Ask HN: How do you find good doctors?

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.

From a far or from direct personal contact ?

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.

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.

ZocDoc?

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.

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.

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.

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/

- 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.

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.

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.

If in the USA, checkout out http://www.amino.com. They solve this exact problem.