Fellowship Story Showcase
Examining physicians: How do you feel? Better choices, care are goals
Dr. Manoj Jain takes a look at the patient doctor surveys that were conducted in Memphis and gives a doctor's point of view on choosing a primary care physician.
Photo by Alan Spearman, Alan Spearman/The Commercial Appeal
Doctors play a unique role in our lives. They ask us to undress, and then they lay their hands on our bodies. They give us drugs that alter our minds. We trust our doctors as much as we trust our spouses -- sometimes more.
Choosing the right doctor can be one of the most important decisions we make.
When my doctor moved out of town, I found myself in the same predicament as one in five Americans -- I did not have a primary-care doctor.
Most people begin their search by looking for a doctor's office close to their home or by asking friends and family.
So I asked my wife, also a physician. She replied with a question. "What do you want in your doctor?"
As a practicing doctor I have an advantage -- I have inside knowledge. I know doctors who listen to their patients and explain things well. I know which doctors' offices schedule appointments quickly and provide care without delay.
Now, however, Memphians who are looking for a doctor have an advantage, too.
Memphis was one of three cities in the nation chosen for a doctor rating survey. Nearly 24,000 local patients rated more than 430 primary-care doctors in the Greater Memphis area. The ratings are available online at the Healthy Memphis Common Table website.
The hope is that with more information, patients will make better choices and hospitals and doctors will improve the care they provide.
The doctor rating survey was conducted by Consumers' Checkbook, a nonprofit, national consumer organization.
Publicizing the Checkbook survey of doctors is one of the projects of the Healthy Memphis Common Table.
"People want to know how doctors are rated by other patients," said Renee Frazier, CEO of the Common Table.
Frazier worked with a team of doctors, statisticians, community volunteers and business groups to develop these health care quality reports -- a project that has been in the making for the past four years.
To rate hospitals, some quality report cards on the Healthy Memphis website use Medicare data. Others rate doctors on their clinical performance, such as how often they give mammograms. The reports that piqued my attention were Consumers' Checkbook's surveys about patients' experience with their doctors, or doctor rating surveys.
But few people are aware that such data are publicly available, whether related to hospitals, nursing homes or doctors. And fewer still use the data to make health care decisions.
Doctor ratings or not, patients may not have a choice of going to quality providers. Their insurance may not cover the best hospitals, or better-performing doctors may not accept new patients.
Still, the doctor ratings are a step down the road toward transparency and accountability in health care.
I met with Robert Krughoff at his Consumers' Checkbook office on K Street in Washington. He looks much like the scientist from the movie "Back to the Future" with uncombed silver-gray hair.
His desk was buried under piles of books and papers. He is the mastermind behind the survey.
Krughoff founded Consumers' Checkbook in 1974, a magazine much like Consumer Reports except that it evaluates service providers like mechanics and plumbers through customer surveys. Now he has begun a major campaign to evaluate doctors, with Memphis as a pilot site.
Consumers' Checkbook has made every effort to make the survey scientific and the data reliable. The survey questionnaire, which delves into the doctor-patient relationship, was developed by the federal Agency for Healthcare Research and Quality.
It contains well-tested questions, such as: How often did the doctor explain things in a way that was easy to understand? How often did you see the doctor within 15 minutes of your appointment time? Would you recommend this doctor to your family and friends?
Typically, a doctor required survey responses from more than 40 patients before the doctor's score was publicly reported. To classify a doctor's score as either "better" or "lower," the score had to be statistically different than the average of other doctors in the community.
In January 2009, 63,717 patients in the Memphis area on health plans such as Cigna and Blue Cross Blue Shield of Tennessee received a survey asking them to evaluate their primary-care doctor. My wife received a survey about her doctor that she gladly completed.
I, on the other hand, pooh-pooh doctor surveys. And as a doctor, I'm uncomfortable being evaluated by my patients, and it's even worse to have that data posted on the Internet.
I asked Marian, a colleague who works in an administrative office, about her last visit to the doctor.
"Oh, it was horrible. I was fasting for a 12:30 appointment. The front desk didn't check me in until 1 o'clock ... I didn't see the doctor until 2:30."
She was getting weak and her vision was blurring while she sat in the waiting room. "My blood sugar was plummeting," she said.
I asked Marian if she would go again to this doctor.
"Yeah, I like him," she said. "He spends time with me. He answers all my questions."
As Marian suggests, studies on doctor-patient relationship show that patients want their doctor to be communicative, competent, compassionate and available at the patient's convenience.
We looked up his rating on healthymemphis.org and, sure enough, Marian's doctor was rated by his patients highly on his communication skills, on questions such as "How often did this doctor listen carefully to you?"
But on the question of "How often did you see this doctor within 15 minutes of your appointment time," he ranked substantially below the community average.
Overall, her doctor received a score of 87, better than the community average of 83.
My search for a primary-care doctor began before the release of Memphis' doctor rating data. My wife had recommended Dr. David Wright.
"He spends time with his patients and the patients love him," she said.
Two decades after completing medical school, I have learned this: Each doctor is different. Some excel in the technical aspects of surgery but will only stand in a patient's room for the duration of a few breaths.
Others have office wait lines worse than those for motor vehicle inspection. Some are arrogant but are geniuses in assembling esoteric facts into a unified diagnosis.
I had my appointment with Wright, and as my wife had predicted, for nearly 60 minutes he listened to me. Like a curious friend, he exhausted me with questions, even asking, "Do you wear your seatbelt regularly?"
From my first visit, I felt that I had made the right choice. But I knew the true test would come once I fell ill.
A year after my initial appointment, I developed relentless low-grade fevers and fatigue for six weeks.
"Why isn't Dad getting out of bed to drop us off at school?" my son wondered.
I spoke with Wright's nurse and had an appointment within 24 hours. Visit after visit, test after test, we ruled out everything from a sinus infection to appendicitis, from diverticulitis to tuberculosis.
A few Tylenols would lower the fever and the sweats, enough for me to complete my hospital work. As an infectious disease doctor, I routinely get referrals from internists on such cases of FUO -- fever of unknown origin.
Worried, I told Wright that one of my patients with an FUO was getting a scan for cancer.
He put his hands on my shoulders and said, "If it was anything like a lymphoma, we would have picked it up in the tests." Patients need reassurance -- even if patients are doctors.
In the end, no cause was found, and the fevers went away. "Probably a viral illness," another infectious disease colleague guessed.
Recently, I looked up Wright on the Internet -- an unsettling place to get information about a doctor, because websites with unsolicited opinion are riddled with flaws.
The survey size is often small, equivalent to water-cooler chatter or local gossip. There's no way to know if a real patient or Wright's daughter is posting the comments. The comments can be abusive, offensive or irrelevant, but can still blemish the reputation of a professional.
But of all the public data available on the Internet, the Healthy Memphis Common Table and Consumers' Checkbook data was most comprehensive. Some 84 patients had rated Wright, and on nearly all the questions he ranked above average. Overall, his rating was 92, while the community average for a primary-care doctor was 83.
I told Wright about the phone tag I played, while sick, with his office staff.
"The office needs to use e-mail and electronic medical records," I suggested. "But I think you are a wonderful doctor. You are smart, you spend time with your patients, and you care."
With a soft voice, Wright replied, "That means a lot to me."
I truly had found a good doctor, and the doctor rating data backed me up.
Dr. Manoj Jain is a physician who works with the Healthy Memphis Common Table. The nonprofit Healthy Memphis Common Table received a $1.6 million grant from the Robert Wood Johnson Foundation to work on initiatives related to public reporting of data about health care quality.
This series was conceived and produced as a project for The California Endowment Health Journalism Fellowships, a program of University of Southern California's Annenberg School for Communication & Journalism.