Is There a Doctors’ Effect on Patients’ Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review

Abstract

Purpose Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients’ physical health after accounting for intervention and confounders such as patients’ and doctors’ data, hospital effects, nor how strong that doctors’ effect is. Knowledge of surgeons’ and psychotherapists’ effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge. Methods Eligibility Criteria : Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients’ outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors’ effects for known variables. Sources Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies. Risk of Bias Using Newcastle–Ottawa scale. Results Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors’ effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients’ outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable. Conclusion Doctors, on their own, can affect patients’ physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors’ effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen.

Characteristics of exceptionally good Doctors—A survey of public adults

“…Doctors with exceptional communication qualities, excellent diagnostic abilities, or outstanding treatment success were equally valued by the respondents and the respondents had no consensus on how many qualities are needed to be exceptional. For our previous systematic reviews, we operationally defined an exceptionally good doctor as one who has exceptionally good patient physical health outcomes [ [5] , [6] , [7] ]. Conversely, our survey respondents took a much broader view on their opinions and experiences of exceptionally good doctors.…”

“…To discern whether doctors' have varying ability in treating patients, the authors conducted a systematic review [ [5] , [6] , [7] ] screening over 10,000 studies and found that doctors have an effect on patients’ physical health, varying from the negligible to substantial, depending on the intervention and outcome measured. This effect persists after all known variables, such as doctor demographics and experience, hospital effects, patient demographics, and risk factors have been accounted for [ 8 , 9 ].…”

Qualitative Study of Medical Doctors on Their Experiences and Opinions of the Characteristics of Exceptionally Good Doctors

“…The authors of this study have previously systematically reviewed studies reporting doctors' effects on patients' physical health outcomes beyond those explained by known factors such as doctor experience. 33,47,48 Results showed there are doctors that have exceptional patient outcomes that are not explained by known factors, suggesting exceptional doctors exist. The aim of the present study is to qualitatively study the opinions of medical doctors on their experiences of exceptional doctors and what made these doctors exceptionally good.…”

Negyven év az orvoslásban.

“…A publikált vizsgálatok -a Physicians' Health Study [3][4][5] és a Physician Work Life Study [6] -külön elemezték a teljes, a cardiovascularis, a daganatos mortalitást, az életmódot és a táplálkozási szokásokat. Eredményeik nem feltétlenül szakmaspecifikusak, hiszen az orvosoknak a foglalkozásukkal kapcsolatos egészségügyi kockázata az átlagos népességgel összehasonlítva eltérő lehet [7,8].…”