How to distinguish a good doctor from a mediocre one
This is a surprisingly difficult question because there is no working system to do this.
The percentage of successful operations performed by a surgeon speaks either of his professionalism or of the fact that he refuses difficult patients (this, by the way, is a serious problem: many doctors with a “golden” resume and equally golden hands do not take on risky cases when there is, for example, a 30% chance of death, but with any other surgeon it would be significantly higher).
Ratings and reviews speak either about the quality of the doctor or about how marketers inflate them.
Patient reviews themselves speak to how well the doctor can present the treatment, that is, essentially, pull the wool over the eyes. Or you can call it soft skills.
But if you need to choose a doctor from among strangers, there are several basic principles that can help you figure out how in demand he is.
Schedule
Any doctor can be booked for six months in advance by changing the price of services. But if the prices are fixed and there is no hint of “free slots” in the schedule, then the doctor is great.
Firstly, this is an appointment for two or three weeks in advance with rare “windows”. More usually means that the doctor is underpaid, he is not in his category (or is plugging some gap in the personnel schedule). Less – problems with the flow. Patients come to the clinic either from the street or to a specific doctor on the recommendation of friends. In the upper segments, the second flow is larger, that is, the doctor's workload is formed approximately half from the recommendations of his patients.
The second part of the flow is recommendations from colleagues. The best indicator of a doctor's level in practice is how often colleagues send their patients to him. This can be found out directly if you are being treated at a clinic (it is enough to ask another doctor who you should contact on your issue), or indirectly calculated from the schedule. A tight schedule without a tail for three months is most often formed from these two sources.
Reviews
Practically uninformative. You'll be lucky if marketers are given reviews from real patients and they repost them to aggregators. But in any case, there will be no negativity in reviews that are controlled by a doctor or clinic.
Ratings are also easily managed by selecting only simple patients.
The reviews themselves are as informative as reviews of restaurants. For example: “Thank you, the portions are big, I give five stars!” – this is exactly the level of evaluation that a patient is able to give to a doctor. The thing is that a person cannot evaluate what happened during the intervention at all: he evaluates only how the doctor speaks and what impression he makes, but not the treatment itself.
A “heroically saved” patient after a medical error may think that the doctor is just a genius! A patient with a complex case, where a lot of painstaking work had to be done and a long appointment was required, may think that the doctor does not know how to work normally. What's more, surgeons who pull out eighth teeth (“molars”) for 500 rubles in one movement are considered very professional. True, without preliminary CBCT there is a chance of paralyzing the face if the facial nerve is close, but these are rare complications. “Well, my friend, this is a living organism! This happens, no one is immune, bad luck.” That's “bad luck” fully controlled via a preliminary snapshot.
In general, the patient does not have the qualifications to evaluate the quality of medical intervention – only impressions of the doctor as a pleasant person.
Moreover, in surgery, a normal review can only be written after five years – you should know this from dental implantation, from reviews of vision correction and other things that are rich in situations “the operation was quick, I liked it”, but not real results in the perspective of several years. We have a guarantee for complex surgery – five years: this is the period during which complications can appear. Patients do not wait that long before writing a review.
What to look at then?
The best option is to come and ask the doctor himself if you are choosing him for serious treatment. But before you go, it is worth trivially sorting out the candidates in the same way as if you were conducting interviews.
So, first, look at the resume. Usually, the clinic's website or some aggregator has a professional biography of the specialist. You are interested in the experience: the doctor should not be a newly hatched intern. Next, you should look at how often the doctor changed his specialization. If he has one narrow one throughout his entire career, that's good. If he supplemented the specializations, expanding his profile, that's also good. But if he “jumped” from one sub-profession to another, then the experience should be calculated by the latter.
Doctors with 20 years or more of experience run the risk of “souring”, that is, treating according to the precepts of communism without paying attention to what has changed during this time. Therefore, be sure to look at training: there should be fresh retraining. In general, a professional doctor of the upper segment studies constantly, and this should be visible in the “resume”. Diplomas should not hang around the office, but a fresh course of advanced training or training in some aspect should be in the profile. It is also good when he teaches himself or conducts scientific work, but this is already extra!
Google the specialist and see how many clinics he works in. Usually, if it's two or three, then it's a strange sign. The exception is surgeons: they very often work in commercial clinics to earn money and somewhere in the emergency room or in a mass compulsory medical insurance hospital – for frequent and complex practice. If your top-class plastic surgeon “sewed up” homeless people in a shelter for five years, 15 people per shift, then, believe me, with a high probability his manual skills will be much better than if he spent the same five years on advanced training courses. This is a very common way to develop skills and expand specialization.
Look at the length of the working day: a self-respecting doctor (I'm talking about dentistry now) in Russia works between six and eight hours, usually closer to six. Any longer is exhausting, and this affects the quality of treatment for the next patient.
Before interviewing regional doctors, I also look at their knowledge of foreign languages: this shows how development-oriented they are. But this information is not always indicated in clinic profiles.
After that, you will be able to select several doctors to visit. There are many issues to discuss at the appointment.
During the reception
First, discuss the treatment plan. We usually use complex cases as examples, so there will be something to discuss. The doctor usually talks about the plan in the spirit of sequential steps. Your task is to ask about the branches.
“What if it doesn't work out here and something goes wrong?” is a normal question. A professional doctor talks very calmly about possible mistakes, failures and complications. Firstly, he will be able to answer with a scenario almost immediately, what he will do if a problem arises. Secondly, he can probably tell (impersonally) about similar difficult cases from practice. He is not afraid of risks, he can assess them very soberly. A non-professional, in turn, will try to hide the risks: “Dear, everything will be fine!”, “This is a living organism, it is unpredictable” – equally bad answers. A professional usually knows the possible risks, can name them quite accurately for your case, can confidently say about the duration of each stage of treatment. At the same time, he will not promise you this duration: usually phrases sound like “In patients with the same profile it takes so much time, similar cases show such results.”
Overall, it gives a lot of clear answers, a lot of certainty, and very clearly tells you how you are likely to feel at each stage.
After discussing the treatment plan, you can ask about the portfolio or similar cases. Usually, the upper segment has it all formalized: the doctor can open and show data either for publications, or for presentations, or for cross-review within the clinic. In the middle segment, doctors do not think about this much, but they are still proud of good work and save some artifacts like anonymized CT images. And they can quickly and clearly show this directly on your profile.
If you are talking to a surgeon, ask how many such operations he has performed. For example, in implantation, there must be more than 1,000 confirmed cases to get into a clinic in our segment. Approximately similar orders are in many other interventions of average complexity. It is clear that you should not ask a neurosurgeon about this.
The next aspect is signing documents. Serious intervention usually means a lot of papers. A sane doctor will explain why each paper is needed and calmly name the cost. At the same time, he will explain why it is so, and if necessary, offer alternatives.
A good doctor also calmly refuses treatment if it is beyond the scope of his approach, for example, if a patient asks for low-quality consumables in order to reduce costs.
A good doctor never sends you to a related profession simply as a profession. That is, not “Go to an orthopedist,” but will name a specific one. If he can't, as a rule, it is worth thinking about changing the clinic.
If you come to a large clinical center, then also ask the receptionist who exactly he or she is being treated by. Not who they would recommend, but who they are being treated by. Usually it is difficult to lie to a patient face to face, and instead of a doctor “recommended for promotion,” they will name you a real specialist.
The last factor is the ratio of the doctor's qualification level and his communication skills. As I have already said, the flow of patients, rating, reviews and the overall impression of the treatment are the skills of presenting this treatment itself, not medical ones. A doctor with mediocre results, but charming, will be as successful commercially as a doctor with golden hands, but a disgusting manner of communication. So, if you see a doctor of an obviously “bastard” psychotype in a commercial clinic and they tolerate him there for a long time – then there is a high probability that he could have achieved this with incredibly good medical results. Because otherwise, the chances of maintaining such a position are small.
In fact, we select doctors for our clinics based on their medical skills. We have separate courses on communicating with patients, we develop soft skills, but I will never prioritize sales over medicine. It is easier to teach communication than to teach medical hard skills. By the way, this is one of the reasons why in general medicine patients are sometimes very surprised by the comments of a surgeon who forgot that the patient is under local anesthesia and not asleep in anesthesia. Some surgeons see people conscious and of sound mind only after their shift.
What else do I pay attention to?
If I have access to the doctor's statistics, I count repeat patient visits. As a rule, patients return to a generally good doctor (although charm plays a role here). After four years of experience, the flow should be about 50% of the schedule.
Total
So, you can go to three or four initial appointments and ask questions. If the doctor answers sensibly about the treatment plan, has a good forecast of possible scenarios, explains clearly, can show similar cases in the portfolio or at least tell about a recent such practice, and at the same time his indications are comparable with the forecasts of other doctors, then, probably, you are making a good choice. If his colleagues recommend him, the chances of a good choice are very high.
Of course, there are exceptions. A super-charming bungler can be incredibly commercially successful, while a silent master can suffer from under-utilization, because instead of “Good day!” he can say: “Patient, I see you're still alive.”
