News
Where is the consumer's voice in "Top Doctors/Best Hospitals" rankings?
*Opinion By Harold DeMonaco
Massachusetts General Hospital*
Medpage Today
There are approximately 800,000 practicing physicians in the United States and not all of them can be the best. Finding the best doctor is a hit-or-miss process, and even when you think you have found one, you really have no idea if your impression is valid. US News and World Report recently released a searchable database of the “Top Doctors” in the United States. Presumably consumers now have the ability to find the best physicians to care for them or family members.
But is this more than simply a popularity contest and is care better when provided by the “top physicians”?
How are these lists put together and is there any evidence that care is in fact better? In his 2004 book, “The Wisdom of Crowds,” James Surowiecki suggested that the collective wisdom of groups results in decisions that are often better that those made by any single individual. He postulates that four criteria appear to be important: diversity of opinion, independence, decentralization and aggregation. Let’s examine the Top Doctors methods and see if they come close to Surowiecki’s requirements.
The Top Doctors list is based on nominations from physician peers either practicing locally or, more recently, anywhere in the US. Decentralization requires the nominator to have personal information about the nominee. A primary care physician who nominates a cardiologist to whom he has referred patients is likely to have some understanding of that individual’s capabilities and is likely to have sought out the opinion of others as well. The nomination process is presumably an independent one with a very small likelihood of concerted efforts to “stuff the ballot box.” And US News and World Report, along with Castle Connolly Medical, provide the aggregation of data. So, based on the opinion of the experts, the list should provide consumers with good information. But there is a big piece missing: diversity, or the voice of the consumer.
Why is it that medicine is one of the few domains where the views of the insiders are held in such high esteem as to almost completely ignore the voice of the consumer?
