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Show A PHYSICIAN TELLS: How to Rate Your Doctor's With professional evaluation still a long way off, here's a set of guidelines MOST OF the 25 million or patients who will be hospitalized in the U.S. in any given year have their health and welfare protected in ways largely invisible to them. - s L They simply take it for granted that these safeguards exist And exist they do; hospitals are under rigid supervision, both by the mediprofession itself and the hospital cal commissions. But what of the millions of other persons who are treated in that last outpost of total medical autonomy the doctor's private office? Here the individual practitioner sets his own standards; no one looks over his shoulder or evaluates his performance. This is the crux of a growing medical controversy what are your safeguards here? Predictably, the quality of medicine tends to vary enormously from one office to another. And the average patient has no way of judging what kind of medical care he is getting except by using the unreliable guide-pos- ts of his own instincts and knowledge, the doctor's reputation, and the effect on his health. Soon, howevor, things may be different. The Federal government, under Medicare and Medicaid, is payand ing the office-car- e bills for millions of people. Even private insurers are offering programs that will cover office care. All of them are beginning to express interest in what they are getting for their money. Forward-lookin- g medical men have come to an irrevocable conclusion on evaluation of office care : we'd better do it ourselves before they do it for us. But there are still problems. For one thing, many doctors say it is an impossible task. Medicine is an art, not an exact science. Many unmeasurables and imponderables go into a doctor's diagnosis and program of treatment that do not lend themselves to precise scientific measurements and, in particular, to comparison with other patients and other doctors. 4 Family Weekly, June 18, 1988 - There is some truth to this objection. It is certainly unrealistic to conclude that rules regulating hospital practice would also apply to office practice. It's a pretty simple matter, for example, to review an appendectomy done at a hospital and decide whether good judgment was exercised in deciding to take the appendix out Appendicitis displays relatively standard symptoms and physical findings. The tissue is examined by the pathologist and adjudged diseased or not, and the postoperative course is usually uncomplicated, lasting a week or less. A hospital record which differs from this theoretical standard case is immediately apparent upon professional examination. The average office case, on the other hand, is usually very different. It is far more likely to be psychosomatic ("nerves") in whole or in part with a bewildering variety of symptoms and sometimes physical findings which defy easy sorting out or evaluation. Furthermore, many of them are "incurable" in the strict sense of the word. The anxieties and tensions which bring many people to the office may go on for long periods of time despite the best efforts of the best doctors to cure them. Other doctors object to the notion of evaluating office medical care on the grounds that it constitutes an invasion of privacy. They insist that what goes on between the patient and the doctor is privileged and confidential. "These people bare their souls to us sometimes," said one veteran practitioner. "If they ever get the idea that some of the information they confide might get to somebody else, they'd tell us nothing and that would be very bad medicine for them, let me assure you." Yet hospital records, which often contain much confidential information, are carefully scrutinized without obvious damage to the physician-patierelationship. Then, too, some doctors feel that nt |