What sites are your doctor checking out?Health writers often suggest Web sites and strategies for finding the best doctor. But what do doctors think about all this advice?
In today’s “Doctor and Patient” column, Dr. Pauline W. Chen talks to other doctors about the best way to find a doctor you trust, and the best places to research health information.
Many of the doctors I spoke to or exchanged e-mail with made commonsense suggestions that were not unexpected. They urged patients to find out which doctors their closest friends really like, to ask a prospective doctor questions like how much experience he or she has with a specific condition or operation, and to make sure that as a patient you feel part of a shared decision-making process and comfortable saying how you feel, or that you don’t understand or that you respectfully disagree.
But many of the physicians also shared links to valuable Web sites, several of which I was unfamiliar with. All the sites are free to the public and accessible to anyone with an Internet connection. When I looked at these sites while writing this column, I became really excited as a patient about the amount of information available.
For a complete lists of the various Web sites suggested by doctors, click here to read Dr. Chen’s full column, “In Search of a Good Doctor.” And then join the discussion below.
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There are some great new social and professional networking sites for doctors like Sermo, radRounds Radiology Network, Medical Plexus, and Labmeeting (for those more research inclined). Doctors can share cases and discuss clinical issues.
— Steve Chan MDA great column, Dr. Chen, by far and away your best.
If you don’t avail yourselves of this information, then don’t whine about not finding good doctors or good medical information.
Is it a lot of work? You bet, but the days of paternalistic medicine where you go into any local doctor’s office and all the information and resources you need are spoon fed to you are LONG, LONG OVER.
— jackthis is my subject I have been searching for a Doctor who can help me with my disability, I had nerve surgery on both feet at the same time in 2005, then 10 mnths later I had tripple nerve release and revision of tarsal tunnel and 10 weeks later same on other leg, I have complete nerve damage from all the surgeries, I am not diabetic nor do I have neuropathy, my surgeon faxed my medical records to a Dr at the Dellon Ins, whom is the professor of the Georgetown Univ who trained my surgeon, his response was I can not help her, I went to almost every hospital in Boston and one of the Director of Neurology said you are so chopped up now I can not help you, I have been put in the catagory of RSD/CRPS I had the nerve stimulator, blocks nothing has helped, my PCP has tried and called so many Doctors and there are no open doors, I am the first person and only person who had bilateral nerve surgery and this alone was the beginning of a huge mistake, then on the 2nd and 3rd surgery I had no tests, not even an xray on my knees before he even cut me at my knees why? I can not answer this or how I allowed this to happen, why did he asume I had nerve damage from my knees to my feet, why not do an xray on my knees, I had the xrey and mri after all the surgerys I have arthritis and wear and tear, I never had an EMG before these surgerys now I can not find a Doctor, I do not care how far I have to travel, I am not giving up, this pain is so undescrible, there has to be a way that I can be treated for this, taking 600mg morphine and six other meds is not the answer, I ask why did this happen to me, my only answer is God knows I would not give up and I keep fighting, doing blogs all over trying to find help, I have written to movie stars, nobody responds, how sad is this world, if I was a famous movie star, do you think I would be looking here for help no, because I would of had an interview on tv three years ago and I most likely would be on my way to recovery, but see I am just another person in the USA that has been so damaged by the hands of another, mistakes are made but please don’t ignore it find the right care, drugs are not the answer, Kindly, Janice Power (Boston, Mass)
— janice powerIn my search for a good doctor I try to go to the top teaching hospitals. I have for the most part had good luck with that approach. There is also an intuitive feel one gets about a doctor from the first appointment. You can usually tell if they are going to be a good fit for you. That in conjunction with their education, experience and demeanor help me to determine if they are the doctor for me. Also office staff means a lot. An efficient, friendly and professional office staff usually correlates to a good doctor. I see the front office as a reflection of the doctor, if he cares enough to hire the right people, that says something.
— edHow about PubMed? Instead of looking at unregulated websites, maybe it would be a good idea to read peer-reviewed, scientific literature!
From Pauline Chen: I use and recommend Pub Med frequently — it’s one of the best resources on the Web — but I think it can also sometimes be difficult to sift through all the articles without some clinical or scientific background.
— Local DocWith more of the cost of health care shifting to patients as a result of high deductible consumer directed health plan designs, this type of information is sorely needed. Most doctors are far too busy these days to set aside time to go through formal interviews with prospective patients.
For me personally, I first look for the proper education and experience based on what’s available online. Affiliation with high quality medical groups and top flight academic medical centers tells me that they’re more likely to be aware of and practicing state of the art medicine, even as it may be emerging via published research evidence.
Ideally the doctor has had direct personal experience with the medical condition(s) to be treated, either themselves or a family member, so that they know first-hand where I as a patient are coming from and understand what I need from them as a provider.
— Health Plan Veteranhttp://www.uptodate.com is my favorite website. Unfortunately, it is not free, but all of the institutions I have been affiliated with have provided a subscription.
— SarahAnother incomplete column by Dr. Chen… if only because it leaves out the number one online reference used by most doctors…
uptodate.com
Far and away the most used site by active medical professionals… this would also be a great site for patients looking for the most current and thorough information regarding their condition. In terms of ease of use, it is much more practical than the sites proposed by Dr. Chen, although it does require either institutional access or a subscription fee.
— DaveI’m confused. Where’s the actual information on how to find a doctor? A billion more websites don’t actually get me closer to finding a person with a medical degree who I can trust.
The article assumes I have a specific condition for which I need a specialist and tells me to talk to my primary care doctor. What if I need to start at the beginning? What steps would one go through to find a primary care doctor after moving to a new city?
Getting a list of the thousands who accept my insurance and then looking up every single name separately on AMA? Really? And then do this again for an Ob/Gyn, and again for a chiropractor, and again for … not likely for most people!
— FRAs a physician I know that there is no substitute for the direct experience with another physician, particularly when working with him or her in a difficult situation. The same can be said about nurses and other members of any team of people working in health care. Nurses probably have their own opinions about us physicians that are equally accurate. I recently moved to a city where I didn’t know anyone in a specialty that was taking care of a close family member. We called the hospital floor of that specialty service and asked the nurses who they can recommend. We were given several names and did some background checking on-line, then made appointments with two doctors in different hospitals, finally selected one of them after the first visit and were not disappointed. Unfortunately, nursing care was not at the same level after a procedure. So here is what I would recommend: select the best possible hospital with the most experience with your problem. Make sure nursing care is at a high level (example: Magnet hospital), find out from individuals working with physicians in the specialty you are looking for to give you a few names and find a way to select one of the names. Finding a good physician is not easy, so Good Luck!
— tutlecI work at a prestigious teaching hospital: you get the very best and the very worst all in one place. If your excellent physician is busy with another patient, you might receive care from his very intelligent student who has never been sick in his life and is on his first week as a resident. Scary.
However, this is not my main thought. What I primarily thought was missing from this article was a discussion on why there is so little feedback about individual doctors. When I call my local primary care location, they ask me to pick a doctor. I don’t know of anyone else that goes to that practice, so who do I ask? The nurses don’t want to give you a straight answer about an individual doctor’s skill because they might step on the doctors’ toes. I’ve received care ranging from excellent to truly horrible at the same location. My good primary care doctors keep leaving the practice after a couple of years, and then I start the search over. I think that doctors need an evaluation method during their years of practice that patients can access. You don’t have to buy an unevaluated house, send your children to an unranked school, or buy a car without driving it. I can only have one physical exam per year, so why should I not be able to see an unbiased report on the skill of the physician beforehand? Doctors are currently very protected by the system that they have set up. This system needs to be opened up to scrutiny.
— PamelaDear Jack (2):
I am feeling just grumpy enough today–as I try to figure something out for my measurably brilliant mother (IQ off the charts), whose neurologist treats her like a child and doesn’t really help her with her Parkinson’s Disease–to tell you just how callous your attitude comes across.
So we’re all a bunch of lazy asses, who expect to be SPOON FED? We actually want medical professionals to be the professionals, and help us? It’s too much to expect special consideration, for someone whose mental functioning has been compromised by the very meds the GD doctor prescribed, because he didn’t really interview her, and she can’t really find the words to describe her condition, because he gave her too much license to take too many units?
So I’ve got to get on a plane to run interference, hope he gets down off his mighty throne long enough to hear from me that she can’t figure out which is left and which is right…that during certain times of day, she’s not sure which direction is the bathroom and which direction is the kitchen?
Uggh. I”d like to scream. Because SHE TRIES. And I try. And lots of people do.
BUT YOU ACCUSE US ALL OF WANTING TO BE SPOON FED.
Hope you never have to take a dose of your own medicine.
— WesleyA helpful site for patient feedback about doctors is:
http://www.ratemds.com/social/
Not all doctors are listed, but many are.
— RMGI second F.R.’s comment in that most of the information that’s out there doesn’t actually help you find a health professional in your area with the appropriate practice to fit your needs as an individual. Most of the resources cited are made for other purposes.
We at http://www.HealthShoppr.com are building that functionality for people who need specific types of expertise and need pricing information (we’ve recently gone live with massage therapists, with Los Angeles being our first area of focus).
For insured services (dentists, primary care) where insurance is a primary buying factor, you may want to look at ZocDoc.com as a place for looking up a doctor or a dentist.
Current directories treat all licensed physicians as commodities with addresses and phone numbers. What’s really important is finding a practice that works the way you want…focus/expertise on your issues, approaches care in a way that works with your life, and available when you need them and at a price that fits in your budget.
— Vijay Goel, M.D.I must respectfully disagree with a number of websites that Dr. Chen recommends. Sadly, a number of the websites are funded by the pharmaceutical companies so one must carefully scrutinize the information.
I think the best website is pubmed.org because it is a database established by the NIH that is a clearinghouse for most clinical trials. While much of the research is done by Ph.Ds, many trials include clinical physicians as well. One must also be careful in evaluating those trials as well because of the heavily funded trials by pharmaceutical companies.
Once one familiarizes themselves with the research, certain names appear again and again. Those are the physicians that I would consider using.
Likewise, since my husband has heart disease, I love theheart.org. I am facinated by the debates of the cardiologists following the release of important data.
I discount all websites that are geared towards lay people. I want my information unfiltered so I can make an informed decision about which physician I think knows their stuff. That requires a tremendous amount of work on my part. Since my husband also has a very rare “orphan” illness, I have had to become vigilant in seeking out the best medical care for him.
— voracious readerI am an MD and have a couple comments.
1. Regarding doctors being a “fellow” of certain medical societies: many societies have simple requirements to become a “fellow” such as board certification, certain skills/experience, and you apply and become a fellow. This is not universal. In some societies, fellowship is a political/academic game. The American College of Radiology is an example. There are two main fellowship tracks for the ACR– either through an academic career or heavy involvement in the local state chapter or national organization. It has nothing to do with medical skill or ability. There are many of us who are dedicated specialists with no political ambition, just a dedication to patients, who are members of the ACR but not fellows.
2. Finding the right doctor for you can be extremely difficult. The right doctor for you might not be the right fit for someone else. Reading someone else’s online review of a doctor won’t neccessarily mean that you will agree with that person. Even the most well-liked people don’t hit it off with some others and those are more likely to head to the internet to blast someone they didn’t like. I have spent years looking for the right internist for myself, and only recently found someone whom I trust (at least I think so far I do anyway).
The best advice I can give is to ask everyone you know well (and whose opinion you value) whether they have a doctor that they like, and then ask why. Narrow down the list to 2 or 3 and make a first appointment, see whether you like the doc, the office staff, etc. If it is not a good match, move on and don’t stick with the wrong person out of inertia. If you know any doctors, ask who they see themselves, and why. If you are new to a city and don’t know anyone, I would start with your neighbors or work colleagues. This is a long process. We try to form a long-term relationship with our doctor, and it does take some time to find the right person.
Kate
— KateDear Wesley (12),
How sad to hear of another experience where a doctor can’t communicate effectively with an older person with a serious illness. It underscores the need in this country for improved training of all doctors and a renewed focus on encouraging bright young MDs to pursue specialties such as geriatrics and family medicine.
Finding a good doctor IS difficult, but it amazes me that so many of my friends will expend energy to choose a new hair stylist, but will passively accept the default referral of the physician on their new HMO card.
— MD, CAI really like the mayo clinic website for finding information about treatment/management for diseases/illnesses/conditions. They tend to cover the whole range of what type of specialist could help, what types of medicines, and simple things that you can do for yourself to help. It’s clear, detailed without being overwhelming, and in plain english.
— JenAs a registered nurse for 36 yrs & a Family Nurse Practitioner for 10 yrs, I would strongly recommend asking RNs who work in the same field as the specialty area one is seeking. Nurses are aware of the physicians & surgeons who have lower mortality & morbidity rates(complication & death rates), know which doctors respond immediately & appropriately to a nurse’s call for a patient’s worsening sign or symptom, and know the doctors who actually care about their patients.
— Merry J Menden FNP-BCPhysicians often refer &/or recommend to their own level of competence or within a group for monetary gain, whereas nurses do not. Nurses have had to “clean up” after certain doctors’ incompetances, but also breathe a sigh of relief when working with excellent physicians & surgeons. Nurses will refer usually to doctors & hospitals that they would consider for their family members. Please note that nurses, like doctors, are not created equal. You need to ask an excellent nurse.
For cancer patients looking for doctor, a good starting point is the National Cancer Institute’s list of designated cancer centers:
— ReduceBreastCancerRisk.comhttp://cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html
I agree with Sarah and Dave–www.uptodate.com is the #1 favorite site for many physicians. I call it the “cliff notes of medicine”. Much better than Pubmed because it gives the latest info on what the disease is & how best to treat it., not just an abstract of an article.
It’s also written by the top experts in each field–and of course it’s always up-to-date.
It’s very very expensive and not available from home except through a personal subscription.
I also like http://www.medscape.com You do have to register for it, but it’s free. Lots of great information.
http://www.happyhealthylonglife.com
— The Healthy LibrarianToo bad Dr. Chen did not mention the Osteopathic physician. There are 60,000 + D.O.’s in the US, most of who are board certified in a primary care field, i.e. family medicine,pediatrics,OB-GYN etc.and have admitting privileges at the ‘most important’ hospitals A great resource has been ignored.
— tkDear MD/CA (17):
Kind of you to express your sympathy.
It’s not easy for some patients to override the limitations they perceive in their choices of doctors (In this case, her all-important neurologist, in a small Southern city), and it’s especially difficult for her to find the energy to improve the situation. My frustration comes from the challenge of helping her from a distance. I can only go periodically, and observe her round-the-clock condition, to try to help. It’s pretty obvious that her meds are somehow out of balance, but she can’t describe symptoms in precise ways. She’d rather seem articulate at those twice yearly visits, than to fumble for words. And the neurologist is all too happy to arbitrarily adjust her meds, and get rid of her.
I actually try to avoid reading Well blogs, when the subject attracts lots of doctors’ comments, because the divide between doctors and patients becomes all too painfully obvious. A few righteous souls show up, but a lot of a-holes also come to the party.
But this time, I happened to get some valuable information (especially from commenters) at just the moment I went online to get some facts about the meds. So, it wasn’t all bad, and I got a shot of adrenaline, to boot.
I really sympathize with the hardships associated with practicing medicine, but I never can reconcile the attitude that patients are a bunch of whiners, who must become experts about their conditions–whether they can reasonably do so or not.
It’s a recurring theme.
— WesleyA doctor is only as good as his or her support staff, from nurses, medical assistants, as well as the receptionist. There are a few exceptions, but from personal experience with my family’s medical visits, it’s more common than not that medical support staff don’t have proper phone skills, don’t ever make eye contact during the visits and can oftentimes be outright rude. It reminds me of the of the old DMV (which has now improved their customer service).
It may be understandable that everyone’s overworked, underpaid, or demoralized with our healthcare system, but there’s no excuse to behave this way when another human being, whether sick or healthy, is involved. Even incompetent billing by an outsourced billing company can ruin the doctor-patient relationship.
Doctors should look at the some of the great hotels for mentoring—from the first phone call to the checkout, every point of human contact is impeccable. Another example is that of a great restaurant: No matter how good the chef, one rude server can ruin a great meal.
The same goes for a doctor’s visit. The entire visit should be viewed as a health-promoting sequence. It’s a team effort. One weak link can ruin the experience.
Unfortunately, this problem is pervasive within all aspects of medical offices from prestigious private practices to major academic medical centers.
Yes, your doctor is the one that’s making all the medical decisions, but just like a great quarterback, can his team win without everyone on the team giving 100%?
— surgeonI’m a former medical librarian and now a full-time faculty member in a library school teaching courses in health information systems and consumer health. I am also the parent of a child with an incurable chronic illness and have worn both the worried-parent hat and the medical librarian hat all too often in the past year.
I share Pauline Chen’s concerns about PubMed and the kind of literature it offers (post #5) — it is a bibliographic database of citations to the clinical and research literature, and that literature is not appropriate for every consumer. However, to say as ‘Healthy Librarian’ does in post #21 that UpToDate is “always up-to-date” is simply not correct. The uptodatedness of UpToDate very much depends on the content area you’re looking in and it cannot be considered an evidence-based review of the literature.
In addition, while PubMed Medline is a database of citations, most with abstracts but not all, articles cited in that database can be obtained through your local public library via interlibrary loan. Or visit MedlinePlus, one of the sites listed in Ms. Chen’s feature, and identify a library near you that can help with consumer health information by visiting this link:
http://www.nlm.nih.gov/medlineplus/libraries.html
Consumers should not consider PubMed a “closed book”.
— Catherine S