Physician ratings reward doctors in narrow practice


Admit it, we all do it. All physicians check their quality ratings on the various online sites. If the site allows comment, we read the comments. If we get a bad rating, we try to figure out who was the patient.

Isn’t that the chronic back pain patient who was addicted to painkillers and got mad at me because I wouldn’t renew their prescription? What did I do wrong? Did my receptionist have a bad day and yelled at a patient? Did I seem tired and disinterested because I was up all night doing emergency surgery?

Very soon we are checking the ratings of physicians we know. We grow suspicious of the results. How does one of the best physicians you know only get a 3 out of 5 while another who just had their third malpractice suit or has not been in practice for over two years get a 5 out of 5?

For better or worse, physicians are now being forced  to determine and adopt  the characteristics of those physicians who get then highest satisfaction ratings. Perception has now become everything. Maybe we should build a water fountain in our front lobby or provide a valet to park the patients cars. Maybe I should stop taking call in the emergency room so I can guarantee seeing patients within 15 minutes of their scheduled appointment.

After careful study, we notice a pattern.  The physicians with the highest marks are the ones with the most narrowly focused practices.  That makes sense. If I only do knee replacements I can streamline my practice so patient flow is smooth and comfortable thereby giving me control over those things I will be judged.  If a patient is referred to me for leg pain they must need a replacement.  Since I have to stick to a schedule, I can’t waste my time checking for a pulse, just in case its peripheral vascular disease.  I will hire a PA to do that.

The only patients I should see are the ones who have already run through then diagnostic gauntlet so if they are seeing me they must need what I provide. I can now shine doing what I do best. I could even have control over the content of the patient satisfaction survey so I won’t get a black mark just because the patient got stuck in traffic trying to get to their appointment. If I am really lucky I can provide a truly unique service so much so that my institution is paying to promote me. After all, these days the last thing a hospital wants are black marks on their surveys as well. How can I not get the  highest grades?

Estimates now are that well over 95 percent of physicians that specialize go into subspecialities. Is it better for the patient? Is it better for the health care system in general?  Given the complexity of health care, its probably best to get to the doctor with the most experience dealing with your particular problem. If I can provide that service, and get the best grades possible, its a win for both of us. The cost and effect  of having to run through that diagnostic gauntlet is yet to be determined.

Thomas D. Guastavino is a physician.

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