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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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