The Doctors’ Effect on Patients’ Physical Health Outcomes Beyond the Intervention: A Methodological Review

Abstract

Background Previous research suggests that when a treatment is delivered, patients’ outcomes may vary systematically by medical practitioner. Objective To conduct a methodological review of studies reporting on the effect of doctors on patients’ physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way. Methods The data source was 79 included studies and randomized controlled trials from a systematic review of doctors’ effects on patients’ physical health. We qualitatively assessed the studies and summarized how the doctors’ effect was measured and reported. Results The doctors’ effects on patients’ physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects. Conclusion This methodological review identified inconsistencies in how the doctor’s effect on patients’ physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report.

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.…”

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

“…Many available RCTs and cohort studies could be reanalyzed to address and estimate the doctors’ effects. 81 When grading doctors by patients’ physical health outcomes, it is at times possible to identify positive and negative outliers whose confidence interval ranges wholly above or below the average performance. Therefore, it can matter greatly which doctor is chosen.…”