There are two items in the news this week that caught my attention. One talks about the use of over a billion dollars from the new Federal Government stimulus package to assess which widely used medical treatments are really best (NYT 2/16/09, "US to Study Effectiveness of Treatments"). The second announces how, Zagat, the prestigious service that rates high end restaurants is now rating doctors according to input from their patients (NYT 2/16/09, "Noted Rater of Restaurants Brings Its Touch to Medicine").

Ok, let's digest this for a minute. First about the evaluation of treatments: Obviously the drug and medical device manufacturers are a little worried since the FDA mostly challenges them to prove their treatments are safe and effective, but not usually to prove that their treatment is better or cheaper than something else. In tough economic times shouldn't we know? And they've been doing this for awhile in Europe anyway, although the head of GlaxoSmithKline, the big pharma company says he doesn't think the Europeans have figured out what to do with the information.

Let's look at this from the patient's perspective. Wouldn't you really like to know if it's better to treat severe neck pain with physical therapy, exercise, and medications rather than surgery? Or to find out the best combination of "talk therapy" and medications for depression?

Last year in the U.S. we spent $2.2 TRILLION on healthcare – 16 per cent of our gross domestic product! Shouldn't we ask tough questions about what works and where the money should be spent most effectively?

I welcome this effort.

Now about rating doctors. This is tricky since patients or family members may send in a rating most often when they complain. I remember how much I hated going to a New York City ear specialist because his waiting room was overflowing, you had to wait for more than an hour, and his office staff was surly. But was he a super medical practitioner? Yes! Would my ranting about the office visit have been unfair to his medical reputation? Sure.

So we have to wonder if patients rating doctors like diners rating restaurants is a good thing. The diner may have a great palate and know everything about fine wine, but not much about treating heart disease, especially if their love of French food and rich sauces got them clogged arteries in the first place! You get what I mean. Rating restaurants and rating doctors is not at all the same thing.

I think the care doctors provide should be evaluated, but by any and all patients may not be the best way. Zagat-rated restaurants - sure. Zagat-rated doctors – of little value?

Evaluation is great when it's done by people in the know. A scientific head-to-head study of treatments that cost us zillions makes sense, an unscientific rating of doctors does not.

I welcome you comments!

Wishing you and your family the best of health,

Andrew