The Tricky Business of Policing Ourselves I

This is a tricky blog for me to write. I want to make it clear that I'm not focusing on my own experiences or institutions, but instead, talking about a more general problem in medicine. How do we deal with physicians who are less competent or even grossly incompetent? Doctors hate it when outside authorities try to regulate us. We want to regulate ourselves. But it is mighty hard to do so.

It is a simple fact of life that some people are better than others. Some anesthesiologists are better than others. Some surgeons are better than others. Unlike auto shops or restaurants or dry cleaners, it's hard for consumers to know which physicians are best. I have witnessed surgeons whose technical skills are poor but whose bedside manners are great who are beloved by their patients. I have witnesed incredibly talented surgeons with little interpersonal charm who aren't liked by their patients. Do patients like the gastroenterologist that finds nothing on the colonoscopy or the one who is more skilled but finds the cancerous polyp? Being a doctor engages so many skills - bedside manner, physical examination, delivering bad news, procedural ability, decision making, knowledge base, and more - and only some of these are immediately apparent to a patient. That is why we like feedback from our patients, but we don't like public rating systems. It might be okay to choose a pediatrician online based on ratings of their touchy-feely nature, but in picking a cancer surgeon, I'd want the meticulously skilled one, even if he's a grouch. It's hard to pick the right physician; there is no clear criteria and no public forum where this information is available.

Furthermore, there are nuances in figuring out who is best at a particular thing. For example, it is easy to pick a world-renown neurologist, but if that person is the foremost expert in Parkinson's disease, consulting them for seizure management might not be the right thing. I've seen this time and time again where a patient picks a "famous" surgeon but for the wrong procedure. As I see more of the world of medicine, I learn that interpersonal connections between physicians is a really powerful factor. I can tell you which anesthesiologists I would want, which surgeons I'd pick, which consultants I'd see. And I'm happy to advise patients when they ask. I have no idea what's out there on Google, but I'd wager it'll have biases and misinformation.