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How Doctors and Patients Can Improve

We have described various ways you can improve your chances of getting the best possible care and results. These range from making sure your doctor has your full medical history to being sure you prepare well for exams and appointments. It is also critical that you get and apply a full understanding of what role you have to play in your care—including what signs and symptoms to look out for, what medications and exercises you need and when, what behaviors you should avoid, and when you should check back in with care providers. You need to ask questions of your providers, take careful notes, and if possible get one or more friends or family members to help you with your care. Resources like those we suggest in our article on Doing Your Own Medical Research can be helpful to you.

We also want to be as helpful as possible to doctors in improving their results. One way we hope to do that is by letting doctors see how their results compare to the results of other surgeons. This might highlight opportunities for improvement that a doctor might not be aware of. We try to be as transparent as possible about our methodologies so that each surgeon can decide how much stock to put in the differences we identify. That's one reason for our technical appendix.

In addition, we want to encourage doctors to tap as many resources as possible to help them target their own self-improvement efforts. There is much evidence that there is big variation in results among different providers and that these differences are often related to the quality of care provided. For example, looking at hospital readmissions after discharge in surgical cases, a recent article in the Journal JAMA Surgery (L. G. Glance, et al) stated:

"Hospital readmissions are widely believed to be an indicator of suboptimal care... Preventable hospital readmissions have many causes, including fragmented and poorly coordinated care, unsafe transitions between inpatient and outpatient settings, and medical errors. Specific interventions such as reducing nurses' workload, comprehensive discharge planning, and early physician follow-up have been found to be effective in lowering hospital readmission rates."

To the extent that outcomes are affected by the quality of care hospitals provide, it is important that doctors do all that they can to influence the quality of hospital care their patients are exposed to. One way to do that is for doctors to choose the best possible hospitals. Another way is for doctors to push their hospitals to improve. Doctors can have big leverage over hospitals where they choose to practice–and can choose not to practice. Doctors can encourage and demand improvements from hospital leadership. There are organizations like the Leapfrog Group that evaluate hospitals for patient safety and that can steer doctors to resources that the hospitals and doctors can use to improve hospital safety.