What's wrong with magazine "Best Doctor" lists.

Health and medicine explained.
June 13 2006 5:27 AM

A Few Good Doctors

Don't look for them on a magazine top-10 list.

NY Magazine's Best Doctors issue

About this time every year, doctors across New York City begin to cast a wary eye at local newsstands. When the bundle of New York magazine's "Best Doctors" issue drops onto the pavement, torture commences for the city's prim and laconic physician class. (Other cities get their chance at other times of year.) It's high school all over again, a life lived at the mercy of cruel arbiters of who is up and who is down. To their credit, I suppose, the compilers of the Best Doctors list define worthiness with more objectivity: They poll local doctors and ask whom they would refer a family member to. With this quasi-statistical information in hand, they go behind closed doors and construct the dreaded list.

To my expert eye, every year the New York survey gets it about half right: Half of the selections are first-rate doctors, no doubt about it. Another 25 percent are people whom I don't know well (though I have my doubts), and 25 percent are certifiable duds—doctors who (hopefully) haven't seen a patient in years but have risen to the lofty realm of high society and semi-celebrityhood.

Of course, the list isn't really about accuracy or quality. It's about sales—not only of doctors' services but also of fancy plaques, directories, and pen-and-pencil sets fitted into paper weights.

Full and fully immodest disclosure: I usually am on New York's list (at least until this column runs). I therefore receive the deluge of offers from the cottage industry that traffics in professional vanity. American Registry offers to create a personalized mahogany plaque for $159 (plus $9 shipping and handling) that displays the magazine cover with my name and specialty etched below. But wait, there's more! If for some reason I want eight additional plaques (for every room in my house?), they'll drop the price to $119 each. Plus, they are eager to serve: Last year they sent out their shakedown letter well before doctors were notified they had made the list. SLD Industries, Inc., bids for my attention with a return address that bears the boring company name, State License Documentation, in a grim font on a no-nonsense envelope. It works—afraid I am about to have my license revoked, I open the letter. Inside I find offers for the Statesman Series in handsome green marble ($189) and the Prestige Series in thick jade-green glass atop a marble base ($199). Castle Connolly, which handles the survey for New York, is too classy to traffic in plaques. Instead, for 75 bucks they offer a directory of Top Doctors: Metro Area in a leatherette cover with gold-foil lettering.

What's so bad about this sort of thing? After all, Who's Who and its progeny operate a similar scam. I would argue, though, that by adopting the guidebook approach, Best Doctors (or Best Lawyers or Best Dentists) fails the public by making a false promise. The real problem at hand—how do you find a reliable professional whose services you very much need—can't be solved as readily as picking a restaurant or health club. You can't run a Zagat-style survey and get worthwhile results. Nor can you pay people to crash the car and then rate the product. The Best Doctors approach—asking other doctors to name the colleagues they trust enough to send a family member to—sounds like it ought to work. But it doesn't.

To begin with, the list is heavily influenced by backslapping, back-stabbing, and old-fashioned old-boyism. Powerful medical departments are too generously represented while oddball offices or people are gone with the wind. Even if that weren't the case, however, the list would be mostly useless.

How do I know? Friends and family are always asking me for the name of a good doctor. I think long and hard. I consider their ages, sexes, the doctor's experience and office location and background, the doctor's and the putative patient's outside interests, the ages of their respective children and the careers of their respective spouses, their hair color, office color, office furniture. I think of everything I can think of.

And still, almost every time, my friends and relatives rue my choice. The endeavor is like setting up a blind date. It should work, right? You know the guy a long time, your wife knows the woman a long time; everybody likes everybody. But then comes the date and splat!—a disaster—plus the original friendships become frayed with silent accusation: You thought I would like her?

The doctor-patient relationship is just that, a relationship, full of all the nonsense and idiosyncrasy that defines the genre. It's why good doctoring has a magic quality, like a good friendship. The intricacy of this symbiosis also is why a "best doctor" can't be determined by asking a bunch of professors whom they might send their brother-in-law to.

Which is not to say the search for a solid doctor is hopeless—just that the guidebook approach has made the task more complicated than it needs to be. Below is my simple one-two-three approach. It's even in glossy-magazine format.

1) Trust your instincts: There are lots of rotten doctors, really really lousy ones, wretched souls you wouldn't want to know as people, much less trust with your health. But they aren't any harder to suss out than the schmucks you meet in everyday life. If your gut says run, then run.

2) Don't trust your instincts if a scalpel is involved: Subjective impression is meaningless when selecting a surgeon. Craft should trump your desire to like them; in fact, it's OK to hate your surgeon. You simply need him to cut and sew very intelligently. So always select the surgeon who has already done the most iterations of whatever procedure you need. Stated in Zagat-ian terms: Which restaurant do you want to go to—the one with the line or the one that sits empty?

3) Shop around: Diagnosticians, sensitive (and craftless) souls that we are, succeed only if we connect. A doctor who is beloved by one person can be a disaster for the next. Think of who ended up marrying whom—there simply is no accounting for taste. So look before you buy. Yes, it takes time, it takes money, it is humiliating and ridiculous and maybe just a sinister plot to give doctors more business. Do it anyway, and do it when you are well.

Magazine "best" lists are a good read for choosing things that don't much matter, like fitness clubs and pizza and a summer vacation spot. But when it comes to the basics—health, education, and welfare—no one but a best-list maniac would seek counsel from the printed page. And for the maniacs, well, we can only hope that someone out there is polishing up a survey on the 10 best ways to cure a best-list addiction.

Kent Sepkowitz is a physician in New York City who writes about medicine.