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Writing in USA Today, Dr. Kevin Pho, author of the KevinMD.com blog, described how he thinks online doctor rating can be made better.  His first suggestion is for doctors to encourage patients to do online ratings.  I could not agree more.  By getting more data on doctors into the public realm, patients will get a more accurate picture of how well doctors are doing.  Patients will also be giving doctors the feedback doctors need to give patients the best possible care.

Dr. Pho’s second suggestion is to prohibit anonymous ratings.  Here, I have to disagree with the good doctor.  Letting patients make their comments anonymously gives patients the freedom to give honest—both positive and negative—feedback without concern for reprisal.  Doctors need honest feedback, and the relationship between patients and doctors can be so intimidating for patients that they may not feel comfortable giving open feedback if it isn’t anonymous.

I appreciate Dr. Pho’s concerns about the downside of anonymity.  There are benefits and risks.  Given what we’ve actually seen from ratings on DrScore, the benefits far outweigh the risks.  Despite Dr. Pho’s concerns about the potential for ratings to be manipulated by patients with a grudge, the average score of doctors with 10 or more ratings is well over 9 out of 10.

Let’s encourage all patients to rate their doctors.  Any grudge will be drowned out by having more representative sampling.

In 1999, the Institute of Medicine reported big risks in American hospitals.  Since then, there have been dedicated efforts to reduce those risks. Are things getting better? A recent New England Journal of Medicine article says no. You can more about the study with its author, Dr. Christopher Landrigan, on Getting Better Health Care.

Ipilimumab

The FDA approved a new drug, ipilimumab, for patients with metastatic melanoma.  Advanced melanoma is a terrible condition for which there is little in the way of effective treatment.  Ipilimumab clearly improves outcomes of this horrible disease with improvement in median survival from 6 months to 10 in patients with advanced melanomas.

While the 6 month to 10 month median improvement is nothing to sneeze at, it isn’t a very high cure rate.  And the cost of the drug: over $100,000 for a course of treatment.  Is it worth it?

If I had advanced melanoma and a 3rd party way paying the cost of my medical care, I would say it was worth it.  If I were paying myself?  I’m not so sure.  The high, high cost for drugs that provide marginal benefits is illustrative of the main problem with have with U.S. health care.  Health care reform efforts that don’t address this central problem are going to solve our crisis.  To learn more, visit http://www.drscore.com/downloads/Health_Care_Primer.pdf.

Doctor attire

Satisfying patients is not just about making the right diagnosis and prescribing the right treatment.  Patients need to know they are seeing a friendly, caring, professional physician.  But how do patients know?  It’s complicated.

Patients’ perceptions are affected by all sorts of variables.  Researchers reporting in the Archives of Dermatology looked at what kind of dress patients expect from their physicians.   It’s a moving target, changing with our culture.  Ties and white coats—traditional doctor attire—aren’t uniformly recognized as needed any more.  Some patients, especially kids, can do without them.

Still, physicians will do well to wear dress that communicates to patients the doctor’s professional, caring approach to patient care.

From Massachusetts’ plans to revamp medical spending to the Republican controlled U.S. House plans to change Medicare spending, there are efforts to move from a health care system that pays for services to one that pays for quality services.  To learn more about practical ways to improve health care delivery by changing incentives, listen to Dr. Mark Fendrick, Co-Director of the University of Michigan Center for Value-Based Insurance Design, talk about how value-based insurance can incentivize patients to seek out better health care at lower cost on Getting Better Health Care.

Concierge medicine

More doctors are choosing to practice “concierge medicine”.  What is concierge medicine?  Concierge doctors care for a limited number of patients who agree to pay an annual fee in return for better access to the physician and more time at doctor visits.  On the one hand, this is great for the patients who can afford it and want better service; on the other hand, there is concern this will take away from patients who can’t afford better service.

For now, concierge medicine isn’t very common, though it is growing fast.  As insurers pay doctors less, more doctors may choose to offer concierge services to patients.  Whether this is good or bad depends on the eye of the beholder, but it is a natural and expected result of a medical care system that has a third party paying for care.

There’s uniform agreement something needs to be done about the rising cost of U.S. health care. The issue has become an acute problem, even for military effectiveness. That’s right. American military leaders testified to Congress about how high health care costs are gobbling up the military budget and threatening military readiness. To learn more, listed to military budget expert Todd Harrison, Senior Fellow for Defense Budget Studies at the Center for Strategic and Budgetary Assessments on Getting Better Health Care.

American Medical News reports that patients would pay their medical bills more quickly using the Internet (Dolan PL, Patients say they would pay more quickly with online access).  This isn’t surprising to us at DrScore.  Facility with the Internet is rapidly becoming ubiquitous.  Patients recognize the potential of the Internet to facilitate all kinds of transactions.

At DrScore, we’ve recognized for years that the Internet can also be used to facilitate getting feedback from patients.  By sending patients a link to DrScore with the bill, physicians can seek feedback from every patient, letting each patient know their opinions are respected, getting the kind of detailed feedback doctors need in order to know how well they are doing and what they can do even better.

Just as online access can ease billing issues, the hassles, costs and limitations of paper-based or telephone-based patient satisfaction surveys can now be avoided.

What’s right and what’s wrong with the U.S. health care system? Does it need a major overhaul or a few tweaks?

In a two part episode, I discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Dr. Berenson describes how incentives need to change to get control of our medical costs.  You can hear both of these episodes and others on my online podcast radio program, Getting Better Health Care.

A title like “Computer bests humans in skin infection diagnosis,” is sure to get my attention.

Can computers beat doctors in actually providing medical care?  A recent study was reported as showing that “a computer program diagnosed a serious skin infection more accurately based on symptoms than emergency room physicians.”

Cellulitis is a deep skin infection that may be erroneously diagnosed in patients who have allergic or irritation reactions in their skin.  Investigators from Rochester, N.Y., and Los Angeles, Calif., evaluated  patients who were hospitalized for cellulitis by emergency room physicians. Dermatologists and infectious disease specialists found that 28 percent of the patients had been misdiagnosed and did not have cellulitis.  The admitting senior residents were asked to make a list of the possible diagnoses of these patients and to input characteristics of the patients’ conditions into a computer program that provided a computer generated list of possible diagnoses.  The investigators found that the computer listed the true diagnosis more often than did the resident physician.

The study does provide some evidence that a computer program may help some non-specialist physicians come up with a more comprehensive list of possible diagnoses than they would on their own.  The authors of the study concluded that the technology “has the potential to direct providers to more accurate diagnoses.”  They didn’t mention that having longer lists of possible diagnoses means that the technology also has the potential to direct providers to more inaccurate diagnoses, too, and that doing so could result in needless testing.

This study relied upon the expert skills of human physicians to make the gold standard judgments about whether patients had cellulitis or not.  While the computer program could help clue some doctors in to possible diagnoses they may not have considered (both accurate and inaccurate possible diagnoses), patients ultimately still depend on the good judgment of their physicians.

At DrScore, we’re excited about using digital technologies to improve medical care.  Giving doctors feedback from patients and making medical care quality more transparent are surefire ways to enhance care. But computers are not beating, besting or replacing doctors just yet.

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