Here`s a story of coincidence. Happened to meet a dentist a couple weeks ago and the conversation got around to consumer-driven healthcare. Healthcare in which consumers have enough information about cost and quality to make choices in their own healthcare just like we choose our fruit in the supermarket aisles. To me this is like voice recognition software was in the nineties–sure to be the wave of the future but too many kinks at present. Permit me to leave that part of the discussion there, maybe for another time and a wider expose´so I can tell the end of the story.
I am a slave to technology so I sought to demonstrate my point about the electronic information on which patients will base their choices. I used my little gizmo to go to ratemds.com, right in the middle of our convo. I explained that ratemds.com was the physician-rating site that was taking off right before our eyes and would soon be the next really big thing. My words were cut short as my friend`s name appeared on the screen next to one very unflattering review! The poster had held nothing back, using a full ten lines to explain why that doctor should not only be stripped of the license to practise, but also deported and placed before a firing squad. Our interaction was brought to a screeching, distateful halt. We sat in silence. I held my gizmo a little nervously, with the look of mixed apology and uncertain distrust in my eyes while my comrade tried fruitlessly to remember the patient and the incident. The following day the following appears in the press:
Docs seek gag orders to stop patients’ reviews (AP)
The headline was slightly misleading, but the journalism was ok. In a few days the issue of doctors having patients sign waivers preventing online discussion started to heat up. In no time the troops rallied and a million frenchmen could be heard singing:
“only rotten doctors would want to silence patients”, “freedom of speech for patients”, “we deserve to know who the bad ones are and who the good ones are” and the song goes on and on.
As oft the case when two opposing sides are BOTH WRONG, the issue deserves a deeper treatment and a little deeper thinking; more time than could fit into a sound bite on Good Morning America . Let`s try that for just a little.
Doctors Rountinely Ask to Be Evaluated By Patients
Firstly, the review of the physician by patients is a step in the right direction and a step that physicians have embraced for a long time. Few doctors want to silence patients. And that also aplies to the thousand members of Medical Justice.
DO NOT FORGET: Most physicians solicit the opinion of patients via surveys and post-visit emails. You have seen the suggestion boxes in the reception rooms, the surveys in the mail, etc. Some dental practices pay dearly for services which will glean patient feedback by email and route it back to the doctor.
The effort to color this discussion as a crusade againnst physicians who want to escape scrutiny does not have a lot of merit. DOCTORS ARE NOT OPPOSED TO PATIENTS OPENLY EVALUATING THEM. This is the reason why polls might show fewer doctors than expected implemeting the waivers.
Anonymous Is Not The Point
All of the above-mentioned tools that doctors currently use are anonymous. Didn`t you notice??? Whoever made anonimity the center-piece of this discussion?? Of course anonimity online makes practices vulnerable to sabotage by their competitors or anyone with an axe to grind. But this is still in my mind a side note. Most rviews are not being generated by nasty competitors.
The Real Concern
The real concern is that most aspects a patient`s assessment are prone to confounding. So information that is being heralded as testimonials to competence and incompetence is not reliable for that usage. Terrible and confounded reviews will be the axe that fells a career built through hard work. Let me explain what I mean by confounded. The motive of the ratings sites is supposedly to let patients know who they should chose to see or avoid. The implied message is let your peers tell you who is a competent physician. But feelings about competence are not isolated. For example, it has been shown that a dispute over the bill will extinguish any good feelings about the encounter. Indeed in my friend`s case the issue was indeed a badly handled misunderstanding about dues by the office staff and not the physician. This is not rare. Ratemds.com allows the poster to name their insurance carrier as a footnote to how frequent and complicated such disputes can be. Other major confounders which can obscure the impression of the quality of medical care include, long waiting times, poor communication especially when the complaint is deemed not serious, and a resistance to accepting alternative medicine therapies. Indeed a few hours on ratemds.com reveals that the majority of negative reviews WERE NOT fuelled by mistakes in treatment or diagnosis.
DOCTORS DO NOT WANT TO BE LABELED AS BAD DOCTORS IF THE STRENGTH OF THE MEDICAL CARE WAS ACCEPTABLE, but maybe other factors were not.
Especially when as a result of HIPAA they have no way of saying “Hey, I was late, but here`s the proof that the medical complaint was managed well. If you understand that I run late, then I am still the right doctor for you”.
On-line or ON-Fair
There are several versions of the saying that a satisfied customer will tell 3 people, but once disatisfied will tell 3000. Online reviews can send the latter figure to 300000! So those who argue that only bad doctors will be afraid of ratings should recognise that mainly dissatisfied customers will take the trouble to rant online. On angieslist.com the magazine story talks about opposing impressions of Dr. Segal himself the founder of Medical Justice. But for many MDs on ratemds.com, negative reviews a year or more old, still remained the ONLY review. A sample size of one has no real accuracy, but the damage has already been done. Isn`t this unfair to bth the consumer and the physician?
Waivers are Wrong Too
Obviously this will make some patients suspicious. “You must know you wil make mistakes if up front you are saying I can`t tell the world about them.” Its the proverbial prenuptial agreement that breaks the engagement.
What Will All This Do To Medical Care?
What if the pendulum swings away from patients filing malpractice suits to physicians filing defamation suits? Could it happen? Maybe. Is there any legal case for a physician whose livelihood is damaged by an unsubstantiated comment to sue the registered user at angieslist.com? Should that overly talkative patient who alleges the doctor did not spend enough time be penalized for her online comment when the doctor`s office can show that she spent an hour at the office of which thirty minutes was in direct consultation for vague abdominal pains which turned out to be nothing? When you get into destroying the livelihood of another human you had better have good grounds.
So this right step wrongly taken could possiblylead to escalation in health care costs, multiple lawsuits and further destruction of the physicain-patient relationship. So what to do…?
Taking The Right Step The Right Way
Evaluating a physician is not as simple and straightforward as rating a movie or a book. The problem with online ratings is not the annonimity of the posters, but the fact that there is an information asymmetry between the patient an the physician. While online ratings site are supposed to help the patient chose competent physicians, the information is not reliable or scientific enough to do so. However, it may prove very costly for some unfortunate physicians. A physician who sits with a patient is judged to have spent more time than if he stood for exactly the same number of minutes during the interview. Physicians who prescribe are seen as doing more than those that refuse to dole out antibiotics.
So let us agree patients cannot judge competence well, that ratings are an important and lethal tool, but that patients deserve their say. Do it responsibly.
- Never post a doctor`s rating until at least TWO reviews have been submitted.
- Let the rating be the result of a brief questionaire in which individual traits are given a numerical value on a continuous scale
- Rate qualitities that lend thmselves to more objective assessment: time spent waiting, amount of eye contact, time to get results back, time taken for doctor to respond to queries after the office visit, did you or did you not receive information on your condition, was there any financial disagreement?
- Dispense with ambiguous comments or questions which patients may not have the expertise to answer like: was my condition treated correctly, or was my exam thorough enough.
- Substitute with did I seek a second opinion, was the second opinion different from the first?
- Comments if allowed should be moderated in order to remove what amount to personal attacks on a physician and keep the discourse centered on the experience and not the very difficult to substatiate tirade of “she doesn`t know anything about medicine”.
- In the extreme if such comments and attacks cannot be moderated, then patients should be required to register to post comments, and part of the registration should include waiving of confidentiality under HIPAA. That`s right. Level the playing field. Give the doctor a chance to respond in full.
- Notify the doctor whenever there is a significantly low rating. Give him an early chance to put things right.
And there are even more suggestions. No one will tolerate an attempt to silence patients. And not many physicians want that either. However, ratings should not be seen or used as a way to penalize or get back at doctors we do not like. Those avenues already exist. Ratings and reviews should serve as opportunities to improve medical care and to help patients find the best available care. Actions guided by that spirit will benefit patients and doctors, who lest we forget, are also patients too.
