Do patients place too much trust in their doctors? (Andersen Ross/Getty Images)Patients are more likely to spend time researching a job change or a new car than they devote to learning about their doctor.
In her latest “Doctor and Patient” column, Dr. Pauline W. Chen looks at a Web site where consumers rate their doctors, along with roofers, dog walkers and a number of other trades. The reviewers appeared to hold non-medical professionals and service providers to a high standard — sharing reviews and photos of past work, for instance. But she noticed that the doctors often were judged on issues such as attentiveness and demeanor, rather than training and experience.
“A healthy doctor-patient relationship does not simply entail good bedside manners and responsible office management on the part of the doctor,” Dr. Chen writes. “It also requires that patients come to the relationship educated about their doctors, their illnesses and their treatment.”
To read more about how blind trust in your doctor may ultimately undermine your care, read “Do Patients Trust Doctors Too Much?,” and then join in the discussion below.
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From 1 to 25 of 227 Comments
“…..the physician’s training, board certification, experience, membership in a respected professional society, safety records and hospital affiliations.”
These are hardly the measure of a good physician. The real measure is a physician who is communicative and competent enough to explain your workup, diagnosis and proposed treatment, and all their likely pitfalls, in a way that makes logical sense to the layman. And then, he/she has to have the competence and the persistence to deliver as promised…..not guaranteed outcomes, but possible outcomes he’s already covered….no surprises.
— jackI trust doctors who are attentive more than doctors that aren’t. Why would I trust someone whose mind appears to be someplace other than on my symptoms and complaints? While I also judge a doctor on training and being board certified, I would not choose a doctor just because s/he has ‘Harvard’ or ‘Yale’ on his/her diploma.
— KJGIt is also important to consider it is hard for a layperson to judge if a doctor is doing the ‘right’ tests. To a certain extent, every time you see a doctor, you are putting your life in his/her hands. I’m more likely to trust a doctor if they appear to be paying attention. I have to judge my doctors on what I can observe and research.
Pauline, do you know why? The patients are lay people who cannot evaluate the medical skills of a physician. And should not need to do so.
The whole basis of a society living above subsistence level is that tasks are divided between its membes. Nothing would suit me better than having a doctor who was truly my advocate, so that I could trust for her to take the initiative and tell me what to do without needing to think myself. Or rather, to think about more pleasant things and concentrate on what I am the expert and good at.
Unfortunately, it ain’t that way.
Truly, you would need to be a doctor yourself to manage with doctors. Hence you scramble for what little information you can find on the Internet. Which pissees me off royally.
You know, if I had wanted to study Medicine, I would have gone to medical school. From the top of my head, I can give you a list of half a million things that disgust me less.
— SusannaNo surprise here. People feel uncomfortable judging professionals like doctors on their credentials because they don’t understand the process through which credentials are conferred. They feel uncomfortable judging on experience because they aren’t familiar with the process through which doctors are trained. But anyone, even a complete idiot, can judge a professional on whether or not he/she looked the patient in the eye when talking or appeared to listen without interruption. It doesn’t matter if the doctor actually got it right and did the correct exam if the patient doesn’t feel comfortable. Comfort is a completely subjective and often unfair qualification, but for an animal in pain, even a human animal, it may be the only thing the patient can do to maintain some semblance of control.
— LynneIn medical school, we are regularly taught that patients value a good relationship more than competence and that “P=MD” (most medical schools are pass-fail these days, we still take tests and our ranked in our class, but no more A’s, B’s or C’s).
Oh, well. Pretty soon medicine will be taken over by “doctor nurses”, and I guess we’ll have these idiot reviewers to thank.
— brianInteresting column, Dr. Chen. I too find it a little puzzling that a roofer, who is contracted to provide a certain specified service at a reasonable price, is compared to a physician, especially in diagnostic medicine, whose task it is to discover something about the client that neither the client nor physician know at the outset, and then manage that condition (if any) responsibly. One would think that there is a difference in the intimate relationship between the consumer and provider here in medicine than in, say roofing. But perhaps not - I wonder if that is what the market is expecting of physicians now which was not there in the past? Basically saying to doctors that the new market paradigm entails that that being empathic and nice is more important than being skilled and experienced? Obviously it’s important as a physician to be both empathic and skilled, but while before the latter was the more important factor, perhaps what these rating sites are telling us is that we were wrong about this.
What concerns me about these sites is that if patients feel that doctors’ skills are interchangable (and they are not, believe me), then doctors will have incentive to APPEAR more reassuring and nice for the sake of garnering favorable ratings, perhaps at the expense of straight-up honesty, which at times is an essential part of the doctor-patient relationship. Let me give a concrete example: If I see a patient who is obese by a significant degree, and thus has high blood pressure and diabetes as a result of the obesity, it would make medical sense to advise the patient to lose weight, say by modifying diet and adding exercise. It would be preferable to simply prescribing medications for hypertension and cholesterol and diabetes. Sounds reasonable, no? But if that patient takes even my gentle counseling the wrong way, or had heard on the TV to “ask your doctor” for the latest hypertension med, and thinks I’m holding out and not treating them properly, then I risk that person logging onto Angies list and giving me a negative review, hurting my rating, even though medically I did the right thing by giving counseling on diet and exercise rather than jumping to a pill. So the patient leaves my office angry at me and goes to another doctor, who really doesn’t care much about the patient and is all to happy to get out the prescription pad and send them on their way, with counseling on diet and exercise not even discussed. The patient, script in hand, goes back on Angies list and gives that doctor a favorable review, even though he didn’t really treat them medically in a proper way. What’s interesting about this is that the second doctor is more attractive to potential patients scouring Angies list, who then get trafficked to the second doctor who gives the patients whatever they want, whether or not it’s the best practice.
— GregBlind faith in ANY authority figure is scary. In my half-century on this planet, and including my witness to the experience of friends and relatives, I promise you that you need to ask questions. It isn’t necessarily that the doctor is stupid or hostile or incompetent or impaired (although I’ve seen examples of all the above); he or she may simply be proceeding on assumptions that are incorrect.
My mother, who was a nurse during WW II, grew up and practised in the “M.Deity” days, and her reluctance to challenge doctors or press them for answers to her questions (or even ASK questions) has led to some hairy situations.
In re judging doctors on personal rather than competence/knowledge factors: I wish I remembered where I read this study, but someone did an analysis of malpractice claims and found that whether a doctor got sued depended less on the outcome of the case than whether the doctor seemed to care, listened to the patient, etc.
— ACWMany, this covers a lot of issues. First, just because one person got well, their wound healed sans MRSA, or they were as good as new does not mean the next person will be as fortunate. In the case of a roofer, if he left one job half undone, you pretty much know–forget him. Secondly, I think education is important. I check the medical board site in AZ to see where the doc went to school, when (age-though we can’t decide if old and experienced is better than young and closer to the classroom), and pending legal actions or scoldy letters and stuff. Yes, doctors vary in skill. I am blind in my right eye after 4 failed surgeries for detached retina–went to a second retina surgeon and he said, “I think your doctor’s partner is a better surgeon that your doctor.” Well, nifty. Too late for that. What I am saying is this is a crapshoot. At a cerain point if you have a real problem, you split the difference and surrender. But along the way, the demeanor, the behavior of the office staff (snippiness quotient) and other qualities that your fellow patients can determine and tell you might be of interest–a la this Angie’s thing. Of interest, but not necessarily the last word.
— StarPeople don’t research their doctors because most people have no choice of specialists anyway - they get a referral from their HMO, and they have to go to that specialist. Research would be pointless. Trust has nothing to do with it.
— ob/gynI admit that in the past I relied more on friend’s opinions than my own research to select my doctors. However, once I had my son, and started working in healthcare, my research skills increased exponentially.
One thing a future survey may want to take into consideration is that parents do spend much more time researching their children’s healthcare providers than their own. I don’t really worry about my own doctors, but if someone’s going to be looking at my child, they are put under the proverbial microscope. Surgeons are reviewed at double the magnification.
The bottom line? Research your doctors! It’s amazing the things that Google can turn up…
— LeonaI am surprised at Dr. Chen’s surprise. A “consumer” of health care is not purchasing a good or service in anything like the environment in which they choose a roofer or plumber. You go to a doctor generally when you are unwell. You don’t understand what the problem is, and your a least moderately worried about the outcome. You want care, not a service in the usual sense. So there you are, face to face with the most hyped profession in the modern world, facing someone who is trained to be analytical, and to hide their thought process behind an impenetrable vocabulary, and all knowing demeanor. How is that anything like hiring a plumber?
Dr. Chen’s colleagues response rather illustrates this: how dare consumers presume to be able to judge his skills? He lives in a world where he deserves absolute trust, because he is the master of the universe within his specialty - either he can cure you, or refer you to his brother physician who can, or it can’t be done.
Of course, in reality doctors don’t really know what they’re doing in many cases. Statistics show they do not follow known best practices, they mis-diagnose at an alarming rate, and they treat patients like machines to be serviced. I can think of no other area in life where the gap between perception and reality is so great.
Modern medicine (doctors, in other words) has saved my life a couple of times. I appreciate teh skill they have and can bring to bear on a problem. But I never felt cared for by a physician until a wonderful former classmate of mine became a local family practice physician. From the outset I said of her that, “I can’t tell whether she is particularly good at medicine - how would I know - but she does give care in the clinical setting.” She’s moved on, but her replacement as a primary care physician is a young PA who is equally good at clinical care giving. The only difference is that in her case I know and she knows she is not the god of human pathology and healing that physicians want to be treated as. She is a smart, caring professional who knows her boundaries, and when to pass judgment up to more skilled thinkers.
— Steve DemuthYes, a few people really get it and are really concerned about surgery or treatment specifics and what other physicians think of theirs (not a perfect barometer, but not a bad one). Fewer still investigate evidence of clinical effectiveness of the surgery or treatment in question (most can’t fathom that many recommended medical interventions have limited effectiveness).
Most people want to trust — and don’t want to investigate. Or (in rarer cases) they are terrified of any surgery or medication and refuse it if they can.
They’re flying blind and it’s unfortunate.
— AnneOne issue is that it’s hard to evaluate what different medical qualifications really mean. Find out if your surgeon is certified or has advanced training? Maybe, but I’ve seen incompetent doctors who have no problem getting certified or taking advanced training. It doesn’t really tell the patient if the doctor is competent or not, just whether they have certain paperwork. And it’s very hard for a patient to get that kind of information about a doctor anyway - I had surgery not long ago and I tried to do research about my doctor, but between the limits put on me by my insurance company, and the problem finding a doctor who was willing to give me an appointment on short notice, I really didn’t have a lot of choices.
Also, there’s more to health care than just clinical results. A roofer either does the job or not, but a doctor is part of your care over a long period of time. Surgery might be one exception - you only need a surgeon to be good at surgery. But if you’re getting treatment long term, your health will depend on much more than that. I’m getting cancer treatment, and my oncologist was a great surgeon. But my surgery was only one day. My quality of life has been affected far more by the quality of follow-up care, and how my doctor has treated me while I’m undergoing chemotherapy - and unfortunately, he’s not very good at that. Of course, I’m glad my surgery went well, but that doesn’t help when I’m suffering severe side effects and my doctor is indifferent and unhelpful. I wish I’d had the option of hearing what other patients thought first - maybe I would have picked the same doctor, but maybe not.
— KarenI had a major surgery last year and I thoroughly researched and my interviewed potential surgeons. The one I chose had outstanding credentials, but he also called me up on the phone only two days after I wrote him a letter; and he has promptly and warmly responded to emails I sent him in the months following my surgery.
— JaneenI agree that it’s a very important point that just because a doctor is attentive and gives you a good vibe doesn’t mean you should trust him or her to treat you, let alone cut you open.
But doctors would be wise to keep in mind that many people go to the doctor to feel better. Sometimes, kindness and attentiveness are just as effective as antibiotics at doing that.
It is essentially impossible for a layman to evaluate a doctor. The real questions one need answer is how good that MD is in difficult cases, and how often he gets something routine wrong. A doctor’s colleagues probably know (in any profession the insiders know a lot about each other). This information is not made public (except in cases of flagrant malpractice or newsworthy innovation), partly for fear of lawsuits, and partly because it includes general impressions in addtion to concrete evidence.
The best source of information is another doctor, ideally in the same specialty and town. They are unlikely to tell you all the details, but they can be asked to tell to whom they would send a member of their own families.
— Jonathan KatzWestern medicine has become a revolving door of very expensive tests, dangerous pharmaceuticals, complicated insurance forms, filthy hospitals and lackluster diagnosis. I find it impossible to trust the doctors if I can’t trust the system.
— haroldI’m now tempted to go research all my doctors, but I have no idea where to begin. Where would I find useful information about my doctors?
— MichelleWell, this is a good topic.
The glaring question for me is: where do patients find all this marvelous information, Dr. Chen?
Care to tell us where we can check quality variables “such as the physician’s training, board certification, experience, membership in a respected professional society, safety records and hospital affiliations”?
The fact is, that, even for highly educated patients (I’m a college professor in humanities - not medicine or science - and no med school at my univ), the obstacles to finding this hard data are immense. I wouldn’t know where to start. Can you tell us?
If I wanted to get a sense of a medical researchers’ achievements, expertise or credentials, I could do a basic bibliography search on PLOS or other databases for his/her publications. But publication record tells me nothing about clinical skills (and academic publication searches are inaccessible to patients without access to university library databases).
This leaves me (and other patients) with two sources of information: our first-hand experience; and second-hand, anecdotal evidence from friends, family and social aquaintances.
Even getting pre-visit information out of doctors and hospitals about prices is almost impossible (ever call a hospital and ask them what an ER visit would cost? try it some time).
The faint undertone of mockery towards patients in your article (oy, those dumb people, too stupid to research their doctors credentials…) is also not appreciated.
Please write your next column, Dr. Chen, about the sources available to patients for all this fine data. We would like to know.
— kimAs a dentist, I have learned empathetic listening is the single most important characteristic that is needed for a good relationship- business and personal. Patients don’t really care how spectacular their fillings are, they just want to be heard and have their wants met.
— glenIn response to Brian’s comment (#5):
— Carrie, RN & Nurse Practitioner studentThe “idiot reviewers” you mention are our patients. The reviewers on Angie’s list are the people who use these physicians (& other health care providers?). Also, us “doctor nurses” don’t want to take over medicine. We do want to contribute to an improved health care system that values quality communication between provider and patient. Advanced nursing education and work experience emphasize communication as well as diagnosis, treatment, etc. Dr. Chen’s article is just one more sign that our patients, as well as our instructors, believe this is valuable.
All of this is not too surprising. The doctor-patient relationship is now the doctor-insurance company-billing company-lawyer-PA-doctor ranking site-website reviews-consumer transaction. Since the “relationship” has been commoditized, there’s no more trust. Naturally, you’ll have to do your research (dig for dirt).
Another important point is that being “board-certified” states nothing about how competent of a surgeon you are. All you have to do is to pass a multiple choice, and sometimes an oral test. Most doctors pass. No one ever “watches” you to make sure you’re a technically competent surgeon. Yes, you’re observed during training, but once you’re admitted into a surgical program based on your test scores, in general, you finish no matter how technically inept you are.
What’s more critical than technical competence is good clinical judgment. A good surgeon has to have both. Unfortunately, I agree with post #9. People don’t have to do any research because they trust their insurance companies blindly to have competent doctors on their lists. It’s not about level of expertise, skill, bedside manner, or local reputation anymore. It’s about whether or not the doctor is in the insurance directory.
— SurgeonI like and trust my primary physician, who acts as a gateway to specialists for me, since my health insurance plan is an HMO. I’ve found that she and I have different tastes when it comes to these specialists, though. For herself, she prefers a no-nonsense doctor who cuts to the chase. I get anxious when I see a doctor, so I prefer someone who has good listening skills.
The hospital my doctor is affiliated with has a neat web page you can use to bring up a list of doctors. It lists where they went to school, whether they’re board-certified, their specialties, and their research/treatment interests. If it looks like I’m going to need to see a specialist, I bring in a list of names, and then my doctor and I figure out whom I should go see.
Board-certified doctors go through a more rigorous education and evaluation process. They’re worth seeking out. In my experience, that’s the only criteria on paper that really counts.
The doctor-rating services aren’t free. If you have colleagues or relatives you can ask for a recommendation, that might actually work better for you than seeing what anonymous raters think about a doctor.
You can also look up to see if a doctor has been disciplined by your state’s medical board. I would imagine most states will let you look that up online.
Like it or not, people evaluate doctors as though they are service providers. A doctor may know everything he could possibly know about a condition I have, but if he isn’t capable of listening to and answering my questions, he’s not a doctor I wish to see.
— HeronDo patients trust doctor’s too much - that depends - is it blind trust or is there a solid foundation on which consumers have built this trust?
Why don’t we, as healthcare consumers, take the time and effort to reserch the quality of the people that we entrust our care - and somtimes our lives in? There are a lot of great websites that organizations have developed who are focused on publicly reporting quality and outcome data to consumers to be able to make better healthcare decisions.
One of the reasons - Moral hazard - the notion that an individual who is insulated from risk may behave differently from the way they would behave if it were fully exposed to the risk. Insurance creates moral hazard. Those with employer based health insurance do not often feel the impact of their wages going towards their benefits - when they get medical care - it’s wither free or a somple $15 co-pay. However, as healthcare payment and provider systems are changing, people are feeling the impact of higher co-pays, higher deductibles or even lack of employer-based insurance.
This is the time to find ways to reach out to consumers to lead them to the information about their doctors and about the hospitals that they have a choice in using.
— JulietDr. Chen, I think your columns are fabulous and usually extremely insightful. As such, I’m surprised to see the lack of insight in this column. I don’t mean that as a personal criticism - I think what this column demonstrates is that even extremely insightful physicians like yourself don’t understand what it’s like to be a patient.
Yes, I agree that there is a widespread prejudice that all doctors are alike, but it’s not about their clinical skills. Ask any non-physician what it means when someone is characterized as “acting like a doctor”.
Yes, there is a TREMENDOUS knowledge gap between physicians and non-physician patients. Even the most communicative and empathetic physician can not bridge that gap during the course of a 15 minute consultation. Medical googling helps some, if you’re willing to put in the effort to translate the medical terminology and if you know enough biology to understand the translation. Even then, the best you can hope to do is to gain a vague understanding.
— MitchIf I ever need surgery, I’ll want to know how many times a surgeon has performed that procedure. That’s a key measurement for a surgeon.
I don’t trust my doctors implicitly, but I’ve run across many doctors who don’t care for it when I ask them to back up their advice, or ask to see someone else for a second opinion. I wonder how Dr. Chen handles that when it happens to her.
— Heron