WASHINGTON  - Americans consider insurance and a good bedside manner in choosing a doctor, but will that doctor provide high-quality care? A new poll shows that people don't know how to determine that.

Being licensed and likable doesn't necessarily mean a doctor is up to date on best practices. But consumers aren't sure how to uncover much more. Just 22 percent of those questioned are confident they can find information to compare the quality of local doctors, according to the poll by The Associated Press-NORC Center for Public Affairs Research.

Today, 6 in 10 people say they trust doctor recommendations from friends or family, and nearly half value referrals from their regular physician. The poll found far fewer trust quality information from online patient reviews, health insurers, ratings web sites, the media, even the government.

"I usually go on references from somebody else, because it's hard to track them any other way," said Kenneth Murks, 58, of Lexington, Alabama. His mother suggested a bone and joint specialist after a car accident.

"I guess you can do some Internet searches now," he added, but questions the accuracy of online reviews.

The United States spends more on health care than most developed nations, yet Americans don't have better health to show for it.

A recent government report found we miss out on 30 percent of the care recommended to prevent or treat common conditions. At the same time, we undergo lots of unneeded medical testing and outmoded or inappropriate therapies.

Yet people rarely see a problem. In the poll, only 4 percent said they receive poor quality care.

About half believe better care is more expensive, even as the government, insurers and health specialists are pushing for new systems to improve quality while holding down costs.

It's hard to imagine buying a car without checking rankings, but checking out a doctor is much more difficult. Many specialists say standardized measures of health outcomes are key, though very little is available.

Doctors who listen are important, but "some of the nicest doctors are the least competent," cautioned Dr. Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice. Higher-quality care actually tends to be less expensive, by keeping people healthy and out of the hospital, and avoiding errors and the complications of unneeded care, he said.

It's getting a little easier to compare multi-physician offices, if not individual doctors. Online report cards in a few states have begun offering some information on quality outcomes from group practices.

By year's end, Medicare plans to have released quality measurements for more than 160 large group practices, with more information on smaller clinics set for 2015. Called Physician Compare, the online star ratings also will include patient feedback.

The goal is to spur better care as doctors check out the competition.

The arrival of large amounts of quality information "is a big deal. It's a huge shift in terms of transparency and driving quality improvement," Dr. Patrick Conway, Medicare's chief medical officer, told the AP.

In choosing a doctor, not surprisingly the top factor is insurance coverage, the poll found.

For the uninsured, it's cost.

Eight in 10 look for the doctor's experience with a specific procedure.

A nearly equal number say bedside manner - their impression after a face-to-face meeting and how much time is spent with a patient - is crucial. About three-quarters say a helpful office staff and how long it takes to get an appointment are important.

A majority, 62 percent, also factor how long they sat in the waiting room.

Asked the characteristics of a high-quality doctor, a good listener is by far the top answer. Others value the right diagnosis, a caring attitude, a good bedside manner and knowledge, in that order.

The AP-NORC Center survey was conducted with funding from the Robert Wood Johnson Foundation, which has financed projects to publicly report data on care quality.

It was conducted by telephone May 27 to June 18 among a random national sample of 1,002 adults.

Results for the full survey have a margin of sampling error of plus or minus 4.0 percentage points. It is larger for subgroups.

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