "To err is human...". This is all about "the human condition" rather than anything inherently awful about our USA medical care. BUT, patients, families & friends can play a big role in getting best care. [Skip down to Best Doctors]
If you are in a true emergency, your choices are very limited. But, realize that "the medical system" is geared up...for
many reasons...to move forward on any issue urgently. You must first decide if the situation you are in is an emergency or not. Just ask the question at any
stage, if in doubt.
FIRST, HELP YOURSELF:
- remember that YOU are the customer: though our USA health care system forces doctors to practice at break-neck speed, you can firmly help them focus on the MAIN feature of your complaint.
- exact information makes the difference: Get your story straight & with specifics...it is your time, money, and life...don't waste it! Whatever your complaint, doctors must mentally sift between hundreds of possible common causes (much less the 10s of thousands of rare causes which affect possibly 25 million Americans). Exactly when, where, how often, how long it lasts, how bad it is, what was your temperature, etc. are details that you can add onto a cell phone calendar or notepad or track on some other type of calendar (or in a set of paper notes or notebook). Be prepared with specific information for an expeditious and best outcome.
- photos & videos: especially if you have a visible & recordable finding or complaint that comes and goes (such as "spells" or seizures or skin problems, for example), use the cell phone, a camera, or a video recorder so that the doctor can actually witness the problem or see what the balance problem or the series of skin abnormalities looked like over the days, weeks, months or years of the problem (see episodes of Discovery Channel's Mystery Diagnosis1 to see how important this can be).
- test results: do not wait too long for results: when a test of any type is ordered, ask your ordering health care provider "How much time should I let go by to hear from you about results?" At most, after a month of silence, hound the office for results! By summer 2013, our hospital will "go live" with an electronic medical record (Epic) which will actually allow a patient to access some of their info (MyChart) in a personal health record (PHR).
- insurance: as diplomatically & firmly as possible, (1) try to persuade the medical care provider office to agree to accept your insurance and (2) convince your insurance company as hard as you can to accept this provider, at least as an out-of-network provider. If successful, you may save youself big money!
Even the best caregivers are limited when your information is limited. If you are unconscious, how will rescuers find out about you? Even if you are well, carry ICE phone numbers on your person and in your cell phone. ICE = "in case of emergency". In Lexington County, S. C., persons can register & place their crucial health information with "My 911". In late May 2005, a national free on-line EMR effort, iHealthRecord, began (you register online & then can print a wallet card so ER can check your health record as you posted it...now acquired by Intuit). By July 2005, another option (by subscription) was ReadMyChart.com. And, the WikiHOW website has an evolving file on this topic of on-line PHR health info in case of emergency (& will likely keep abreast of other providers of this service).
Your primary care doctor would likely refer you to a specialist
if you need one. Though "board certified" is not at all a sure-fire stamp of approval or method for indicating
excellence in a specialty, you can find out if your specialist
is "Board Eligible" (has the training which qualifies to take the
exam) or "Board Certified" (passed the exam) in his/her specialty
by checking at the American Board of Medical Specialties.
It's easy to check for board certification--just tap into their
web site. This site requires registration by the site visitor, but the website information
is free. You simply search the database using the doctor's name.
Different consumers/patients have different ideas of what constitutes "the best". So, again, nothing on this page or in this web site constitutes advice.
Do you have clearly in mind what you think constitutes even a good doctor? If you are newly moved to a location and don't have any known medical problems, ask people who you meet who seem to think like you do (at church, at work, in the neighborhood) who they prefer and why. The "troops" who work in the medical profession with the doctors (operating room employees, lab employees, radiology employees, nurses, nurses aids & technicians, pharmacists) often have strong opinions as to who the best are (but they may base their opinion on likeability, business relationships, or the personality of an unusually outspokenly self-confident physician rather than capability)! Ask any of them you might meet for suggestions. Do they think he/she is a good doctor because he's fun to play golf with...or because of what you'd view as important reasons? It may even be possible to pay a doctor for advice as to "the best" for a particular problem. However, for the very reason (above) that there are so many different views of what is "best", most doctors will not give that kind of advisory consultation. But they may be willing to tell you who they would send their spouse, parent, or child to and why...then you make your own mind up.
Some hospitals keep information in their health libraries which might be useful & available to the public. They may be able to give you information (such as a listing of members of their medical staff) which will allow you to draw up a list of possibilities. Some systems have a "doctor finder" fucntion on their web site. See that HHS link in the above box as info sources along with Mayo, Cleveland Clinic and eMedicine.
There is an evolving varient of primary care practice (generally labeled as "concierge" or "botique" care) in which a prospective patient pays the doctor a $1500-2000 annual fee which allows that doctor to limit his/her patient load & assure your access to his/her care with significant one-on-one time. Such can be supplimented with urgent care visits or independent "minute clinics' or "ambulatory care" walk-in treatment facilities for cuts, scrapes, or single episodes of what you think are limited (episodic) illnesses.
Doctor & hospital rating websites are risky because (1) their ratings information may be based on highly incomplete
or evolving tracking information and (2) could be highly biased toward negative information because angry people are much more likely to go to the trouble to
attempt to damage a doctor than to be complimentary to a doctor. And, their anger may well be entirely unjustified. A popular magazine for doctors ran an article in their 1/5/07 issue about ratings websites titled, "Trashed on the Web? Now What?". And, the tracking data may be seriously outdated. With that in mind, note
You might check with national or local offices of the
organization (advocacy group or support group) related to your condition (for example, American Cancer
Society for a cancer patient) for tips on listed local doctors.
The Agency for Healthcare Research and Quality (AHRQ)
has an online file that amounts to "Choosing
a Doctor"...a lot of the advice seems like "over kill" to me.
But, you may find it helpful.
Moving your residence: if you are moving to a new geographic area & have/had an illness that requires being followed by a particular type of doctor, ask your current
doctor (which you will be leaving) for recommendations or tips on finding a suitable doctor at your new location.
It is a matter of personal preference as to whether to seek out "the best". Hopefully, in planning for dealing with a problem, your local physician can help decide to what extent you should go to "get the best". For example, most expectant mothers are satisfied to birth their baby at their local hospital (regardless of the fact that there are "best" obstetric hospitals in the USA). For best hospitals and clinics in America, check out U.
S. News & World Report's website for that organization's opinion. Or, you may find the
accreditation status of the local hospitals at the JCAHO or DNV websites.
Or, one could check the hospital out at the Hospital
Compare web site. Or, look up Consumer Choice Awards of the National Research Corporation, whose
hospital ratings derive from annual surveys of 200,000 USA households.
An evolving on-line source about doctors, hospitals,
clinics, and procedures is at Health
Grades (I have found their info far from current). I'm not sure whether it requires a subscription or not, but Consumers Reports Health Ratings (based on The Dartmouth Atlas of Health Care) does. To see Public Citizen's ranking of how aggressive a
state's oversight board is, see Public Citizen & click on "Health Research
Group of Public Citizen" divisions. As to hospital safety ratings having to do with accidents, errors & infections, here are two sources as of Nov. 2012: Hospital Safety Score (free) and subscription-based Consumers Reports, above.
Another source that assists patients in finding the right doctor is BEST DOCTORS, INC., a Boston based company founded in 1989 by two renowned physicians affiliated
with Harvard Medical School. Library reference rooms carried their books up to 1997. Until about 2000, Best Doctors provided services to individual subscribers. CURRENTLY, Best Doctors
provides access to dependable, high quality medical information and care for individuals with serious illnesses and injuries as well as other
medical services only through employer benefits programs. Also, they will provide info about experts to their Best-Doctor doctors who request it. "The global health solutions company, which has grown to over 30 million members worldwide, uses state-of-the-art technology capabilities to deliver improved health outcomes while reducing costs. Best Doctors seamlessly integrates its trusted health services with large self-insured employers, insurers and other groups in every major region of the world. The company also designs and implements international insurance programs that help people be sure they get the right health solutions." For information on how your employer may enroll, you may contact 800-223-5003 or visit the Best Doctors website. There are lots of useful links on their Face Book page. The Best Doctors list represents the top 5% of physicians practicing in the United States, that list being of over 40,000 doctors representing more than 45 specialties and 400 subspecialties.
Though patient membership is available only through employers, the company works with over 50 magazines and newspapers annually as well as PR contacts at hospitals and other healthcare
provider locations to provide the list of doctors chosen in a specific area for reference purposes. For list availability information, please contact firstname.lastname@example.org or
800-675-1199 x3315. This is not to be confused with Top Doctors.
What about "bad doctors"? Any doctor can have been sued
or named in a lawsuit [societal adverse impact of lawsuits]. Almost ALL doctors have been NAMED in at least one lawsuit. I've (EBS) been Credentials Committee Chairman
our hospital since about 1978 (for over 30 years). Problem doctors we have encountered
did not have lawsuit problems!!! Problem doctors may very well come
across to the patient & family as very confident, authoritative,
charming, and persuasive...even claiming to be very advanced and "cutting
edge" in their skills.
Citizen's Health Group maintains a data service that allows
you to run a background check for disciplinary actions against
the doctor you are checking out (about a $10 charge as of 6/02).
You may get immediate results on-line, by e-mail, or by snail mail.
They are said to possess info on 115,000 actions against 35,000
physicians since the 1960s.
- Discovery Channel's Mystery Diagnosis [episodes listing HERE].
(posted 2002; latest addition 28 February 2013)