Have I told you how much I love Amazon? Its the awesome! Let's say I need something - an external hard drive (because I do...for back ups, but thats another post). So I goto Amazon and I type in "external hard drives". Boom. I get a list of, not surprisingly, external hard drives. Which one do I chose? Fortunately, Amazon has some great data and filtering options. I want a desktop drive, not portable, so I filter those out. Next, I sort by popularity, which ones have sold the most. Among the top three sellers, I can then see which have the most user comments. From there I can drill into the comments to see what people have to say. Pretty soon, I know exactly which drive fits my price, features and quality expectations.
Why does Amazon's shopping experience work so well and where is the analogue in healthcare?
Amazon works because it plays into how consumers make choices. We are fickle things, us humans. Our behavior around choice is often described as fuzzy; we are both logical and emotional at the same time. Which hard drive's case looks cooler? Amazon's visual layout tackles that problem. Which one fits my practical needs of price and size? The filter settings help me narrow the list down. Finally, which is better? Which drive do other people like the best, and why? Which one sold more? Those are qualitative data points. We intrinsically value something which has sold more; usually for good reason. If two products are similar (price, features, etc), we go with the wisdom of the crowds.
How do people pick a surgeon?
If someone is going to cut you open, how do you pick who does it? There is no Amazon for surgeons. There is no national site where you can type in "ACL repair" and see a list of smiling faces in white lab coats. You cannot then filter by cost, or star rating or - as I'll suggest is most important - number of cases. This is a potentially life altering decision and yet according to the American College of Surgeons, most people spend less time making it than they do researching a vacation.
There are a few ways to look at statistic. Perhaps people aren't as invested in the decision as they are where to sip mahitahis. But I don't think that's the case. I think people do care who cuts on them. We just don't have any way to do the research. There is no Amazon for healthcare.
Right now, there is no way for consumers to comparatively shop for a doctor. So what do we do? We let another doctor tell us which surgeon to see. Hopefully its a good fit, and we like that surgeon. That's a little like buying a car based off what a mechanic suggests; not entirely a bad thing. But, where is that mechanic's vested interest? How do you know, based on recommendation alone, how reliable that car is?
A few weeks ago, Ed Lovern published a post on his great blog asking, "will consumers really use data about hospitals to make choices?" Ed questions if people really use CMS' HospitalCompare site to view quality measures across different hospitals. I share his skepticism. I think the data is largely abstracted and of little value to consumers. When I shop on Amazon, I don't want to see which brand is most popular, I want to see which exact hard drive more people buy. We need to get to the procedure and doctor level.
In a 2003 speech, then IHI Director, Dr. Don Berwick called for a request for proposal (RFP) form hospitals who wished to preform his knee replacement. Dr. Berwick's first requirement was "Don't kill Don." He went on to add:"report your current frequency of injuries...Demonstrate your awareness and use of the 'Dartmouth Atlas and eliminate excessive care...show your measurement of functional outcomes and your total knee replacements..."
Its is that simple.
There needs to be a national database listing the number of cases, costs and complications. Adjust it by risk so very skilled surgeons who take on more complicated cases are no penalized. Publish it. Make it searchable, sortable and filterable. Let physicians upload videos about their philosophy of care so we can also factor in the important emotional aspect in decision making. Let patients leave comments about their experiences. Give us the tools to make the educated choices about our own care.
A start would be simple raw data on volumes. Each doctor should, on their website, publish the annual number of cases they do for each procedure the preform. Start there, so - knock on wood - should I ever need a total knee replacement (who are we kidding...not should, when), I can find the doctors who have done the most. Do you want someone who does 10 a year or someone who does 400 a year? Who gets more practice? From there we can begin to add data points like length of stay, total cost, complications, etc. We deserve this kind of data.