The Supreme Court’s pending decision in the King v. Burwell case will answer whether millions of people will keep their insurance subsidies, but it’s likely that no patient in America can answer the simple question, “Is my doctor good?”  Facing a major surgery, wouldn’t you want to know if you are most likely to get better in the care of this doctor or if you should go to a different one?  Even people inside healthcare can’t answer that question.  Right now, almost no doctor can answer the simple question, “Are you good?”

Exceptions exist.  Cardiac surgeons, some orthopedists and clinicians who treat people with cystic fibrosis often track and compare their patients’ outcomes.   But the lack of doctor data is particularly odd given easy availability of information about services. TravelAdvisor.com lists the best hotel in Myitkina, Burma and anyone with a smartphone can find the best barbeque joint within a mile.  But doctors?  Life-or-death healthcare?  That’s different.  

Angie’s List carries reviews of doctors.  “Orthopedics – foot and ankle” is lodged between “oriental rugs” and “painting.”  Other sites rank doctors with grades, star ratings and “best of“ lists.  But none can answer the simple but very specific question, “Is my doctor good at treating what is wrong with me right now?”

It’s a question worth asking.  In 2004, 100 percent of the patients who received heart transplants at the two leading American centers survived for at least a year.  All six of the patients at the worst center died within a year.  Needing a heart transplant, you’d want to know that you weren’t number seven.

Doctors should know if they are good at what they do.  Hanging on their walls, their diplomas evidence that they are long-educated and well-credentialed.  But training and results are different, even for “specialists.”  An orthopedic surgeon who does great knee replacements isn’t necessarily a good shoulder surgeon.  Doctors, like athletes, have limitations.  Michael Jordan’s basketball prowess was nowhere to be seen when he faced even minor-league baseball pitchers.   Making it to the pros in two sports is rare.  Likewise, a doctor will be better at some medical arts and worse at others.    

Results beyond life and death matter, too.   Functional outcomes – what patients are able to do as a result of their care – have lifelong consequences.  In Hamburg, Germany, patients who have prostate surgery at the Martini Clinic suffer post-surgical rates of impotence and incontinence one-fifth as often as patients whose surgery was at the average German hospital. Those impressive results reflect two decades of committed effort measuring the results of surgery and continually improving care based on what was learned.

It’s true that measurement will require new systems and impose new costs.  Knowing one’s skill level takes effort and expense.  But patients should be able to get outcome data for every condition a doctor treats, and they shouldn’t have to rely only on the Internet’s anecdotes.  Physicians and hospitals that already track this information do so efficiently, with data analysts and automated systems that keep the burden off of physicians.  They also risk-adjust it in sophisticated ways to ensure its fairness and accuracy.

Facts are friendly.  Outcome data allows consumers to find the best services and prompts underperformers to improve.  In the US, airlines change processes in response to their on-time arrival and lost baggage records.  Faced with evidence of subpar outcomes, some doctors may choose to seek additional training or to concentrate in other areas of medicine where their results are better.

Doctors have an ethical obligation to measure and report their results, but it’s an obligation honored mostly in the breach.  The leading physicians’ ethics manual describes the “special obligation for the physician to serve the patient’s interest” and to “forthrightly help patients make informed choices among all appropriate care options.”  (Italics added.)  A patient’s informed choice depends on knowing whether the doctor is good at treating the patient’s specific condition.  Beyond the patient, how can a doctor refer a patient to another physician or recommend treating a patient without knowing his or her own skill level as well as that of other physicians.

No physician can know the outcome every patient will achieve.  Yet every physician can track how well their patients do as a result of care and how their patients’ outcomes compare to those achieved by other doctors.  In more complex cases, teams of caregivers should track and report their outcomes together.  MD Anderson Cancer Center reports its teams’ outcomes in treating head and neck cancer, comparing them to others where there are national baselines and comparing against its own prior results when external comparators don’t exist.

Healthcare exists for patients.  They deserve to know what they can expect from their care.  U.S. doctors need to step up and answer the simple question, “Are you good?”

Wallace is a visiting professor at the Geisel School of Medicine at Dartmouth and a Public Voices Fellow.