When people are ill they want the best care they can get but of course professionals vary in their interests, skills and expertise. So how do you find out who the local expert is?

People imagine that their GP knows all the local consultants and will send them to ‘just the right person’. This is understandable but mistaken. Firstly there are usually several hundred consultants at any one hospital in Britain – keeping up to date with who does what, let alone who is best at what is impossible for GPs.

But even if you’re GP does happen to know who is best, they then have to manipulate Choose and Book, the new mega system to support ‘choice’ which makes it intentionally hard for GPs to use to refer to a particular named consultant. Intentionally because it’s much easier to manage waiting lists when all referrals for a particular specialty or service come into a single pool. So choice is sacrificed to shorter waiting times.

The NHS has traditionally got round this by saying that all services meet minimum standards so you don’t need to find the best. Recently the lameness of this response has triggered an interest in PROMs – Patient Reported Outcome Measures. If we don’t know who is ‘best’ then we’ll ask you, the patient. So PROMs aim to measure how you felt before an operation and then again some weeks afterwards.

The Darzi report, which is this year’s bible on how the NHS should develop, says that we should use PROMs right across the system in the hope this will help people choose who they want to see. And give a valid answer to the question that managers are also very interested in, namely ‘which of our doctors are good?’ (And, by implication, which are less good).

Trouble is that whilst PROMs are useful they are very far from perfect. To make valid judgements about outcomes you need to have a big enough sample and make sure that inputs – the casemix of people seeing different consultants or teams – is the same. If one team specialises in difficult cases their outcomes will be different to those handling easier cases. And of course you need a reasonable number of cases for each procedure and each surgeon. The danger therefore is that PROMs will just mean many more surveys for patients plus a whole new industry processing the answers and tweaking the answers to try and get a ‘true’ picture.

For our part we think that the emphasis on choice is in some ways – literally – misplaced. The 'choice' policy puts the question at the wrong point in the process. Ill people make poor shoppers, and whilst they most definitely want to be involved and informed in decisions they usually want to be looked after rather than labouring under a mountain of 'choice' decisions. Once patients have experienced a particular service (and hopefully are feeling better) they have very decided views about what they liked and what could have been better. Using these views as a quality driver makes much better sense – and is what we try to do at Patient Opinion.

How to give patients accurate, useful information to help them make better choices is an important question that keeps coming round and round like a bad penny. PROMS, Choose and Book, Information Prescriptions, NHS Unlocked, IWantGreatCare all represent different approaches to this problem. Sadly trying to find who is the ‘best’ doctor for some condition or operation is a simple question that can only ever have frustratingly complex answers.

Among all its myriad wonders, one thing the web does well is enable every voice to count. Even the voices of people who don't usually have a voice.

That's been one of the key values driving the Patient Opinion team. And now we're pushing this a little bit further through our partnership with Homeless Link, with our attempt to bring the voices of homeless users of health services into the heart of the NHS.

Will it work? We don't know, but we think it's worth a try. Remember, On the Internet, Nobody Knows You're a Dog.

James has been busy creating big pictures of Patient Opinion postings, and Paul has talked about our recent work with Rotherham Trust, where staff made promises to themselves. We will be publishing those promises on the site in the next few days, but in the meantime here is an interesting combination of our last two blogs.

Here is a Wordle of 50 promises that Rotherham staff have made.

The other day we blogged about "the big picture" of the last 100 postings on Patient Opinion.

So a few people said: "well, OK, but what about the responses from the NHS?" And, obviously, we couldn't resist. So here's a Wordle of the last 100 responses posted on Patient Opinion.

Finding ways to combine these two aspects of great health care, the highly personal and the highly systematic, is the task of health professionals in the 21st century.

Click here if you want to see an example of a story brim full with acts fo work and courage - or here for one that fails on almost every count.