How doctors should deal with physician rating sites

It’s not a bit unusual at big retailers to have the clerk circle the web site at the bottom of the receipt and suggest you visit and leave your opinion.

I try to ignore these sites. They are unscientific crap.

I’ve had my practice posted a few times that I’m aware of, suprisingly all in a positive light, but I still think this practice is wrong. Most comments will be negative, because a satisfied patient will not often take the time to post.

An angry patient will track down every site they can, and post on it, and then post more under different names. Especially those seeking pain meds or angry that you refused to fill out disability papers.

I don’t think the ballot box should be stuffed by either side.

Well, Jill makes a good point: such informal survey websites may be pseudoscientific garbage, but they are not necessarily crap for information. If a physician or her staff is not considered “nice” or “available” or “on time” by at least one patient, then she may have a personality conflict or marketing problem or office inefficiency that she needs to know about. For sure, she’s got a communication problem with at least some folks at the moment and point of delivery of service that demands attention, and she doesn’t know if these are sentinel events. We’re not taught many of these skills or rewarded for such people-oriented performance in medical school or residency, so why would we be successful here? You get the behavior you reward, HR folks tell us, rather than not getting the behavior you punish.

So then every physician ought to beat these pseudo surveys to the punch but not discount the information. First, communicate honestly, genuinely, authentically. We need to show emotional intelligence in addition to our other smarts – although, again, we were rarely rewarded for this in training. “Yes, I’m late because the ER is stacked up and I got caught there because we don’t have enough PCPs in town, and I’m as angry as you are about it. What can we do about this? We’re all in this together, aren’t we?” “Yes, I’m angry today because MY people are getting turned down by BCBS for the care they need. What can we do about this?” Make patients shareholders, give them a stake in our mutual care, our mutual efficiency, and shift the focus of discourse from YOU to the root cause. Of course, if the patient says “I don’t care about you, Doc,” then maybe you don’t want that patient. Empathy goes both ways; screw fake Aequanimitas. And if we are inflexible and can NOT do these things, then – yes, maybe we really are the problem. Second, involve patients in our own blog or social network so it becomes their own blog or network. You build compliance, you build market share, you build forbearance and forgiveness if you DO mess up, you build friends. Not just PCPs but even the wisest among us – the neurologists – were people before they were doctors.

Me being a neurologist, I know this stuff….

If patients had access to the insider knowledge that physicians and other healthcare providers have about the “bad” doctors and the “good” doctors there wouldn’t be a need for the, admittedly, bogus rating sites. I suspect it’s really more about being consistently good – not just rising to the occasion when the doc’s in the mood and having a good day.

If physicians had a credible way of policing themselves and patients could trust that they aren’t all covering for each other there wouldn’t be a the need for the sites. And perhaps, less malpractice.

There are lots of small ways in which a physician cuts corners or doesn’t do his/her best (all in the name of efficiency) that don’t harm a patient in ways for which the patient cannot compensate (e.g. not taking the time to carefully dissect breast tissue away from ALL the chest muscle during mastectomy, taking a “minimal amount” – patient can compensate, but is permanently weakened), but do cause damage.

Think about the possibility of keeping detailed accounts of outcomes that must be open to the public. The patient can choose the surgeon that does take the time to carefully dissect ALL MUSCLE and the result will be that ALL SURGEONS will do it, taking muscle only when there is no other way to safely complete the procedure. None of them wants that reputation.

That’s just one example. I’m sure there are many, many ways to create scoring of outcomes for procedures and care. In his book “Better,” Atul Gawande wrote about the creation of the Apgar score and its effect on infant mortality. Suddenly doctors did better work, took the time to save babies’ lives that previously had been considered hopeless. He talks about creating similar scores for surgical outcomes. There must be ways to apply this idea to create a system that rates quality of care. And, I’m not just talking about the high drama, live or die type of care – but the small stuff that really impacts a patient’s experience and long-term relationships (read TRUST) with the healthcare system.

The patient that is experiencing small weakness due to “minimal muscle loss” from mastectomy can carry on, but has a daily reminder of the loss. It actually does matter, even though no one in healthcare accepts the patient experience as valid. No one’s watching. No one’s measuring – so none of the doctors believe it has any impact.

Patients complained for years of “chemo brain,” and were ignored until finally, someone, decided to see if there really was something to it (I’m guessing it was done to prove the patients wrong). Wow, the stupid, complaining patients were actually right – there is such a thing as chemo brain. It began with anecdote. It ended with scientific methodology and continues with research to both explain it and treat it.

Step up. Find a credible system to measure quality of care and quality of experience. Provide the light of day to the insider knowledge you already have. It matters.

as an ER doc… if you can decide whether or not to come in and see me based on my ratings on these sites… you probably have no business coming into my workplace to begin with

It seems like while most of the doctor rating sites tend to be a sounding board for patient dissatisfaction, patients often use things like how long they were in the waiting room and other factors that are not directly attributed to the physician’s knowledge and skill set to judge the physician. This is really not a fair way to assess a physician’s abilities. Recently a bad review was posted about me on MyDocHub.com, and though it did not list the patients name, I knew the patient since what he described in the review was already brought to my attention.