
Ask HN: How do you find good doctors? - pdevr
There are many ways to find out whether a programmer is good or bad. Even if someone is hyped by peers, once you work with him or her for a week, you will know whether he&#x2F;she is good or bad.<p>In medical field, this is difficult to do.<p>You usually don&#x27;t get the chance to work closely with them - and moreover, most people don&#x27;t have the expertise to evaluate themselves.<p>The doctors who are &quot;acclaimed&quot; and have written papers may not be great at diagnosis as well as providing the best solution.<p>How do you go about identifying great doctors? What are your thoughts on this?
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ericb
A family member needed a surgery that had a 60% complication rate, so this was
a topic I researched. We flew across the country to the doctor I found, who
invented the technique, publishes on it, was improving on it, and performed
more of this repair than anyone I interviewed. He said "I don't get those
complications" and he was right.

Here are my takeaways for finding the right person:

\- Surgical success is highly correlated to number of that exact procedure the
surgeon performs. The most important question is therefore how many of this
procedure a surgeon does a year. The more narrow the specialization, the
better. Ask this, and compare.

\- It is worth travelling for complex procedures where possible. Find your
person and make it work.

\- Doctors often list their specialties and areas of interest on their
website. Pick one who is specializing in what you need, and for whom it is an
area of interest.

\- Age-wise, it seems like surgeons with 10+ years of experience are best, but
ones nearing retirement age may be out of their prime. I think there's science
backing up declines in vision and maybe fine motor skills.

\- Searching pubmed is a great way to find out who is publishing on an area as
well as the complication rate and outcomes for what is being proposed.
[https://www.ncbi.nlm.nih.gov/pubmed/](https://www.ncbi.nlm.nih.gov/pubmed/)

\- Specialists trump generalists.

\- Bedside manner does not correlate with outcome particularly well, so "seems
nice" is the wrong way to choose a doctor.

\- Larger and more prestigious hospitals tend to attract better talent, so the
most convenient option (closest) is often the worse choice.

~~~
pdevr
Thanks for the first point - pointed out by marckemil and you.

Agree with almost everything which you said. Regarding the last point, I guess
the exception would be those small "niche hospitals" which are not that well
known, but perform the same type of procedures month after month, year after
year.

------
Powerofmene
I think there are a number of ways to identify good doctors. First and
foremost you have to define what is a good doctor, i.e., one who does minimal
tests or one who does a lot of tests to determine a diagnosis when needed;
availability for same day appointments or has a flexible appt schedule so you
can get in when needed; someone who keeps staff so that you become known to
them and that you know them; good "bed side manner; spends a few minutes with
you and has you on your way or one who will sit and talk with you as long as
you need him/her to do that; one that values patient time and does not keeping
you waiting for prolonged periods of time regularly; someone who still does
rounds at the hospital; someone who listens to you and does not discount what
you are trying to tell them; etc to name a few. Once you know what a good
doctor looks like to you, then:

1\. Talk to friends, colleagues, etc to identify their doctors and what they
like/dislike in their doctor.

2\. Check with the state licensing board to see if they have disciplinary
actions, etc against them

3\. Check for feedback on the doctor online

4\. Schedule an appointment to meet the doctor. If they are not what you are
looking for when yo u meet them, keep looking.

Finding a doctor that is everything you want and deserve has become harder and
harder. But you certainly can't find one if you do not know what it is that
makes a good doctor good to you.

~~~
pdevr
Those are good criteria for filtering out the obvious negatives and using all
of them together helps in weeding out some of the false positives of each
criterion. Thanks.

------
uberduber
I've had to learn this the hard way as I've gotten ill.

Finding a PCP is different from finding a specialist. For a PCP I'm looking
for someone I can have a relationship with, reasonable access/availability,
and the ability to make appropriate referrals and coordinate specialists. If
you have a lot of complex problems, this is pretty much impossible to find
inside insurance. I have found some good, caring doctors in insurance but I
either can't get timely access or they can only give you so much time so I
have to go to a direct pay or concierge provider. Some doctors will meet with
you for 10-15 minutes for free or sometimes a nominal fee if you explain
you're not looking for an exam, just interviewing PCPs. Your PCP is the one
who will end up doing most of the referrals.

As for the specialists, medicine has become so super specialized. Let's say
you get diagnosed with some rare cancer. If you start searching the medical
journals and read, you will find the same names over and over again. You can
call or e-mail the doctor, explain your situation and see if they'll do phone
consults or talk to your PCP.

~~~
pdevr
I always relied on my insurance - the concept of concierge provider is new to
me - thanks for that idea!

------
alex-
Having moved to the US from a country that had a universal health care system,
the idea of choosing a doctor was quite strange to me.

Luckily I have not really had a need, however my colleges have suggested that
when the time comes looking to high profile clients is a good indicator of
quality. i.e. if you have a knee issue goto the people that your local NFL/NBA
team use for knee issues.

The idea is that they, and their team, have done more extensive research than
an individual can. Of corse this assume that these Doctors are affordable.

To further complicate this suggestion I have heard that some sports people are
willing to sacrifice longer term results (once their careers are over) for
short term results (at the height of their careers) and so choose physicians
accordingly.

------
marckemil
As an academic physician myself, I've been thinking about this for some time.
There are many parts to this answer.

First, what makes a _good_ physician? It's not all about being able to
diagnose diseases, because let's face it, 95% of our practice is essentially
"bread and butter". What you may think is difficult is what we do all day. A
good physician is a good medical expert, but also a good communicator,
collaborator, leader, health advocate, scholar and is professional (see
CanMEDS framework). All this combined is a "good" physician.

Now, as others have pointed, seeing a subspecialist is better in some cases.
Again, most issues can be dealt with by an "average" physician without
problem.

For surgeons, there's a link between how frequent a procedure is performed and
outcomes. If you need something "special", see a surgeon that does that
procedure often. It doesn't guarantee a good outcome (one can do a crappy job
often!) but there's a correlation.

For the complication risk, this can be a double edge sword. Highly skilled
surgeons are often referred complicated cases at high risk of complication, so
their numbers aren't good. The others get the "easy" cases so their numbers
look better...

From my experience as a trainee, research "status" ie number of publications,
talks, books chapters... don't correlate well with quality of care. They can
be good at writing grants and papers, but when it comes to getting things done
in the clinic, it's a different story.

As for physician review site - Yelp; well, that will give you mostly
information of the physician's communication skills, which is a big part of
our job, but probably not what you have in mind when trying to find "the
best".

I'm a radiation oncologist specializing mostly in lung cancer and brain
radiosurgery. Even _I_ have a hard time judging the quality of the _radiation
therapy_ treatments decisions and parameters of my own colleagues (treating
other sites). I can't imagine trying to find a "best" physician for a specific
problem without my network and my background.

Thinking about it, I would follow your PCP's advice; who he-she knows,
classmates... We know who the "good & smart guys" are. As I said above, it
doesn't guarantee quality care, but it's a good start. If it's a really
important problem, seeking a second opinion is usually the way to go. I would
go to a tertiary care centre (university hospital) with a good reputation.

~~~
pdevr
Your first hand experience is evident in your answers.

Following PCP's advice (even indirect recommendations) is good - it makes
sense - of course, as long as the PCP himself/herself is a good doctor :-)

The difference between rating a doctor for communication skills and rating for
actual "performance" is what makes sites like Yelp not-so-useful for this
task. Agree.

>Even I have a hard time judging the quality of the radiation therapy
treatments decisions and parameters of my own colleagues

Probably. But your judgment (expert/peer review) will most of the time be far
superior to the layman's judgment.

------
jhwhite
I think some people leave ratings and feedback on Yelp. Some people use
healthgrades.com.

I use to work in the marketing department for a major academic health system
and we found most people chose their doctor based on having a picture on their
bio page on the hospital website AND smiling in the picture. <\-- Not even
joking.

------
jrowley
I'd start with a good hospital. And how you defines good is going to be
personal. For me, I'd lean towards larger teaching hospitals in larger cities
because I think teaching hospitals generally have good values that resonate
with me.

~~~
mikeleeorg
For me, I agree as well. Some might balk at the idea that you may get a
resident treating you, but with a supervising attending, you're pretty well
covered.

Also, good teaching hospitals can attract some great medical teachers with
lots of experience. And while being a great teacher doesn't necessarily make
you a great doctor (or vice versa), the caliber of these people will likely
attract motivated students.

------
amorphid
If in the USA, checkout out [http://www.amino.com](http://www.amino.com). They
solve this exact problem.

------
googletazer
Its more important to avoid to 20% of bad doctors then get the 20% of good
ones. Anyone from the middle slice is ok as long as you respond to treatment.

~~~
pdevr
Thanks. How do you go about identifying the bottom 20%?

~~~
ben_jones
Do they prescribe pain killers, anti-depressants, or similar drugs with huge
potentially life-changing side affects after only a short appointment? Do
second and third opinions from other physicians frequently go against the
advice of your first doctor?

~~~
sushid
Your suggestion might make sense if you have all the time in the world, but
say you're going in for some small skin problem. Are you really going to test
diagnosis #1 with two other doctors before you even begin your treatment?

------
usgroup
From a far or from direct personal contact ?

~~~
pdevr
From afar, when you do not know them personally and have not interacted with
them.

~~~
usgroup
Doctor network. Start with doctors you know and use them to find or to screen
doctors you don't. As others have said, you're screwed for anything non
specialist where you can get good rate of success data for similar procedures.

If you're fishing for a product idea, I'd suggest it'd be useful even if you
could relate doctors on pubmed to their specialities and practices or simply
crawl all the hospital websites for their staff. Just knowing what options you
have is half the battle. The other half is picking between them.

------
mrlyc
[https://www.ratemds.com/](https://www.ratemds.com/)

------
PhrosTT
ZocDoc?

------
drakonka
This has been a huge problem for me with veterinary doctors. Sorry if this
turns a bit long, it was quite an experience in incompetency and confusion.

Unfortunately we did not look for a good veterinarian until we had an actual
emergency. I am making this same mistake with my own health right now - I do
not have a regular doctor. It seems difficult to do so - vets don't expect to
be personally screened, especially when the patient is completely healthy and
doesn't actually need their attention yet! We looked up well reviewed clinics
and such, but did no research into the individuals themselves.

When a well reviewed clinic messed up a routine surgery on my kitten and sent
him into a month of hospital stays and more surgeries, it was all too rushed
and panicked to find a good vet. When you are rushing your pet to the hospital
emergency room twice a day or leaving him there for days to weeks at a time,
you don't get to pick the vet; it is whoever is on-call at the time. Aside
from that, I am sure the vets you get are generally competent at their jobs,
_but_ they have piles of journals and history from previous days to catch up
to and you have to keep rehashing the details with each one. Not to mention
the fact that they are on-call to deal with multiple emergencies and can't
really give one patient their undivided attention.

It is a long story, but he ended up staying at a teaching hospital several
hours away because nobody at our local hospital seemed to be able to figure
out what was going on, and we had been told that it was meant to be among the
best in the country. They did all they could, and did help, but in the end
even they gave up on him and sent him home to be put to sleep. It's a miracle
he's still here with us.

"Funnily" enough after he was home we found out there was a highly regarded
internal medicine specialist at this local hospital 5km away - we were told
that he's seen all the specialists. We searched for specialists online before
and never saw her name. We coincidentally got an appointment with her after
the main part of this incident was over and our cat was back home but very
touch and go (a receptionist said "We have a free slot with our internal
medicine specialist, she's a little more expensive, but she's great!", like it
was nothing - like we hadn't just spent a month looking for specialists who
could help him). The specialist said she wished she saw him sooner - she'd
have made some different choices. We now see her every 6 months for checkups.
It really highlighted the communication breakdown that can happen in a rushed
emergency situation like this, if she'd just seen him sooner maybe he would've
have had to go through as much as he did.

I wish there was a better way to find veterinary doctors, but aside from doing
as much research as possible (about the doctor _and_ the condition in
question) and trial-and-error in terms of which vet you get I still don't know
of the best way. The only thing I know is now that we've found a good one,
having gone through so many questionable choices made by other professionals
in that month, I'm afraid to see anyone else. I have even less idea with human
doctors and don't know if any of this is transferable to human experiences.

~~~
ben_jones
I wonder what would be the best way to deduce where these doctors and
veterinarians go to when they have an emergency. What podiatrist,
omptomologist, <insert specialty here>, do they themselves go to?

~~~
drakonka
I have wondered this too. This question made me think about voluntary public
disclosure on the parts of doctors. Of course we are unlikely to ever see
doctors disclosing _their_ chosen doctors, but this made me remember something
we can possibly use to screen human medical professionals:

Dr Leana Wen started an initiative where other doctors can volunteer to
publicly disclose any sponsorships they may hold from pharmaceutical
companies, called Who's My Doctor. It may be worth favoring doctors who have
signed this pledge and disclose their sponsorships in our search for "good"
doctors: [http://www.whosmydoctor.com/](http://www.whosmydoctor.com/)

Both the human and animal medical profession seems rife with sponsorships that
influence treatment. In the case of the veterinary field this is mostly a case
of large pet food companies sponsoring veterinarians and veterinary schools,
so vets tend to be highly biased towards recommending these diets since this
is all they're taught. In the case of human doctors this seems to be drug
companies. Personally, I believe disclosure of any sponsorships that may
influence a medical professional's recommendations to their patients should be
required by law.

