Exactly. Even with credentials and training and awards, the only reliable system is gossip from people they work with. And then, you have to know who's delivering the gossip to know if their judgments are worth trusting -- if people don't have the knowledge and finesse themselves, they can't identify the faults that the other is making. Recently I watched a doctor forcefully squish a baby's head during cesarean delivery simply because she cut the opening too small and forced it through rather than took the time to widen the slit a bit. Mother doesn't know. Nobody's going to tell her. Baby won't stop crying and crying, can't explain what's wrong. Then you see people years down the line walking around with weird-shaped heads. This was after I had to tell the other one at the table to change her gloves because she handled unsterile operating room furniture and then went to put her dirty glove into the mother's open belly, had I not caught it. Plus they sewed it up sloppy, which will increase her chances of rupturing the uterus later and having painful scars. This place has a great reputation: sepsis and malformed head and trauma to the woman's belly skin all in one go.