Thursday, February 19, 2009

Rating Doctors

The blogs and twitters are alive with commentary both good and bad on the concept of rating doctors. It all seemed to be triggered by a NY Times article: Restaurants Brings Its Touch to Medicine that discussed briefly the concept of developing a ratings system for doctors.
Now the editors are asking people covered by one of the country’s largest commercial insurers to post reviews of their doctors and rate them in categories like trust and communication. As in other Zagat guides, the responses are summarized and presented as scores that, in this case, are edited by the insurance company WellPoint. They can be viewed only by WellPoint customers. The reviews are being introduced online to millions of WellPoint’s Blue Cross plan members across the country.
Many folks jumped in - I tweeted the article and Paul Levy Blogged the conundrum which generated a veritable avalanche of comments including my own both positive and negative. e-Patient Dave (I still have not received an answer to where he keeps his time machine to cram 33 hours into a 24 hour day!) weighed in
I don't know how it'll all shake out. Being publicly judged by others is challenging at first; I've come to accept that some people are crazy and there's no accountin' for tastes, let alone the variability of provider or reviewer having a bad day.
and the justifiable concerns (this from Lachlan Forrow MD FACP)
...but if we develop systems that make it easy for any unhappy patient to post for the world her/his unhappiness and name my name, that would be a serious threat to my morale, and while it might not make me actively avoid patients I thought might express their unhappiness (though it might) it would almost certainly have reduced my energy for actively seeking out “difficult patients” because I found the challenges and occasional rewards had satisfactions that outweighed the frustrations.
But I think anonymous said it best for me:
Ratings are coming: On the web nobody needs your permission or approval to set up a ratings system. If it seems unbiased, fair and rates the things people care about it will get traction.
Do you want to help steer the bus or get run over by it?
I agree and here is what I said

  1. We have to start somewhere and adapt as we learn more about this concept
  2. It is currently being done anyway and with little consistency or transparency
  3. Like it or not much of the rating is about the overall experience, not so much the care or the doctor but the decor, cleanliness, friendliness & helpfulness of the staff, the quality of the food..... to quote a recent discussion with a specialist radiologists in cancer care "the value measurement has changed: it used to be measured based on whether you were carried out in a box or walked out, now we are so much better and more successful the measure of success is about everything else, food, decor, the linen"
  4. Having seen some of the shocking comparisons of success/failure rates in different hospitals for the same conditions even taking account of a different case mix I would definitely want some indicator on quality/comparison to help make my choice for obtaining what I believe to be the best care for myself and my family.
So lets get over it and get the ball rolling - the beauty of rating systems is that the community is self policing and correcting. Outlandish claims that are out of sync with the majority are quickly identified and squashed and attempts to manipulate the system are discovered and exposed quickly.

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