Is the Ratings Game Stacked Against Doctors?
Like my colleague Michelle Andrews, I've been following the proliferation of doctor-rating sites. And like her, I can see theoretical value in them. They could be a good tool when seeking a primary-care physician—someone who should have good people skills besides a solid base of medical know-how: the ability to listen between the lines, to say, "I don't know," to look at his patients and truly see them.
I'm bothered, however, by the viral spread of these sites and by how thin and potentially misleading they are. Yes, Web users know at some level that what they read about a doctor hasn't been carefully vetted. Do they mentally apply a correction factor when they read a post flaming (or overpraising) a doctor? Maybe they do. But it's hard. How do you put words on the screen into perspective when you don't have any? And it's so easy to take swipes on an anonymous website. It's no news that our online personalities are different, and not necessarily for the better.
Take my primary-care physician. He's a good listener, doesn't rush me, thinks outside the box when necessary, and possesses other qualities, like a mischievous sense of humor, that I value. He's also somewhat reserved, which a couple of people I've referred to him told me they didn't like. They found him lacking in empathy. I can imagine their comments on one of the physician-evaluation sites. I can imagine how some might read those comments and cross him off their list of potential providers. "Who needs a cold fish?" they'd figure. In my opinion, crossing him off before trying him out would be unfortunate and unwarranted.
I don't think doctors should be rated as if they were restaurants or plumbers. (Angie's List, which posts consumer ratings for this and other household services, is about to expand to include physicians.) I'm not a client or customer of a doctor; I'm a patient.
But if this trend is an unstoppable force, two elements should be adopted by every website: Comments about a primary-care provider shouldn't be posted until at least 10 are received (five for specialists). And independent facts should be checked.
On the rating site Vitals.com, highly praised by one of Michelle's readers, my doctor was credited with five publications. In fact, the author was a Brit with the same name. I'd already been familiar with the site, and had raised the error with Vitals several months ago. They actually disagreed that it was a mistake, and there it sits even today. Can I be blamed for wondering what else the site might have gotten wrong?
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Reader Comments
Doctor ratings are helpful
Online doctor ratings may be stacked against docs to a degree, but it isn't nearly as bad as the "news." Happy patients are never going to be front page stories, but horribly bad medical outcomes are. The public gets a very warped impression of doctors.
By having more patient do online ratings, doctors and the public benefit. The public gets to see how doctors are really doing, and doctors get the benefit of learning how they can do an even better job for their patients.
Hundreds of doctors send their patients to the online doctor rating site I started, www.DrScore.com, as a way to get feedback. The doctors' overall scores are published online. Of doctors with 20 or more ratings, the average score is well over 9 on a 0-10 scale. What are we gaining by trying to hide high patient satisfaction scores?!
I hope more of my patients give me feedback.
Comarow says:
Thanks for your comment. No disagreement here about the potential value of physician ratings. I said as much.
A key word, I think, is the word "more" in your statement: "I hope more of my patients give me feedback."
Physicians, magazine reporters, and other providers of services and products know that unhappy consumers are the ones most likely to call, email, complain to friends and family, and, presumably, post comments indicating their displeasure. If two or three patients are sufficiently exercised to review a doctor, one or two of their comments may well be negative.
That isn't much of a sample, statistically speaking. That's why I suggested a required minimum number of patient comments before any are posted.
Your comment seems to back that up implicitly. You say that "[o]f doctors with 20 or more ratings, the average score is well over 9 on a 0-10 scale." How about those with 10 ratings? Five? Two?
Paitient and Industry Reviews
These ratings websites sprand up out of patient demand. If patients weren't craving this information the websites wouldn't be growing.
If the healthcare industry started providing their credible ratings these sites wouldn't be so popular. So why hasn't the healthcare industry started providing this vital information?
They like being above the law, free from critique to practice a good or bad skills for their entire career. This is fine for the good doctors who make up the majority, but what about the bad apples, how will they improve if no one tells them they need to?
Patient reviews coupled with industry reviews would together paint a better picture. Until the healthcare industry we have online patient reviews, which is a liot better than nothing.
Staff, Healthcare Reviews, http://www.healthcarereviews.com , rate your doctor, hospital and more.
Doctor Ratings Make Sense
MyDocHub.com comes close. Consumers need to take back control of their patient satisfaction, and as in other industries, only the consumer can effect change. So in the case of MyDocHub.com, patients rate their doctor based on waiting room times, total wait time including the time in the patient room with the doctor, and a simple rating of 1 to 5, 5 being the highest on how satisfied they were with that appointment. The ratings are averaged out, so one poor score does not hurt the doctor, but on the other hand, various poor ratings may indicate poor performance by the doctor, since the wisdom of crowds determine a more accurate assessment of the doctor.
Ratings
I am a young cancer surgeon. I've worked in practice now for 8 years.
I'm watching the relentless rape and destruction of our health services in this country by increasingly consolidated health insurance entities.
Don't fool yourselves, they are the enemy. Years ago, when we had a healthy and competent MD work force, it was pointless to "rate" doctors. Everybody knew that professional standards were pretty hard-core; the gig payed extraordinarily well, and it was really hard to get through the brutal training and screening process.
In stepped private insurance. With lobbyists and billion-dollar budgets, they conspired to invent rationing systems thinly veiled as "health plans". They stole all your money, and continue driving up premiums well beyond the actual costs of delivering care. They then conspired to steal MD pay (Look up Bill McGuire and the Pacific Care/United merger, and you'll see the model of how they do it) and continue to steal, deny and downgrade payouts for "claims" (note: not BILLS) they "adjust" to their ends.
They have all the money, and make all the rules. They LOVE phony quality 'rating' systems, and are free to manipulate these to further downgrade pay. Gives them a fake excuse to steal more money. Case in point: Blue Cross rated doctors based on 1) how many BC providers they saw over a certain period of time; and 2) a set of random and contradictory factors of "quality" that doctors either have no control over (e.g. whether a patient actually GOT a mammogram-- not whether the doctor RECOMMENDED or ORDERED one!) or is meaningless (e.g. within a certain time frame, was a stool sample sent for occult blood AND a patient happened to have had a colonoscopy-- for if they did that counted against quality...). Other such nonsense was then reported out as a doctor being "high or low tier". We already have no leverage in negotiating with these mega-merged monster insurers, and they already pay us whatever paltry fees they feel like casting at us-- why give them yet more weapons to destroy us?
It's all garbage.
Rating systems and quality reporting will never fix anything. You can't shine excrement and expect gold. Professional quality comes from robust systems that reward the best and the brightest to enter, and have a level of prestige that instills pride and excellence.
Like it or not, it's money that makes the world go round. Rob us of our pay, treat us like the lowest form of employees, and you will get sullen, factory-style medicine. Hey-- they already ration your care as it is-- do you want them influencing who THEY say is "good" or bad? You know they are coming up with rating systems themselves, and when they roll those out, all you people who so desperately want "ratings" will mindlessly accept whatever they say... because it will be all packaged up on nice slick websites and you won't have to do the work.
There is no hope, people, until you put these people in the jail cells they deserve and stop paying premiums.
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U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.
Doctors???
I do remember back in the 50s,60s,70s,and 80s when we had Doctors, but now like the Veterans Medical Centers they've been replaced by NURSE Practitioners or Physision Assistents..
Mar 19, 2008 13:50:58 PM [permalink] [report comment]