Rating Doctors: A Rank Practice?
Doctors aren't thrilled about the growing crop of websites that invite patients to post online, Zagat-style ratings and comments about their physicians. Nobody likes having his performance judged, and the anonymity of the Internet encourages the sort of no-holds-barred criticism that can feel—and may be—unfair. But the American Medical Association's stance against them seems shortsighted. Instead of trying to discourage people from logging on and registering their opinions, doctors would be better served using the sites to learn what their patients think.
Sure, the information is subjective, but why should consumers rule it out on that basis? It's sorely needed. Patients are paying more for their health coverage all the time, and they want value for their money. But it's not easy to comparison shop for doctors. It's hard to find out what the fee will be until after the fact, and good luck locating data that help you evaluate whether Doctor A is more nimble with a scalpel than Doctor B. Everyone agrees that we need more reliable tools to help patients evaluate clinical competence and improve pricing "transparency." A doctor's clinical skill, after all, is the most critical measure of his or her abilities. But communication skills and accessibility matter, too, and who better to give you the lowdown on those details than other patients?
Insurers and others have been forging ahead. Earlier this month, the insurer WellPoint announced that it has teamed up with restaurant-rating company Zagat to launch a new physician rating service for plan members in four states beginning in March. The tool will let people rate their physicians, assigning points for their trustworthiness, communication skills, availability, and office environment. It will join other members-only health plan sites as well as several that are open to the general public, like the recently launched TheHealthcareScoop.com, CareSeek.com, and my personal favorite, RateMDs.com.
Beware, says the AMA's president-elect, Nancy Nielsen. Such sites "add nothing to the quality of patient-physician communication and understanding," she said in a statement. "There is no guarantee that the opinions about a physician even come from that physician's patient—anonymous opinions can come from anyone." Still not convinced these sites are risky? "People may express dissatisfaction on these forums because they wanted a medication that wasn't medically necessary, or because they didn't receive a prescription or service that was delayed or denied by their insurance company," said Nielsen.
Fingers tingling in anticipation, I logged in and clicked around the rating sites, on the lookout for bones being picked and axes being ground. What I found surprised me. People are indeed opinionated about their doctors, and they're not shy about saying what they think. But here's the thing: The majority of online posters—75 percent of those on RateMDs, for example, according to the site's cofounder John Swapceinski—want others to know how good their doctors are. They want to share their great experiences, and they go on at (sometimes tedious) length about their doc's terrific bedside manner and extraordinary skill. "The most wonderful doctor," "never felt rushed," "answered all my questions," "a gem." In fact, sometimes the tributes are so over the top it makes you wonder if maybe the doctors themselves are goosing their ratings. Anonymity, after all, cuts both ways.
With ratings on more than 120,000 doctors and about 400 new ones added each day, RateMDs is the heavy hitter in this arena. Warmed by all the sunny accolades, I searched the RateMDs site for my own doctor, a gynecologist in a medium-size group practice whose clinical and interpersonal skills are top notch, in my opinion. But, dismay! Her rating, based on one review, is "poor." Clicking anxiously through to get specifics, I see that the poster thinks the doctor herself is "fine," but dislikes her practice: "I have never been to a doctor's office that is less accessible and less personal than this place," she posted. Well, she's got a point. It's like Grand Central there, and to the extent that a nurturing office environment is important, that feedback could be useful to both prospective patients and to my physician's business. The comment was typical of the negative reviews I saw: thoughtful and specific, a potential gold mine of useful information for any doctor interested in customer service. (Of course, you can't rely too much on one review, or even several of them. The WellPoint site won't rate a doctor until 10 patients have registered their opinions.)
But doctors aren't focused on what they might learn from the ratings. It seems they'd rather control their patients than listen to them. (One website, medicaljustice.com, even offers doctors contracts to use requiring their patients to get doctors' permission to rate them online.) No one is suggesting that people use anonymous doctor rating sites as their sole means of evaluating a physician. It's critical that people evaluate a doctor based on clinical competence, not just bedside manner. But harrumphing that consumers should shun these sites because they can't verify their claims smacks of medical paternalism. After more than a decade of shopping, chatting, dating, and researching all sorts of topics online, people know that on the Internet what you see is not always what you get. Doctors should give them credit for that.
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Reader Comments
Let the Internet be the Internet...
It's a fact -- in today's world of user-generated content, it's natural to expect "reviews" of pritnear every consumer good and service provider. As long as the review is in the context of a broader picture, and as long as the doctor has the ability to not only respond to the consumer but share his or her own clinical expertise and philosophy of care, then let the Internet be the Internet.
That being said, Michelle Andrews appears to assume that any doctor who doesn’t want ratings does so because he or she has an ulterior motive to hide substandard care. Not so. There are a lot of cranks out there who can seriously damage a physician’s reputation simply because they were kept waiting too long or had an altercation about billing. Any site that takes on doctor ratings needs to keep this in mind…and provide a forum for civil and thoughtful discourse.
Miriam Bookey
Xoova
www.xoova.com
Unbalanced Equations
As per AMA's code of ethics - Doctors are not allowed to advertise in superlative terms - like saying "I am the best doctor in this area for this procedure" etc.
Then why should not the other end of the equation be maintained and not have the world 'rate' doctors saying this doc is better than the other or worst ?
And about "Pay for Performance" for Physicians - its like saying Physicians are allowed to function below excellence but might get paid less ! What ! Are not Physicians required to function at their best anyways ?? Hippocratic Oath ?
Positive Ratings = New Patients
I wonder how many doctors are seeing an increase in new patients due to POSITIVE ratings on these sites.
Evaluating a Dr.
We evaluate all kinds of services from a barber to a mechanic. Why should a Dr. be different?
Often it's about personalities. Hopefully a person should cocentrate on expertise and whether or not the Dr. gives a damn.
Having said that when a patient requests a medication and the Dr. says no they owe it to the patient to give a reason. Not just no. That's not good enough. If they don't answer such a question perhaps they don't know.
A balanced view
Two levels of discernment happen when one reads reviews and opinions, online or off. The first is of the review content: is it plausible, balanced, intelligent and consistent? The second level is the judgment of the reviewer him/herself: does the reviewer sound thoughtful, knowledgeable, credible? As Michelle Andrews suggests, Internet users are experienced in evaluating the content they consume, and just as we have been taught “you can’t believe everything in print”, so do most understand that opinions online are user-generated content.
CareSeek, mentioned above, allows the reviewers to qualify themselves as Doctors/Providers, Nurses/Caregivers, or CareSeekers/Patients when they choose their member type. By allowing others to better understand the perspective with which their review was written, there can be a deeper appreciation of the content and of the reviewer’s point of view. The goal is to present a balanced viewpoint from all participants in the care team, nurses, patients and doctor commentary.
Rating MD's
I'm concerned about this reporting because it's always one and not balanced at all, I understand about venting but I'm not so sure this is the right forum to do it. This has also to do with NON-CONPLIANT Patients, just because they often don't get what they want, they then bad mouth the Physician and ruin his/her reputation. I also understand that Physicians must explain the rational for every plan of care including Meds for each patient and if the patient does not understand the reason for a particular plan of care or a prescribed medication, then I strongly encourage that particular patient to be assertive in seeking the rational from the Physician and in the event that the patient does not understand then get a second opinion or write three or four most pressing question to your Doc on your next visit-remember the time constraints that Doc and patient encounter it's usually 20 min per visit and if the patient has multiple medical problem that's another ballgame- you simply don't have the time. Try Communication it's a two-way street, it'll decrease frustration and confusion-substantially.
Physician Ratings
You article touched to the point on anonymous ranking destroying hard-earned lifelong reputations. Many physicians are besides themselves with the harmful effects of negative ratings. Bad press is probably good for ratemds but certainly not for the individual physicians.
I am working with a new company, <a href="http://www.vitals.com"> Vitals.com</a> that will allow physicians to refute all ratings. A physician portal will give doctors full control on the accuracy of information. Doctors who violate their data are subject to lockout. We are going to attempt to walk the tightrope between consumer and physician satisfaction.
Physician rating sites
It's concerning for any business with a fairly small customer base that ratings could easily be manipulated up or down by someone with an an interest in promoting or disparaging it. For that reason, I'm not sure I would trust star or numerical ratings for a physician, but I'd certainly want to read the comments.
Rating Physicians
I am not surprized that the president-elect, Nancy Nielsen, is less than enthusiastic about the rating of AMA members. The American Medical Association (AMA) is little more than a large labor union/user group that represents the interests, needs, and requirements of its members
-- first and foremost -- not patients. The customer/patient's total medical and administrative experience can be a powerful tool for consumers to evaluate, identify, and select a physician that fits their individual needs. A rating system is a great start!!!
Vitals.com is good
I looked at the site recommended in the commentary thread - Vitals.com. Great site for thorough information on doctors (I learned a lot about my children's pediatrician) and I like how they do reviews and ratings.
medical fraud and melpractice
i was injured at work while employed for the city of norfolk. the ist.doctor said to me, he didn't know if he can help me but he can get me a oscar for acting. then he refuse to see me.the the next doctor told me the bulging disc and the bone spur pressing on my spine was nothing.then said he was sending back to work as a truck mechanic,but refuse to sign my return to work slip required. that caused me to be charged with abanding my job, saying there was no medical reason for me to be out of work. i'm now a retiree as their medical approved my disabilty. it cost me 525.00 a month in pay. also i have deformity in my spinal cord at the same location(c-5-6)level
Rating Doctors & Hospitals
I have been trying to find independent, objective information on several doctors recommended to me for knee relacement surgery. I have been searching the internet with little success other, at best, some cursory information. I plan to look at the web sites in the USA Today article but would appreciate the benefit of your homework and subsequent experience. Last, any comments on research reports that are available for a "fee", care they worth it, do they provide the details you want and need to make informed decisions or are they general in nature? Thanks for you input and guidance.
Richard. Thousand Oaks, CA
Ratings a must
Though the opposition to the ratings are intense specially from the medical community, we should try to understand that this is service just like any other service and it is in the best intrests of the consumer that he gets to choose a doctor of his choice based on performance rather than referrals from his family and friends.
I had written a piece for an Indian Business daily the link to which is below
http://www.thehindubusinessline.com/2008/01/18/stories/2008011850180900.htm
Doctor ratings are helpful
I'm a dermatologist and started the www.DrScore.com physician rating site several years ago. Openness is good for doctors and patients. Few people realize how high doctors' patient satisfaction scores are-- they average over 9 out of 10!
One of the best things about using the Internet to rate doctors is that it gives doctors an easy, inexpensive way to get feedback from patients. Doctors want to give patients great care, and getting feedback is important for achieving that goal.
Without online ratings, the only thing we're likely to read about doctors are the rare incidents where things went badly wrong. Let's get representative information into the public domain. Doctors should be encouraging patients to go online and do ratings, not try to stop it.
Rate doctors, hospitals and all healthcare suppliers
Websites are springing up to fullfill a need. There is no internal reviews or public accountablitity within the industry, they would rather protect everyone that expose the few incompetent doctors.
Internet surfers are savy enough to filter out biased b.s. online and get useful information from the patients reviews, don't believe people who say these sites are wrong because there's no such thing as an incorrect 'opinion'.
Take the rankings a step further and rate your hospital, dentist, nurse, chiropractor, medicine and more at Healthcare Reviews http://www.healthcarereviews.com
Keith Conaway
I would like to know if Dr. Keith Conaway, Shawnee Oklahoma, as pending lawsuits or mal-practice suites pending. My husband will soon be a new patient and we have no information regarding this new doctor.
Doctor Ratings Online
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.
Rating physicians
I think physician information is very imporant. ESPECIALLY information that is not just another creative advertisement for the physician, produced by the medical institution's marketing team.
I also think the exact sub-specialties should be included. Reason: My adult son, who has hydrocephalus, just came home after his 72nd surgery since '98. (yes 72) The initial nsg seemed to have problems with infections, putting the catheter(s) in the wrong place and then making a joke about it, etc. After his last mistake, he ignored all calls and we were advised by the ER staff and one of his PA's that it might be best if we seek another opinion. He has since moved onto another state and is happily practicing while my son is in constant pain and promise of more surgeries.
In the doc's new hospital bio, hydrocephalus is not mentioned. But, after a dozen surgeries, when I asked him about his experiences, he said he had done many surgeries and that my son's surgeries were so easy even a resident could to them. (maybe he got sloppy)
My point, had I known 10 years ago that he did not have enough experience with this condtion, I would NEVER have subjected my son to the pain and suffering he is going through.
If I took my chevy to a mechanic and he lied about his specialty and his lack of experience caused me to have an accident, I could sue him and he would be dealt with. If I asked an electrician to fix my air conditioner and it malfunctioned causing a fire, I could also deal with him. And there is enough information about these specialties - they have no problem letting me talk to other customers, etc.
Why can we not find information about the kinds of surgeries different specialists perform and a report card so we can make an informed consumer decision? I say, let me know what other people have experienced and I will feel safer. Give me credit for having the intelligence to know that someone is just complaining when the best they can come up with is wait time and bad bedside manner. If I were writing a critigue, I would say this surgeon's bedside manner was non-existant (rarely saw him) and he was not proficient in matters relating to hydrocephalus, but I also know he is brilliant with another more complicated brain procedure, as I have met two people who have wonderful success with their cases.
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Just what the doctor ordered.
Feb 01, 2008 11:22:24 AM [permalink] [report comment]