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Posts Tagged ‘online physician ratings’

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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One of the benefits of online doctor rating — a benefit to patients and doctors — is a transparency of medical care quality that will help people identify the bad doctors, the uncaring ones, the ones who, according to some patients, you wouldn’t send your dog to. Patients aren’t the only ones who know about these doctors.  Doctors know about them too. They have seen patients who were seen by these colleagues, and all of those patients were unhappy with the care they received.

I know that online doctor rating isn’t going to find many such doctors.  In fact, quite the opposite, online rating of physicians is going to show there aren’t nearly so many “bad doctors” out there as people think there are. Let me explain.

I’m a practicing dermatologist.  I see patients who have seen another dermatologist in town, maybe a dozen or so of that doctor’s patients.  Every one of those patients was unhappy with the care they received, and none of those patients received treatment that cured their condition.

Now that’s clear evidence the other dermatologist didn’t know what they were doing, right?

No, not right.  You see, every time that other dermatologist clears up his or her patient’s rash and gives his or her patient a medical care experience the patient is happy with, that patient continues seeing the other dermatologist and doesn’t come see me.  I  see that doctor’s outliers, the occasional patient who, for whatever reason, didn’t get better or who was unhappy.  I’m sure that the other dermatologist sees a few of my former patients too, only the ones whom I didn’t cure, only the ones who were unhappy with me.  Our observations give us a misleading picture of other people.

Well what about those doctors whose patients post comments like, “I wouldn’t send my dog to that doctor?”  That kind of comment does happen, and, sadly, I’m sure that’s the true opinion of the patient who makes that comment.  But those comments are generally not anywhere close to representative of what the vast majority of that doctor’s patients think.  I get comments like that at times (thankfully less often than I used to, having learned from patient satisfaction feedback what I was doing wrong).  I’ve been rated over 500 times on DrScore.com.  The average of those scores is 9.1 out of 10 (not bad, according to my mom).  Still, occasional patients give me a 0 or a 1 for their experience.  I know they may think everyone gives me a 0 or 1, that I’m a “bad doctor,” but the great majority of my patients think I’m a 9 or 10.  So far, that’s true for all the doctors with just 10 or more ratings on DrScore.

There may be “bad doctors” out there, but I suspect they are incredibly rare.  There weren’t any in my medical school class, and I have yet to meet one in person.  If there are any, I hope we do smoke them out with online ratings.  If they exist, maybe the online scrutiny will wake them up to the need to improve the quality of care they offer.

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A simple solution — greater transparency for all.

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An e-mail arrived from a marketer offering to help market my medical practice.  The message talked about how the Internet can be good or bad, how doctor rating websites can negatively affect a practice, and how this marketer has solutions for how to put the Internet to better use.

I have a solution, and it’s really quite simple.  Doctors should be encouraging their patients to do online ratings.  Doctors are doing a great job for their patients.  What doctors need is transparency: We ought to encourage patients to do online ratings so that the public sees the great quality of care that doctors are providing.

On the DrScore.com rating site, the average score of a doctor with 20 or more ratings is 9.3 out of 10!  There’s no reason to want to hide that.

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Medicine is a science, but it is also a highly personal experience.

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I noticed on the back of a banker’s business card it said:

“Reliable, responsive, empathtic and competent service.”

We docs are trained to give competent service: the right diagnosis, the right medicine and skilled surgery.  But like the customers in a bank, our patients also deserve our attention to reliability, responsiveness and empathy.

Yes, medicine is a science, but it is also a highly personal experience.

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I have two amazing colleagues who specialize in skin surgery.  I send many patients their way, and uniformly those patients return telling me how awesome my colleagues are.

Just the other day, I asked one of these patients what was so special.  He said they were terrific, that everything about their office was terrific, that their nurses were terrific.  He loved the way they carefully explained everything they were doing and how the nurse held his hand during the procedure.

I’m sure the surgery was good, too, but what this patient noticed, what all patients notice, is personal care. If your physician provided great personal care for you, please tell him or her. Go to www.drscore.com and take the quick online survey to rate your physician.

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Make sure you check out the Getting Better Health Care Radio Program on webtalkradio.net. My latest interview is with Dr. Nancy Oriol, founder of the award winning Family Van program in Boston. She tells us about the barriers to accessing our health care system and how reaching out to the community can help reduce those barriers.

Want to reduce your health care costs? Don’t miss my interview with Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare.   She tells us how we can save money on preventive care, including information on which screening tests we need and which we don’t.

The previous show with David Coates talks about the politics of making needed changes in our health care system.

Another show not to be missed is the interview with Dr. Sandra Kweder, Deputy Director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.  She explains what the FDA does to assure that marketed drug products are effective and safe.


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Doctor patient communication

The Archives of Internal Medicine reports that communication between doctors and patients isn’t always what it should be.  The study of 89 hospitalized patients found:

  • Of the 73% of patients who thought there was 1 main physician, only 18% could name the physician
  • Only 67% of the physicians thought patients knew their names
  • Only 57% of patients knew their diagnosis
  • Only 21% of physicians said they always provided explanations of some kind
  • 90% of patients getting a new medication said they were never told about any side effects

The researchers concluded that steps to improve patient-physician communication should be identified and implemented.  Boy, is that an understatement!

To start, perhaps doctors could leave each patient a business card with the doctor’s name on the card.  That would help patients know their doctors’ names.  Even better, have a line on the card where the diagnosis could be written.  I’d include the doctor’s cell phone and e-mail address to help enhance communication between the doctor and the patient and their family.  And perhaps the doctor ought to have a checklist of things to do so that whenever a new prescription is given, the patient is given a written explanation about the medication, including the potential side effects to look out for.

Of course it would help for every patient to be given the opportunity to give their doctor feedback through a system like www.DrScore.com to identify these kinds of problems and solutions to them ASAP.  A “Please give me feedback at http://www.DrScore.com” would be a nice addition to that business card.

We are so invested in improving medical care, with billions and billions of dollars going to the development of new treatments that may someday help someone.  Just a little common sense and some inexpensive solutions could be done right now to enhance the care that most patients receive.

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The AMA and 47 state medical societies authored a letter to insurers about the unreliability of “claims-based” doctor ratings. Claims-based studies use the billing information doctors send to insurers to assess the quality of the care that is delivered. The AMA letter cited studies by the RAND Corporation showing the limitations of these studies.

The AMA hasn’t offered a better way to assess the quality of care doctors provide. Measuring the quality of medical services that doctors provide is extremely complicated, especially because we want doctors to tailor treatments to each patients’ specific needs, preferences and desires.

One aspect of medical care that may be most easily measured is patient satisfaction. This is what we measure and report at DrScore.com.

Patients always know how satisfied they were with their experiences, and there’s growing recognition of the value of patient satisfaction measurement. Government reimbursement programs covering health care may soon require patient satisfaction measurement. The medical boards that certify physicians may require doctors to document and report results of patient satisfaction surveys, too.

This is good news for doctors. Doctors give patients great medical care, and open reporting of that quality is bound to help the public see what a good job physicians are doing.

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