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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.

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.

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