A discussion arose around looking for a new doctor and what it meant for a doctor to be “Board-certified”. We called a friend who is an M.D. She explained that this was an exam administered by an organization of specialists. “A lot of the questions aren’t very relevant to practice and there are plenty of people who are good at taking tests who can pass the Boards without being good physicians.” What if someone didn’t pass the Boards? Could they still practice as a specialist? “Absolutely.”
How about looking at where a doctor trained? A doctor can’t graduate from residency without having achieved a certain level of proficiency at least certified by the hospital where he or she trained, right? At least a few of the doctors at the hospital have to agree to sign his or her diploma? “Wrong. Finishing residency means that you spent three years in residency. If it was a very competitive residency, it means that the doctor looked good when graduating from medical school and getting matched. But if he or she slacked off during residency, you have no way to know.”
I was beginning to get worried. In aviation you don’t get a pilot’s certificate based on having taken a minimum number of hours of lessons, though there are minimum hour requirements. You get a certificate when an independent FAA-designated examiner (or the FAA itself) flies with you and compares your skills to a published standard. Was there nothing like that in medicine? “There used to be for surgeons, but it was too hard to administer so they got rid of it.”
Just when I thought that it couldn’t get any worse, I reflected that hospitals were non-profit organizations. The typical non-profit is focused on its staff, avoiding employee lawsuits, and growing its cash hoard. There is little interest in the customer or the quality of services delivered. If a resident was doing a bad job, maybe there was no way to fire the guy. “Your fears are justified,” my doctor friend responded. “I trained with one guy who was spectacularly incompetent. He came close to killing a few patients. Everyone knew that he was incompetent. We were all dragged into a room by the head of the program who explained that this guy might sue if we continued to give him negative peer evaluations. Thus we were not allowed to say anything bad about him in the future. He finished his training.”
So… in a world where people who plug computers together get certified by Microsoft, it seems that there is some check on a doctor’s quality when he or she finishes medical school and virtually none after that. How could a patient find a good doctor then? “The only way is through personal recommendations from other physicians.”
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