Why Public Health

Want to know why public health is important? Take a look at this great infographic that details exactly how public health has transformed society: Go to the infographic.

In a January 21, 2013, issue of Forbes magazine, entitled “Why Rating Your Doctor Is Bad For Your Health,”  Kai Falkenberg described a downside to doctor rating, doctors giving patients care that the patient wanted but that the doctor didn’t think was needed, or worse, that was even harmful.  The article suggested that doctor rating may at times drive doctors to lean to heavily toward patients’ and their families desires, even when it wasn’t in the patient’s best interest.

It’s an interesting issue.  First, this article point out the power of doctor ratings to change doctors’ behaviors.  Presumably, there’s an upside to this, encouraging those doctors who are not fully meeting their patients’ needs to more fully address patients’ concerns from patients’ perspectives. For the most part, one would think that’s a good thing. 

Is it possible that doctor rating goes too far?   It is certainly true that more testing, more drugs, & more hospitalization are not always in patients’ best interests, and it may be — frequent or not — that some patients want and expect more treatment than they really need, more than would be beneficial, even so much that it would be harmful. 

Who should choose?  Is it better to have a system where the doctor takes responsibility for the final decision without pressure for not following patients’ wishes?  Would a system where patients decide — supported by a doctor who educates and provides counsel — be more appropriate?  The answers to these questions may come down to perspective, perspective shaped by concerns for patients’ autonomy, for their protection (even from themselves), and the costs of health care decisions and who is paying for those costs. 

Ratings can give doctors important feedback on how they are serving their patients’ needs (as seen from the patient’s perspective).  Overall, doctors have strong patient satisfaction ratings (on average, well over 9 on a 0-10 scale on www.DrScore.com), and a caring doctor who educates patients and gives them wise counsel is sure to have exceptionally good overall ratings.  What should a doctor do when a patient demands something that the doctor cannot ethically provide?  Should fear of a bad rating cause a doctor to mistreat a patient?  Obviously not!  In the instances where this is an issue, doctors should suck it up, stand tall and provide the best possible medical care, not worrying about one low rating among so, so many high ones.  The solution isn’t to give up doctor ratings but to encourage them, so that a fuller and more representative picture is publicly transparent.  The Internet has made this a part of the future of our health care system.

Listen to a podcast interview with DrScore CEO, Steven R. Feldman, MD, PhD, at Medical Author Chat, in which Feldman discusses his recent book, Compartments.

DrScore CEO Steven Feldman, MD, PhD, was recently interviewed by the patientslikeme blog about patient satisfaction, psoriasis and adherence. Read the full interview.

Health Outcomes Research in Medicine, a leading medical journal that focuses on patient care and treatment efficacy, just listed the 25 most downloaded articles from their website, http://www.healthoutcomesresearch.org, and DrScore’s research on patient satisfaction in outpatient populations is currently the top article. The article uses DrScore’s deep database of patient satisfaction data to examine patient satisfaction with outpatient care in the United States. Co-written by DrScore CEO Steve Feldman, MD, PhD, and DrScore research head, Rajesh Balkrishnan, PhD, the article was published by Health Outcomes Research in Medicine in 2011. Read the article online.


When we look at doctors who have a lot of ratings, it isn’t unusual to see lots of high ratings and an occasional low rating.  The average score of these doctors is very high.  But if you took a whole lot of doctors like that and they only had one rating each, the average would still be the same, but there would be a lot of doctors with one 10 and a few with one zero.  The score of those doctors who have just one low rating obviously isn’t representative of their practice.  What could be done about this?  Well the answer suggested by some people is not to show ratings when there are few or to get rid of doctor ratings online altogether.  We think that people are smart enough to interpret the scores if they are told how many ratings there are.  When doctors have just one low score, rather than throwing it out or hiding it, we encourage them to ask a few patients to put ratings in.  That way, a more representative score is there for people to see.  Moreover, we should always keep in mind that the detailed feedback that comes with a low score can be a gift to the doctor, giving the doctor valuable feedback on the concerns of one of their very few unhappy patients, hopefully the kind of feedback that will help the doctor not have unhappy patients in the future.

At one of my recent talks, a doctor expressed his concern with the evolution of systems that will begin rating the quality of doctors. He described how if a very sick patient is transferred to his care and the patient dies—for reasons totally beyond the doctor’s control—it would cause his quality score to look very poor. I empathize with his concerns. Assessing the quality of doctors’ treatment results will be highly dependent on the ability to control for the baseline severity of patients’ illnesses—what is called “risk adjustment.” With the complexity of human physiology, psychology, and sociology, it will be very difficult to adjust for the impact of those characteristics on doctors’ results.

DrScore reports how happy patients are with their doctors. Are these patient satisfaction ratings equally difficult to interpret? While there may be some variation in the population at how likely a patient would give a 10 or a 0 on a rating scale, overall, patients are accurate reporters of how satisfied they are. And whether patients have a mild disease or a severe one, if they have family support or they don’t, if they take their medications well or not, or if they have a host of other co-morbid illnesses or are otherwise well, they should still have an experience with their doctor that leaves them satisfied with the care they are getting.

Happy New Year

Happy New Year. Time for new year’s resolutions. Let’s resolve to do our part to make American medical care the best it can be. You can help today by giving your doctor the feedback he or she needs to do what they most want, to give their patients great medical care. Go to www.DrScore.com today and complete a brief survey on your experience with your doctor.

Selection Bias

It is hard to put terrible tragedies in perspective.  While the magnitude isn’t the same, this principle applies to doctor rating, too.  There are 2 to 3 million office visits to physicians in the United States every day, some 800 million per year.  How many make the cover of the newspapers?  Fortunately, no more than a handful make the newspaper cover, but each one in that handful represents some tragedy that may leave people feeling there is something “sick” in our medical care system.  Perhaps it is a pediatrician who abused children.  Or a hospital that killed a patient by giving the wrong blood.  Those horrific events are tragedies, but they aren’t representative of the millions of office visits that occur each day which don’t make the news, visits that are invisible because everything went fine, normal visits that weren’t newsworthy.

Doctor ratings websites like DrScore give the public a means to begin to see those invisible visits, to realize that the great majority of patients are happy with their doctors.

States across the country are facing budget crises.  With health care spending being such a large part of state budgets, cuts to health care expenditures are surely coming.  Arizona has proposed a number of measures to cut costs.  One is a fee charged to Medicaid-enrollees who engage in unhealthy activity.    Another is to cut  payments for organ transplantation.  In Physician Practice magazine, editor Bob Keaveney decried the cuts.

Keaveney makes good points about how so called “death panels” in the health care legislation were bogus but that real death panels are happening when states decide not to cover organ transplants. But can we continue to pay for everything?  Probably not.  At some point, we have to recognize that paying for those transplants comes at the cost of not paying for other things we’d like to have.  The people who have to make these choices are not in an enviable position.

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