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Posts Tagged ‘DrScore’

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.

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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.

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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.

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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.

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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.

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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.

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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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