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

Characteristics of exceptionally good Doctors-A survey of public adults

Background

Systematic reviews have found that doctors can have a substantial effect on patients' physical health, beyond what can be explained by known factors. In a previous qualitative study, 13 medical doctors were interviewed on their experiences of exceptionally good doctors, and all had met at least one such doctor.

Objective

To determine how common it is for exceptionally good doctors to be encountered by patients and what are the characteristics of exceptionally good doctors.

Design

Mixed methods cross-sectional survey of 580 Amazon Mechanical Turk participants. Questions included doctor and participant demographics, and 34 Likert questions on characteristics of exceptionally good and average doctors. Free-text questions allowed participants to describe exceptional doctors, record their experience, and provide survey feedback. Stratified sampling ensured gender parity and 33% of participants aged ≥55 years. Analysis included descriptive statistics, statistical modelling of associations between Likert scale scores and patient demographics, and factor analysis.

Results

Of 580 responses, 505 (86%) were included in the analysis. Factor analysis confirmed internal validity. Most respondents (86%) had met at least two exceptionally good doctors, of whom 55% were specialists. 58% of respondents regarded doctors as exceptional based on an overall impression with multiple reasons. Doctors were most commonly considered exceptional based on one or more of their personality, diagnostic, or intervention ability. Respondents who reported the doctors "willingly listened to them to the end" scored their doctors higher on 33 of 34 Likert questions, except for popularity. They also rated average doctors lower throughout.

Conclusions

Exceptionally good doctors appear to be commonly encountered by the adult public. Listening to patients willingly to the end is a highly rated and influential characteristic, suggesting that listening could be targeted for quality improvement.

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

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.

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