Published on
Updated
Reading 3 mins.
in collaboration with
Michaël Peyromaure (urologist)
Medical validation:
May 03, 2023
In its issue of April 27, the weekly Le Point published a very extensive list of the 1000 best expert doctors in 14 specialties. But do the evaluation criteria really reflect the quality of care? Professor Michael Peyromaure explains to us how this is misleading.
For the first time in France, doctors named in a ranking
At first glance, the journalists of the Point for their April 27 issue. For 18 months, three of them analyzed more than 30,000 publications by university doctors, with the aim of building an unprecedented list: the crème de la crème of expert doctors in France, in 14 specialties (cardiology, ophthalmology, digestive surgery, orthopedic surgery, urology, cardiac, vascular, thoracic surgery, infectiology, neurology, female cancers, dermatology, and rheumatology).
The result is 14 lists, comprising a total of 1,000 expert doctors, personally named, like a list of the best students in France, whom you must contact at all costs if you want to be better treated.
A classification to better identify yourself as a patient? Yes, but…
The Point does not hide it. By this classification, the journalists of the Point intend to allow readers to “find your bearings in an unequal and obscure healthcare system”. In short, their work wishes to refer all patients who need a second professional opinion on a pathology, to do so with the best professionals there are. And this, without the assistance of the National Order of Physicians, thus ensuring complete autonomy in their research and their results. In itself, the idea is noble. But the process, on the other hand, can raise questions.
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Indeed, to arrive at this ranking, the journalists analyzed not the practices of these doctors or their techniques, but… the number of publications to their credit, those which have the most value in academic journals. Assuming that the greatest “publishers” also have their names in major hospitals, the top experts named here are those with the largest volume of academic publications.
However, as Dr. Kierzek, medical director of Doctissimo, reminds us: “99% of doctors do not publish. The problem is not the doctors in the ranking, but the fact that some who do not publish anything and are not in this ranking are just as good, sometimes better with patients”.
Three ethical issues in one ranking
To fully understand how this classification can pose a problem in practice, we contacted Pr Michaël Peyromaure, head of the urology department at Cochin Hospital in Paris, himself a university student, but who protests against the criteria favored here. .
According to him, the proposed classification poses three serious problems:
- A first ethical or even regulatory problem, because for the first time, we are not talking about a team, a service, but a particular doctor.
“In France, it is a particularity of our system, we cannot advertise ad nominem for a doctor. It seems to me that this way of proceeding with the classification is a breach of our medical ethics”.
- The second problem is undoubtedly the most serious and is based on the evaluation criterion for selecting the best expert doctors, those of the medical publications.
“Publications are not a guarantee of good clinical practice. Writing articles and going to conferences is not a guarantee of being a good surgeon or a good doctor in practice. Sometimes it is even the opposite, those who talk the most at congresses are those who are the least at the bedside of patients. will be well operated”.
- Finally, the professor mentions a last problem, that of the discrimination established by a magazine:
“This classification separates university doctors from non-university doctors in hospital care, in university hospitals or in the private sector, completely forgotten, who are just as good and just as experienced, and sometimes take better care of patients. This excludes from the outset all doctors and surgeons who, due to their purely clinical activity, do not publish in journals.
What would a relevant ranking be?
Still according to Professor Michael Peyromaure, transparency is however important. “I have always been in favor of the publication of results and the evaluation of establishments, which are rarely done in France. But this must be done according to relevant criteria: the volume of patients, the techniques available, the complications identified and, of course, the satisfaction of the patients and those operated on. Provided you target expert centers and not just “star” doctors. Academic prestige has nothing to do with the way of treating.