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Posts Tagged ‘physicians’

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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A very nice blog post described the difficulty in getting some doctors to recognize the importance of measuring patients’ satisfaction.  The blog post differentiated patient satisfaction from “clinical quality.”

While the blog post was right on the mark in many ways, differentiating patient satisfaction from quality of care may be a mistake.  Patient satisfaction is a critical dimension of the quality of medical care.  Sure, making the right diagnosis and prescribing the right treatment are essential elements of good medical care, but patient satisfaction is an essential element as well.  To achieve great medical care, patients must feel cared for.  The way to find out if that’s being achieved is to ask them.

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Suppose there was a story in the newspaper with a headline like this:

Pope calls for an end of Internet posting about rogue priests

And let’s suppose the article went on to say something like:

After meeting with the Council of Cardinals, the Pope called for ending Internet postings about rogue priests.  The Pontiff’s spokesman said that the Pope and the Cardinals agreed, after seeing a profusion of websites rating priests and posting comments about problems in the Church, that such posting was not only defamatory to priests and the Church but also unfair because priests were not permitted to respond to the postings or even to acknowledge that the poster was a parishioner.  The Pontiff’s spokesman decried the fact that only unhappy Catholics were posting material about their priests, giving people a very biased perception.  As a solution, an American Cardinal has suggested that the Church might try having church-going parishioners sign a contract in which the parishioner would agree not to post online any material about the priest or their church service.

Of course, this is just an exercise of the imagination.  But it is an interesting  to consider, particularly because many doctors have espoused contracts with patients as an answer to the “problem” of Internet rating of doctors.

The Internet is a tool, a powerful tool, which massively expands people’s ability to communicate, transmit and spread information and disinformation.  Doctors are rightly concerned about their reputations and the potential for Internet posts by patients (or by people claiming to be patients) to wrongfully accuse doctors of malfeasance, incompetence or greed.  But the genie is out of the bottle.
Doctors need not give up hope, however.  The Internet is an equally powerful tool to let the public know about the real quality of care that doctors are giving patients on a day-to-day basis.  By encouraging patients to rate their doctors online, doctors can give the public a much more representative view of what American medicine is like.  Doctors devote their lives to the quality of care they provide patients.  There’s no reason to hide. In fact, proposals to limit the public’s ability to communicate their experiences with their physicians are counterproductive, only making it look like doctors have something to hide.  Embracing online rating will help increase public awareness of the dedication of physicians to their patients.

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Research from DrScore demonstrates that physicians with more reviews have significantly higher ratings.

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DrScore has released the 2010 Annual Report Card on Patient Satisfaction. You can find the press release at BusinessWire or read it below:

Doctor Reviews: Physicians Who Have More Reviews Have Significantly
Higher Ratings, Reports DrScore

Online doctor rating website releases its 2010 Annual Report Card on Patient Satisfaction

WINSTON-SALEM, N.C. (Jan. 18, 2011) – Doctors should not fear reviews and ratings; in fact, they should embrace them and proactively ask their patients to rate them, according to data from DrScore.com’s 2010 Annual Report Card on Patient Satisfaction. DrScore researchers found that doctors who had 10 or more ratings on the website had an average rating that was two points higher than the average rating of all doctors on the site.

“For 2010, the average rating for physicians across the site was 7.1,” said patient satisfaction expert Steve Feldman, M.D., the founder of the online doctor review site DrScore.com. “However, doctors with 10 or more ratings had an average score of 9, and doctors with 20 or more ratings had an average score of 9.1 — a significant increase.”

The Annual Report Card is based on the results of more than 54,000 ratings by patients who completed a patient satisfaction online survey to review their doctors at DrScore.com during 2010. This year’s Report Card also showed that while the average rating for all physicians decreased slightly from 2009 to 2010, (7.4 to 7.1), it increased for those physicians with 20 or more ratings — from 8.9 to 9.1.

“Doctors who have a higher number of ratings are getting more representative scores, and they are probably more attuned to patient satisfaction,” Dr. Feldman said. “Instead of having one patient who may be frustrated or angry go fill out survey, these doctors are most likely asking all of their patients provide feedback. That means the happy patients are being heard, too — not just the ones who have a problem.

“We hope that doctors will see these scientifically verifiable results and start proactively asking their patients to go online and complete a patient satisfaction survey,” Dr. Feldman continued. “Doctors are doing great work, and the majority of patients are happy — it’s information that often gets lost in the news cycle.”

By asking patients to rate them, doctors are also providing better information for consumers/patients, so they can make more informed choices. “Obtaining more physician ratings is better for doctors and better for patients,” Dr. Feldman said. “It’s a win-win.”

As in years past, the Report Card found that wait time was an important indicator of patient satisfaction. Interestingly, this year’s survey found that seniors (65+) have become less tolerant of long waits. When they had to wait an hour or more for the doctor vs. 15 minutes or less, they experienced a 37 percent drop (compared to 2009’s 27 percent drop) in their average satisfaction rating.

“In 2009, the data showed that younger patients placed a greater emphasis on waiting time with regards to being satisfied with their doctor visit, while those over 65 were more forgiving,” Dr. Feldman said. “However, that gap has closed. This year, the 37 percent drop for patients 65 and over was extremely close to the 40 percent drop for patients 34 and under.”

For 2010, researchers at DrScore.com also evaluated differences in patient satisfaction between men and women, but found the data surprisingly comparable. The only slight differences were how men and women weighted certain aspects of care. In general, men tended to rank treatment success and treatment follow-up as more important relative to other aspects, while women ranked thoroughness and friendliness higher.

According to DrScore data, there are two issues that can destroy patient satisfaction: long waits to see the doctor or a visit with the doctor that is too short. “If the doctor is running late and keeps the patient waiting, he or she should explain the reasons for the delay and take plenty of time with that patient so the patient knows the doctor cares,” Dr. Feldman said. “In addition, it’s important that doctors provide a way for patients to give feedback.”

Dr. Feldman suggested several ways doctors could increase their patient feedback:

  • At the end of the office visit, ask patients if they have any questions or would like to provide any feedback about the physician, staff or office.
  • Give patients a card asking for their feedback and directing them to an online doctor review site such as www.drscore.com.
  • Provide a link to an online doctor review site such as http://www.drscore.com on the home page of the practice’s website with an invitation to “Give Us Feedback!”

“At DrScore, we believe that to provide the best care possible, physicians need patient feedback via balanced, validated, online patient surveys,” Dr.Feldman said. “Great medical care is about more than just providing the right diagnosis and the right treatment, and doctors need patient feedback to actively improve their quality of care.”

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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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