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UI researcher: Best Doctor surveys not always way to find good physician

IOWA CITY, Iowa --What does it mean if your doctor is not among those listed as "Best Doctors"? Maybe nothing in terms of good care, says Dr. Arthur Hartz, University of Iowa professor of family medicine.

"There is no evidence that best doctor surveys identify good clinicians," he says.

Hartz notes that the results of most surveys are influenced by physician status that depends on the physician's position and ability as a lecturer, researcher or administrator.

"A good researcher and administrator does not necessarily make a good clinician," he says. "We found that the best measure of a good doctor is experience -- the number of patients a doctor treats."

Hartz and his colleagues, Drs. Jose Pulido and Evelyn Kuhn, published that finding in today's issue of the American Journal of Public Health.

The validity of most of the "best doctor" surveys have not been assessed by objective measures such as patient outcomes, Hartz says. In the first study to evaluate the "best doctor" surveys, Hartz and his colleagues rated doctors in terms of patient outcomes and compared them to those voted as "best doctors."

The researchers studied the patient outcomes of physicians who performed coronary artery bypass graft surgery in New York, Pennsylvania, and Wisconsin. The "failure rate" of each physician was measured in terms of the physician's mortality ratio, which is the actual number of deaths divided by the average number of deaths among patients with similar risk. The higher the ratio, the worse the performance.

They found that the mortality ratio was similar for physicians rated as "best" and for other physicians. Some physicians rated as "best" had high mortality ratios.

Much more important than rating as a best physician was the number of surgeries the physician performed. The mortality ratio was lowest for physicians who performed more than 400 bypass surgeries in a three-year period.

"Our results suggest that the number of patients treated may be a better indication of quality than is reputation among other physicians," Hartz says.

He believes that the results of these findings apply to physicians in other fields.

11/4/97