Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We should value quality when we shop for health care

Celine Gounder, MD
Physician
June 21, 2014
Share
Tweet
Share

Over the years, my husband’s parents, Helen and Dave, have both suffered unnecessarily from bad medical care. They are not alone.

A botched cataract surgery left Helen with a torn iris. One of her eyes can’t adjust to light, and for the last several years she’s worn sunglasses indoors. Her urologist kept treating her with the same antibiotic for urinary tract infections without testing to see what bacteria she had. When her symptoms persisted for months, I finally intervened. I ordered urine testing myself — I’m an internist and infectious disease specialist — and prescribed the right antibiotic.

More recently, Helen’s internist missed a diagnosis of diverticulitis — a colon infection — that landed her in the hospital for a week. Dave was diagnosed with Parkinson’s disease five years ago. His neurologist sent him home with a very expensive new brand name drug, instead of prescribing him the gold standard medication, carbidopa-levodopa. Dave’s fine motor skills and tremors got so bad this past year that he couldn’t manage the buttons and zippers on his clothes. Soon after, he agreed to see another neurologist for a second opinion. She started him on carbidopa-levodopa, and his symptoms improved remarkably.

Perhaps my in-laws have been especially unlucky. But I also know Dave and Helen chose their doctors on the basis of convenience — in their case, location — rather than quality.

This is all too common. When I see new patients in clinic, they rarely tell me they came to our clinic because they heard about the quality of our health care.

As a practicing physician, I know that not all doctors provide the same quality of care, and patients trust the technical aspects of medical care are fairly standardized. But while standards exist, doctors don’t always follow them.

We should value quality when we shop for health care. Like my in-laws, we can be hurt by bad choices. But consumers approach health care differently from other consumer goods. Health care affects us personally. We feel uniquely vulnerable in a way that we don’t when deciding which refrigerator or washing machine to buy. Understanding and navigating health care is complicated and intimidating. It’s also hard as a consumer to feel passionate about the measures we use to track quality in medicine. What does it mean that a higher proportion of one doctor’s diabetic patients have hemoglobin A1c’s at goal than another doctor’s?

In the absence of easily accessible and interpretable information about quality, most patients make decisions about health care based on convenience, cost and the interpersonal aspects of care. All these considerations are important, but they aren’t surrogates for technical quality.

With most consumer goods, cost is a proxy for quality. A more expensive restaurant will generally have a higher Zagat score. A Lexus is a better car than a Kia. But health care is different. A higher sticker price doesn’t necessarily translate to higher quality.

We know if we’ve been kept waiting long for an appointment or if our doctor hasn’t called us back. We know if the receptionist was rude or the nurse was rough. A patient’s experience of health care matters. But a number of the websites where patients may provide doctor ratings can be misleading. They typically capture the opinions of a handful of vocal patients with extremely negative or positive things to say. They may also reflect the opinions of posters who aren’t even patients of that doctor. And some are just inaccurate (one site listed me as an otolaryngologist — I’m not one — at a hospital where I don’t practice).

Medicare will eventually report on physician and hospital quality measures, but what you’ll find online now is limited and unlikely to be any more helpful to the average consumer than the agency’s release of billing data. There have also been local efforts in some parts of the country to collect and digest information on health care quality for consumer consumption, as in Minnesota, Wisconsin, Maine, Massachusetts, Washington, Oregon, New Mexico, Pennsylvania, Detroit, Cincinnati, Cleveland, Memphis, and Humbolt County, California. The most frequent users of these quality reports have been physicians looking to improve their scores, and there has been a positive impact in some places. Blood sugar control among diabetic patients in Detroit improved by 14% between the initial report (in 2006) and 2011. The proportion of seniors vaccinated against pneumonia in Cleveland increased from a quarter to almost three-quarters in a year.

A few states have gone a step further and partnered with Consumer Reports, the ratings guru, to make information on health care quality more accessible to patients in Minnesota, Wisconsin and Massachusetts. These and several other regions are working with Consumer Reports to release more physician report cards starting in 2015.

Employers also recognize the value of high quality care, which saves them money in health care costs. In Maine, for example, the State Employee Health Commission and Jackson Laboratory cut employees’ co-pays and deductibles if they visit highly-rated physicians and hospitals.

ADVERTISEMENT

Unfortunately, many of us don’t live in parts of the country where good information on health care quality is available. That puts a greater burden on us to learn about and request quality care. Consider reviewing one of these checklists with your doctor at your next appointment: general prevention, heart disease or diabetes.

When you move or change health insurance, be especially careful in choosing your primary care provider and the health system in which the PCP works. The more your doctor values quality, the more likely your doctor is to work with high-quality colleagues. At a minimum, your doctor should be board-certified and in good standing. Ask others who work in health care who they’d recommend. Interview your doctor. Ask doctors how they keep up to date with the latest in medicine: through pharmaceutical company representatives, journals or conferences?

We’ve noticed big changes since my father-in-law Dave started seeing a better neurologist and taking the appropriate Parkinson’s medication. He doesn’t clutch his arms to quiet tremors like he used to. He doesn’t sleep all afternoon, sedated by his old medications. Dave’s back to doing some of the cooking, something he’s always enjoyed. He smiles. It’s good to have him back.

Celine Gounder is a physician and medical journalist.  She can be reached at her self-titled site, CelineGounder.com. All views expressed in this article are hers and should not be attributed to any of her employers.

Prev

We need more clinical time outs

June 21, 2014 Kevin 6
…
Next

Living with my son's schizophrenia: From fear to hope

June 21, 2014 Kevin 1
…

Tagged as: Primary Care

Post navigation

< Previous Post
We need more clinical time outs
Next Post >
Living with my son's schizophrenia: From fear to hope

ADVERTISEMENT

More by Celine Gounder, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Achieving the holy grail of wait-free medical care

    Celine Gounder, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How doctors can change the way they work and care for patients

    Celine Gounder, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care needs more physician CEOs

    Alexi Nazem, MD
  • The health care system will cause its own physician shortage

    Advait Suvarnakar and Aashka Suvarnakar
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • 3 ways physician-pharma partnerships are improving quality of care

    Jack Pinney, MD

More in Physician

  • Why health care can’t survive on no-fail missions alone

    Wendy Schofer, MD
  • The unspoken contract between doctors and patients explained

    Matthew G. Checketts, DO
  • The truth in medicine: Why connection matters most

    Ryan Nadelson, MD
  • New student loan caps could shut low-income students out of medicine

    Tom Phan, MD
  • Why “the best physicians” risk burnout and isolation

    Scott Abramson, MD
  • Why real medicine is more than quick labels

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • What street medicine taught me about healing

      Alina Kang | Education
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Why health care can’t survive on no-fail missions alone

      Wendy Schofer, MD | Physician
    • An addiction physician’s warning about America’s next public health crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gen Z’s DIY approach to health care

      Amanda Heidemann, MD | Education
    • What street medicine taught me about healing

      Alina Kang | Education
    • Smart asset protection strategies every doctor needs

      Paul Morton, CFP | Finance
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • What street medicine taught me about healing

      Alina Kang | Education
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Why health care can’t survive on no-fail missions alone

      Wendy Schofer, MD | Physician
    • An addiction physician’s warning about America’s next public health crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gen Z’s DIY approach to health care

      Amanda Heidemann, MD | Education
    • What street medicine taught me about healing

      Alina Kang | Education
    • Smart asset protection strategies every doctor needs

      Paul Morton, CFP | Finance
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We should value quality when we shop for health care
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...