Rate your doctor (why we wrote the story)

Consumer empowerment has reached new heights -- with average Americans weighing in on professors, plumbers, just about everyone. Most people would say that's a healthy trend, one not without perils for individuals but nevertheless empowering for consumers overall. Now doctors are finding themselves subject to such ratings. And they're squeamish.

It's understandable. Physicians are morally compelled to provide care to even the most combative, unreasonable or irrational patients. And what might they get for their efforts? An anonymous attack for all the world to see.

Reporter Shari Roan had been noticing the growing number of doctor-rating sites (RateMDs.com, Vitals.com, DrScore.com and others) at the same time her eldest daughter was telling her how helpful RateMyProfessors.com is for college kids in signing up for classes. "I started thinking about whether the doctor ratings sites were useful, accurate and fair," she says.

What she found was a public hungry for more complete information about the men and women to whom they entrust their lives. Americans don't apparently believe that medical boards, insurance companies or doctors themselves will tell the truth. And so they've turned to each other.

"What surprised me once I got into reporting the story was how emotional many of the comments are," Roan says. "People are really angry, and my sense is that it reflects the state of healthcare in general."

We understand the pros and cons of this trend -- as, we're sure, do readers. The online world is a risky one, reputation-wise and in terms of accuracy. But patients want -- and need -- as much information as they can get when stepping blindly into the healthcare abyss. They also deserve accurate information.

Like it or not, ratings of everyone are likely here to stay. For them to be truly useful, however, our story suggests that more people -- not fewer people -- need to weigh in. Not just with the bad -- but with the good.

-- Tami Dennis

Photo: Ken Hively / Los Angeles Times

Comments

[Dan W.]

I am a frequent poster to RateMds. I find it a very useful public service. If these rating services were not available, then stories like mine :http://adventuresincardiology.wordpress.com/ would remain secret and the physicians and hospitals involved would never be held to account, causing even more unnecessary suggering.

[J. Gatan]

Thank you for writing this story - and please keep writing it. It should go on the Consumerist!

There is a treasure trove of stories out there that can help doctors see themselves the way we patients experience their competence and compassion, or lack thereof. It will also help medical students focus on what's important to learn to become physicians who will make optimum treatment decisions for patients based on the sincere desire to help people and not just to help themselves to the fruits of a lucrative practice.

[Steve Feldman, MD, PhD]

This article hits the nail on the head. Having more ratings is good for patients and for doctors. I've been asking doctors what they thought the average doctor’s patient satisfaction score would be. On a scale of 0-10, they gave answers in the range of 4-6. Some pessimistic doctors said 2 or 3, some optimistic ones said 7 or 8. The actual median score of doctors (with 20 or more ratings) on the www.DrScore.com online patient satisfaction survey website is 9.5 out of 10!

Doctors don’t need to be squeemish about patients rating doctors on the Internet. We've got nothing to hide. In fact, we probably have the greatest collection of physicians of all time! Doctors should be encouraging all our patients to rate us on the Internet.

Doctors spend years in school and then continue their medical education for the rest of their lives. Their lives are committed to providing great medical care. Every day doctors give patients great care, and none of that great care makes the news. Online ratings would let the public see a more representative picture of the great job U.S. physicians are doing every day. We certainly aren’t going to see a pretty picture of medicine in newspapers or TV news broadcasts. Everyday good medical care isn't news-- only the rare horror stories are.

Getting feedback from patients can only help us achieve our goals of giving our patients the best possible medical care. Heck, even if we do get a bad rating from one of our patients, we should consider that a gift, because that patient is giving us the kind of feedback we need to do an even better job than we are doing now. And ultimately, that's what doctors are trying their best to do.

[David Sears]

To the LA Times:

Re: Rate Your Doctor, I'm not squeamish. Review me all you like. I have opinions about my patients, not all positive. You might consider writing "Rate Your Patients" so that feedback could be bilateral.

David Sears, MD

[Maurice Bernstein, M.D.]

My "Bioethcs Discussion Blog" has covered a number of topics which have brought out from my visitors consistently concerns about issues they feel physicians are ignoring or practices that that physicians are unwilling to change. A single example of such a topic has been patient modesty issues (http://bioethicsdiscussion.blogspot.com/2007/12/patient-modesty-volume-2.html#comments)which have ranged from alleged unnecessary patient exposure in the operating rooms to the presence of female assistants or other females present during examination or procedures on a male patients genitals. There is also concern expressed in the lack of availability of assistants or nurses to meet the patients gender requests with a bias of attention against male patients. These visitors find that their experiences are common to the medical practice system and wonder how they can have the medical profession recognize their complaints and lead to some change in the system.

Of course, all the postings are anecdotal and anonymous and it is hard to judge either on my blog or on others to what extent the views expressed are common in the patient population. But the presence and intensity of the views are certaintly worth noting and considering. ..Maurice.

[KLB]

I think a valuable service would be a rate your patient website. I think my privacy as a provider is equally as important. I resent be given some number that defines quality. Medicine is complicated and the outcomes are not always satisfactory. I think being rated like any other consumer product or transaction is insulting and lacks any understanding about the what the art of medicine is about.

[KateNonymous]

It's not easy to learn about doctors. I was lucky to be assigned to a primary care physician who I like very much. He's referred me to a couple of specialists, with varying results. The plastic surgeon (tricky mole removal) was excellent, but I had an unsatisfactory experience with the OB-GYN I was sent to. Although my husband and I had a pre-conception interview with her that went well, it wasn't until I miscarried and required a D&C that we realized how bad she was at providing information. Then, as we talked to co-workers who had recently had children, we learned that a large number of them had also been sent to her, and had also been dissatisfied with their interactions with her--regardless of how successful their pregancies and deliveries were.

I can understand why doctors are leery of this new trend. But as a patient, I know that it's not always easy to gather information about the people who treat your illnesses and perform surgery on you. And that's a lot more vital than whether or not your professor is interesting.

[Elle in FL]

I find the claims that a doctor can be nearly ruined after a negative posting from one patient somewhat difficult to believe. I cannot help but wonder if there were prior complaints that led to such a catastrophic loss of business and professional standing. As for the doctor who says that different rules apply because the practice of medicine is inherently different from other services, he should keep in mind such changes have been produced partly by the advertising of medical care. Once thought to be gauche, it is now commonplace. Inevitably, marketing will encourage patients to approach their healthcare with a different mindset, “shopping” for the product or service that they perceive as best fulfilling their needs and desires.

I used doctor-rating websites for the first time after a medical crisis a few months ago. I went to an ophthalmologist with a corneal ulcer and was berated by one of the rudest and most arrogant people I have ever met. This doctor made an already frightening and painful experience even worse. No, I am not a thin-skinned or sensitive person, and my prior experiences with doctors have been overwhelmingly positive. While in the exam room, I had the distinct feeling that I bothered him because he was not able to treat me and had to refer me to a cornea specialist. Being a relative newcomer to my town, I had no familiarity with his reputation but have since noticed that he advertises very heavily in the local area, specifically offering an array of laser-based corrective eye surgeries. My interpretation of my experience after the fact is that I was a nuisance because I was a genuine medical emergency and not a potential $4000 procedure for a few minutes of work.

My situation was hardly in the malpractice category, but I was treated horribly and was absolutely disgusted by the whole experience. Had I, in my job, behaved in that manner with the people I provide services to, I would have been the subject of immediate disciplinary action.

I agree with the statement that “rate your doctor” websites are not going to stop the bad doctors from being bad, but that was not my motivation as a patient in using them. The objective is to prevent anyone reading them from falling into the same trap that I did. In other words, save yourself some grief and take your business to the competition. Would I have posted had the websites not given the option of anonymity? No. I live in a small town and am aware of the cliquishness of the profession from relatives who work in medical fields and would not want to jeopardize the quality of my future healthcare.

Fortunately, my story ended happily when I changed doctors and found an angel. And yes, I gave him rave reviews on the same websites.

[Gale Wilson-Steele]

The sector most qualified to review doctors may be the nurses and allied health professionals. They have the training to understand clinical competence, they have the perspective of seeing many doctor/patient interactions, and they are patients themselves. The NurseRecommendDoctors site listed has the right idea, since most of us would love to ask a nurse (and do, if possible) whom he or she might recommend for care.

[Phyllis Hollenbeck MD]

As both a patient, and a physician, it both breaks my heart and makes my blood boil when I hear of (or have happen to me) a miserable experience with a doctor. It's why I've written my book, "Sacred Trust: The Ten Rules of Life, Death, and Medicine", and what I'm working to change in the way we teach would-be physicians.

Everyone (patients and colleagues) usually knows who the "jerks" in medicine are, i.e. those doctors who don't seem to understand what the human work is about. We work for the patient, a fellow being asking for help. And I agree that rating websites can help prevent another person from suffering at the hands of a jerk; suffering that they feel in body and soul. The way to do it is to be as specific as possible about the "sins" committed--and whenever possible, practice being able to speak up in person, in the office, to the doctor as he or she commits them. That might even help the person who has the appointment after yours.

[Cheryl]

Some doctors have made devastating errors and really hurt patients and then refused to take responsibility. I speak as a patient in such a situation who tried to have the doctor investigated by the disciplinary board but they did not even start an investigation. In addition, the surgeon that spent 6 years and 4+ surgeries correcting the errors "did not want to get involved."

The "bad orthopedic surgeon" accused me (under oath) of talking him into the surgery. Then he (again under oath) said the reason I kept falling down was that I was an alcoholic! (No evidence and no prior mention I am in fact NOT even a drinker!)

I did not want to hire some professional expert doc for a medical malpractice suit.

Where on Earth does an honest, innocent, injured patient go? Shouldn't the public be warned of this doctor in a public data base? Why do docs protect each other?

My blog on my experiences:
http://advocateyourself.blogspot.com/

God bless the majority of you who are great doctors.

[Ken]

I just had a hip replacement. Unfortunately, I made a bad choice in doctors. He had NO bedside manner. He was totally uncaring about pain he inflicted upon me. He ripped off a piece of surgical tape that was attached to MANY hairs on my leg next to my incision. I let out a OH DARN IT (actually it was a bit stronger than that :) )He says "you don't need to talk that way." Not "I'm sorry", or anything. And this was the day after my surgery!!!!!

He also did not care how much pain I was in after surgery. If it were not for caring nurses (that I found out later, that defied his orders and gave me additional pain meds), I could have shot my self in the head ---- it was REALLY that bad. About a week after my surgery, I called to see if there was a different pain med the doctor could give me. Initially, I got his office assistant, and she passed on the question. She also told me that she had received 5 phone calls that day saying other patients oxycodone was not working for them either. She agreed with me that there might be a bad batch of the medicine being dispensed. It was after hours when I received a return call. It was from one of the other doctors in the office. He said he would call me back, which he did, just a few minutes later. He had called to my doctor, and my doctor said no - take what I had. I could tell the doctor I was talking to was embarrassed delivering this message.

Now, a couple of months after the surgery, I am STILL in pain. It is not as bad as right after the surgery, but enough that over the counter doesn't even touch it. I called for a refill for darvocet (a mild pain medication). I was told I needed to go to a pain clinic - they were not giving me any more medicine!!!! After reading on the web about nerve damage that can occur during hip surgery, I now have to find another doctor to see if the first one messed up. Needless to say, I am posting on every web site that allows you to rate a doctor. This guy is just no good.

vns_flytrap@yahoo.com

[Patient]

It's disturbing how many doctors act as if they are helpless in the face of patients. Just look at the number of physicians commenting here that there should be a "rate your patient" website. For all the education and supposed service doctors provide, it's astonishing how very few are accountable for running their practices as a competent business. Doctors have benefited grossly from the free-market, yet when honestly held accountable and critiqued like any other profession, it is the minority of doctors who act like grown-up professionals. Instead they whine and quibble, childishly suggesting that the solution to the problem is to rate patients in return, give the people who need quality care a "taste of our own medicine" instead. Yet, like the hero needs the villain, isn't it always the patients keeping doctors in the perpetual lime-light as tireless public servants? This is indicative of a much larger, destructive complex that has poisoned the medical "system" and silenced the real victims: the public. Perhaps if the physicians posting here could act like the responsible pillars of our communities that they're treated as and take momentary pause, they would realize that the reason there's no rate your patient website is because doctors are accountable to their patients, not the other way around. As doctors, you made a choice that speaks to privilege that isn't even an option for most and in return for the six-figure salaries, you are in the employ of your customers like any other profession --except the plumber actually remembers her customers' names. The problem isn't that consumers want to take an active part in their decision-making and treatment --the problem is that, as exemplified by the comments made here, there are a vast number of physicians whose thoughtlessness and careless practice is finally being publicized for what it is, and most dangerously, it threatens the complacency of doctors to blame their patients instead of taking action.

[Juliet]

I often wonder whether your experience is affected by your ability to control a situation.
I think when we feel vulnerable and helpless or feel our wishes were ignored or dismissed that we start to feel unhappy....
There are of course, extremes - like blatant sexual assault, insensitive and callous behaviour like leaving a patient naked on a trolley etc...
Within those extremes though...I think it depends on control.
I have private health insurance which means I have choice of Dr and hospital - no one is forced on me...
I feel confident with my GP to ask questions and have even departed from her recommendations for cancer screening after doing my own research.
I think more than ever, patients need to be informed - particularly with cancer screening (risks and benefits) and getting second opinions before agreeing to surgery or other procedures.