Can social media help measure physician quality?

I am consistently bemused by those who recommend more rigorous or more pervasive standardized testing as the primary means for insuring physician quality. The vast majority of physicians have already passed through a complex gauntlet of multiple choice exams, extended credentialing and certification processes, and lengthy tests of knowledge and skill. And yet, some physicians (to put it bluntly, sorry friends) are very bad at what they do.

Intellectual intelligence is necessary, but not sufficient, for doctoring. It is emotional intelligence (EI) that is sorely lacking — because it has neither been cultivated, nor selected for, by many training programs. Some educators openly acknowledge the problem, pointing to “extra-curricular activities” as their primary means of distinguishing equally qualified applicants. The disappointing reality is that non-academic performance may be a tie-breaker for students with similar standardized test scores, but raw scores almost always trump any other factor. In the end, we have a physician work force that is highly adept at assimilating and regurgitating facts, but is only accidentally good at human interactions.

Is there hope for change in this arena? I believe that the prognosis is guarded. As our culture becomes more and more digital data-driven, a tsunami of “meaningless use” threatens to drown us all in false quality measures, electronic medical record documentation “quality assurance” requirements, and analysis of trends without comprehension of context or influencing variables outside the scope of the measuring instruments. Lies, damn lies, and statistics. We can’t get enough! And guess who are the biggest proponents of these methods? Why, people who only excel at standardized testing — mostly because their true flaws also lie outside the measuring instruments. Bad doctors (sometimes turned-administrators) themselves are often fueling the onslaught of fruitless quality improvement initiatives.

Dr. Howard Luks, orthopedic surgeon and social media activist, wrote a provocative blog post on the subject of why physicians don’t engage more in social media. He suggests that many avoid it because they lack people-skills in the first place and don’t genuinely enjoy engaging with patients. If you’re a “jerk” in real life, he argues, then what advantage is there to making that more obvious on blogs, Facebook, Twitter, etc.? Better to stay socially quiet.

The interesting thing is that social media might be the most reliable way to discover whether or not your doctor is kind, thoughtful, observant, and detail-oriented. Reading a physician’s thoughts online can help you get to know their true personality and work ethic. In the future it would be nice if medical schools and residency training programs took the time to read applicants’ blogs (for example) instead of crunching their test scores for admission via the path of least resistance. An extra hour of reading up front could save our medical system from a new wave of low EI providers.

As Seth Godin put it, “Uncaring hands are worth avoiding.”

We all recognize the importance of this statement intuitively, but have a hard time quantifying “caring” with standardized tests. That’s why admissions officers and patients alike must use their judgment when selecting doctors. We pay verbal homage to the importance of “clinical judgment” in medicine but in reality are culturally afraid of straying from numbers to support our decision-making.

How will you know a good doctor? You’ll know him [or her obviously] when you see him. And sometimes you can see him best on social media platforms.

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A few caveats of course:

1. Social media is a sensitive but not specific test. Meaning, you can probably accurately identify caring doctors from their blogs, etc. but if they don’t have one, it doesn’t mean they aren’t good/caring.

2. It may not matter if you find a great doctor online if they’re not in your limited ACA network.

3. Direct primary care is a potentially excellent way to get connected to exceptional doctors. I am a fan of this movement and have been actively involved in a practice in VA. The practices can reduce costs and enhance quality care, though recent caps on health savings accounts have reduced consumer freedom to spend pre-tax income on direct primary care.

Val Jones is founder and CEO, Better Health.

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  • Thomas D Guastavino

    When I was in training there were several attendings with very demanding and rough personalities, just the kind of surgeons who likely would not get high scores on any social media sites. There were also surgeons who were very personable and likely would score high. Problem was the first group clearly were better surgeons. When the second group got in trouble they were good at talking themselves out of it but that really did not compensate for the poorer outcomes.
    What I learned from this was simple. If I or my family needed, surgery go with the surgeon with the worst personality. That surgeon was getting by on their skills, not the ability to talk themselves out of a jam.

    • rbthe4th2

      Is it possible to teach or help those who are friendly get better skills? Is it possible to work with those of a rougher demeanor to learn social skills? We seem to be loaded in areas with doctors who take the non clinical/non patient based areas. If someone can make the grade as a doctor, it would seem more efficient to give them training such as with autistics, to learn how to work with others. Or more CME work to upgrade skills. As Ghandi said, “You’ll find there is room for us all”.

      • Thomas D Guastavino

        Sure , you can go ahead and take the time to teach whatever you want. For me it just seems simpler to go with the rougher demeanor.

        • DoubtfulGuest

          Good points. Bedside manner is overrated. I’ve had a doctor pat my hand and gaze sympathetically while “listening” to my “concerns”. We got nowhere and she got compassion fatigue by the second visit. I had another doctor who never once made eye contact. He only muttered “uh -huh…yeah…uh…..huh….” while taking notes. I happened to look at his “new patient” letter afterwards. He took everything seriously, put everything I told him in the right context, and we did make some progress. I’d recommend him to anyone, social skills be darned.

          There’s no substitute for basic courtesy, though.

  • DoubtfulGuest

    Respect and basic courtesy are very important. I take these review sites with a grain of salt, though. There are many reports that Yelp, at least, manipulates reviews and business owners. After my experiences that I describe elsewhere in this post, I’ve gotten over the idea that doctors need to have great bedside manner. They just can’t be “on” all the time. Their work is too tiring and demanding. Perhaps some public education campaign would help us develop more reasonable expectations:

    “Your doctor is a nerd. Get over it!”

    “Your doctor’s had no sleep for three days. Give her a freakin’ break!”

    and so on. :)