"Patients, not doctors or insurance companies, are the true customers in the health care system," says Vicki Rackner, M.D., a surgeon and expert in the doctor-patient relationship. "New tools will make it easier for patients to be more effective and informed health care consumers."

Many consumers make choices about what books to read or restaurants to frequent or movies to see, based on word-of-mouth or reviews in the media. The consumers' decision about whom to call "my doctor" or which hospital to choose for heart surgery or where and when to go for which cancer screening can be life-altering. Yet, there's surprisingly little information to guide those critical decisions.

Smart health care consumers ask three critical questions, notes Dr. Rackner:

• Which doctor or hospital gets the best results when treating patients with my medical condition?"?
• "What's it like being a patient under the care of this doctor at this facility?" and
• "How much will I pay out of my own pocket for this care?"

"Most people are surprised to learn that not all doctors and hospitals are created equal," says Dr. Rackner. "Some hospitals and doctors get better results than others; they perform better. There's wide variation in the measurable clinical outcomes, such as the number of years similar patients survive after cancer treatment, complication rates and days of hospitalization. Consumers have a hard time getting their hands on this kind of performance information. Published lists of best doctors, really nothing more than the results of popularity contests, report the perceptions of these doctors in the community. In the future, outcomes data will offer the objective reality, making it easier to identify the doctor you want to see because he or she gets the best results."

"A good medical outcome is one factor proactive patients consider when deciding where they get health care, but that's not the whole story," says Dr. Rackner. "Patients value both the desired medical destination-the good clinical outcome-as well as the style and ease of the journey. Think about how parents-to-be make choices about where to give birth. For most, it's the look of the birthing room, the amenities and the feel of the hospital rather than the rates of c-sections or infant mortality. Often, the best medical outcome and the optimal patient experience go hand-in-hand, but that is not always the case."

She continues, "Some patients base their choices about health care providers solely on the experience of a satisfied friend or co-worker. Each doctor and hospital has a culture of caring. The welcome of a hospital greeter or the presence of tea and coffee in the waiting room or the punctuality of the doctor offer evidence that someone has thought about what it's like to be a patient there."

Although Dr. Rackner unequivocally supports the collection of information about patient satisfaction, she recognizes the many challenges in interpreting this information. "Asking patients whether they're satisfied with the medical care is like asking people whether they're satisfied with their vacation. It depends. The major factor is whether their expectations were met. Someone who dreams of a luxury resort will be dissatisfied with the camping trip that was the dream vacation of another," she says.

Finally, what customer would make purchasing choices without knowing the price tag? Patients do it every day even though out-of-pocket costs influence health care choices. If you knew that two treatment options for low back pain--bed rest or an operation--offered similar results for large groups of patients, financial realities could tip the choice. Costs are the driving force behind patients who make the bold and clinically questionable choice to go abroad for medical procedures, despite the challenges for follow-up care should early or late complications arise. Both doctors and patients will undoubtedly get more skilled in discussing the ultimate taboo topic of money because it's an integral part of each and every health care decision.

Dr. Rackner notes, "There are many benefits to this emerging trend of measuring and distributing these health care measures. The process of measuring medical outcomes will undoubtedly lead to improvement. Cost information will help patients act with more fiscal responsibility. Satisfaction surveys help focus on identifying and meeting the patients' needs. It's a reminder to both doctors and patients that the patient is the customer in the health care system."

Vicki Rackner, MD, FACS, founder of Medical Bridges, serves the business community by helping health care consumers move closer to a doctor-patient relationship that is a collaborative partnership. Her focus is where the "rubber meets the road" - in the clinic exam room where plans are made and in the patients' homes where the plan is carried out. She suggests to patients exactly what to say and what to do during an encounter with a health care provider so they get the health care they want, need and deserve. Dr. Rackner is an author, speaker and consultant.

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