How to tell the difference between a good and bad doctor

Unlike other professions, it's hard for the average person to assess if they have a good or bad doctor. For most people, unless you have had a lot of experiences with different doctors, you just assume that all doctors are a certain level of good (because they are doctors?!) but unfortunately, this is just not the case. It’s harder to judge the quality of doctors as an outsider because you can’t objectively judge the output, whereas with other professions you can (even if you are not trained in that profession). 

Take for example gardening. You don’t need to be an expert to assess whether a gardener did a good job or not, the output is clear to everyone - do you like your garden or not? Does it meet your standards or not? You can not do the same with healthcare because the output (your health) can be independent of the quality of care given. You can have a great doctor but a terrible outcome simply because your disease is hard or acting unusual. What you can assess, however, is the quality of care given to you, even if you aren’t a doctor. 

This is a short and sweet list of ways to assess the quality of your doctor based on my experience with doctors (I have had a lot of experiences with doctors, across multiple specialties, including ward and ICU doctors). I find these parameters to be true across all specialties, including nurses.

1. A good doctor knows your history and has read your notes before your meeting. In theory, every doctor should be doing this, but many doctors don’t. If a doctor does not know your prior history then they will not ask you the right questions which means they will not get the right information out of you and therefore you may receive the wrong treatment. A bad doctor will just take a quick look at your notes or test results and start prescribing medication based on previous handover notes or hospital protocol. A good doctor will repeat your medical history to you, confirm the symptoms you have experienced, confirm the diagnostic tests done, confirm the medication that has been prescribed, confirm the outcome of said medication, and confirm the current dosage you are on before getting into any new details or questions. This lets both you and the doctor know that your diagnosis is indeed correct and you are indeed on the right path with the right protocols and the right medication in place. 

How to check if your doctor has read your history:  I suggest asking the doctor to first let you know what they know, after which you can fill in the blanks. If they are only reciting the medication you are meant to be on then you have a bad doctor. A good doctor will go through the entire flow (symptom, test, results, medication, outcome, dosage). If they find information missing in the notes they will ask you to fill in the blanks to make sure you are on the correct path and will also update the notes for the next time. If you find yourself in the “bad doctor” situation ask for information confirming your symptoms, tests, results etc until they are going through the logic of the decision-making and seeing if the plan of action today makes sense.

2. A good doctor takes detailed, honest notes. Similar to point one, just as a good doctor reads notes, a good doctor takes notes. A good doctor notes down all that was discussed in your meeting, including any revisions of previous discussions, and uncertainties about timelines. A bad doctor only notes that you have been seen, restates your diagnosis, and writes down the medical plan of action. The latter is pretty bad because it makes it very hard to 1) confirm that the right things are being treated and 2) harder to spot and correct any misdiagnoses or mistakes that may have occurred along the way. 

How to check if your doctor has taken good notes: Ask to see or hear the notes taken today. If you feel scared asking this question because it comes off as entitled or rude, you can add the caveat of you “wanting to stay on top of your appointments to make it easier for your next visit and/or other interactions with doctors”. Doctors like it when patients do some of their work, so they shouldn’t feel offended. If they recite bad notes to you (including missing important information), then correct them. Sounds obvious but needs to be said.

3. A good doctor checks the dosage of your medication regularly. If you are being prescribed medication regularly it is unlikely that you will be on the same dosage forever. A bad doctor will continue to prescribe the same dosage of medicine without first checking if you are responding well (even if you say you are fine). A good doctor will take the relevant measurements and then confirm if the same dosage is appropriate. A good example of this is blood pressure medication. Let’s imagine you run out of your usual blood pressure meds and you have just come in for a check-up and top-up of your meds. A good doctor will first ask you what your blood pressure has been like since your last check-up, check your notes to get a sense of the general trend, take your blood pressure then and there, and then decide if the current dosage is still suitable. A bad doctor will ask you what your usual dosage is and simply prescribe, or in truly terrible cases, check your blood pressure, dismiss abnormal readings as an “off day” and prescribe your usual dosage. If you find yourself in the latter situation do not be afraid to ask your doctor what your last few readings were and if this is within normal range. At this point, most doctors will feel a bit scared to say “No it’s not normal and the trend is also not normal, but I will keep doing the same thing anyway”

How to check if your doctor is on top of your dosage: Ask for the relevant measurement for your medication, ask if it is within normal range, and then ask what the trend has been like for the last however weeks or months. If it has been on a downward trend ask why that is. If they try to slam you with jargon or say it’s fine, ask them what happens if it continues to go on a downward trend. At that point, they will make some plan of action to cover their asses.

4. A good doctor makes you feel heard. This one is harder to describe. As the non-medical person in the room, you most likely will ramble on about irrelevant details to your case, but your doctor should never make you feel like you are rambling about irrelevant details. That is the sign of a bad doctor. If you find your doctor cutting you off and only responding to very specific things about your case (e.g. you have come to the kidney doctor about your kidney, but also complain about your heart and they completely ignore the latter) then you have a bad doctor. Sometimes the two things truly are unrelated, but even so, it should be documented in your notes and the necessary referral should be made to the right doctor. Other times these random rambles can provide a breakthrough to your case (this is what happened to me).  As a “patient” it's best to share everything (because you do not know what is relevant or not). A good doctor hears everything, acknowledges everything, and has a plan of action for everything. A bad doctor hears only what they want to hear and discards the rest. 

How to check if your doctor is listening: Before your appointment make a list of all the things you want to address. At the end of the meeting go through each item on your list to ensure everything has been addressed and has a plan of action. If something hasn’t been addressed bring it up again but one at a time. That way the doctor has no choice but to address each one.