If you want to go to dinner or see a movie, it's easy to find reviews and make a reasonably informed choice. If you're choosing a doctor, it can be hard to tell which practitioners are good and which aren't so good.
Economists call this an "information problem" and say it's one reason the U.S. health care system doesn't work as well as it could. A new Web site is trying to help fix that problem by surveying thousands of patients about their experiences with physicians and posting the results.
Patient Central is the project of a nonprofit group called Consumers' Checkbook.
Robert Krughoff founded Consumers' Checkbook in 1974, after a frustrating experience with a mechanic. "I was driving away from an auto repair shop one time, and it was the third time I'd been there for the same repair," Krughoff says. "I realized I would be going back for a fourth time. I thought, well, it would be good if there was some way to find out which are the good auto repair shops."
The nonprofit began rating more workaday professions like mechanics and plumbers before making the move into the touchier sector of health care. Krughoff says he wants to make sure Consumers' Checkbook gets it right.
"There are a lot of surveys out there," he says. "If you go on the Internet, there are all kinds of places where you can go to get ratings of doctors. And those ratings of doctors are often based on two patients, or five patients. Sometimes [they] may not even be the doctor's patients." Krughoff was wary about doctors and their staffs — or doctors' enemies — doing the ratings. "We wanted to do a truly reliable survey free of any kind of bias," he says.
Several large insurance companies agreed to provide Consumers' Checkbook the names of patients and doctors. The group mailed out thousands of surveys asking patients whether they felt their doctors listened to them and explained things clearly, and whether they could readily get appointments.
In late July, Consumers' Checkbook launched a pilot version of Patient Central, with results for the Denver, Memphis and Kansas City areas. Krughoff pulls up the Kansas City ratings, which include 677 doctors.
A doctor named David Graham tops the list with an overall rating of 96. "Says here that is statistically, significantly better than the average doctor in the community," Krughoff notes. "Actually, it's way statistically significantly better."
Graham had been rated by 100 people in the confidential survey. Krughoff says his group knows those patients really did visit Graham.
The problem is that any list with a top-ranked physician also has a bottom-ranked one. Krughoff doesn't want to talk much about that person. When I tell him I'm going to call that person, Krughoff replies, "Knock yourself out."
Like many things in health care, the quality of individual doctors is hard to gauge. Patient surveys may tell you a doctor is a good listener, but he or she could still be a lousy doctor.
I called the bottom five doctors on the list. The doctor rated the lowest didn't call back. A check with the Kansas licensing board shows that in 1996 he had been disciplined for sexual misconduct and distributing controlled substances on a "gratuitous basis."
One doctor at the bottom did call back — Mitzi Groves. She says it appears that the results for her were skewed by a single patient out of the 26 who filled out the survey. Groves says that patient gave her the lowest possible score in every category. "They gave no comments, so I can't even think back to what would have happened here," she says.
Groves describes herself as a good listener who cares about her patients. She says surveys like this can be useful for figuring out what you're doing right and what you could do better.
"I think when this survey was done, [it] was in the middle of flu season," she says. Groves remembers trying to see a lot of patients, squeezing people into the schedule. The disgruntled patient probably felt like Gore was rushing, which she may have been.
Flu season is a challenging time for doctors trying to juggle patients and help everyone who needs care. Groves and her colleagues can try to fit them all in, but that means the patients don't get a lot of personal attention.
The doctors, meanwhile, are just trying to think about what's best for everyone's health overall. And that's something the Patient Central survey doesn't really measure.