Consumer Doctors

By Jim McVeagh 26/07/2010


Found this in my e-mail today

Hi Jim,
I remember reading a while ago that you thought a medical ratings website might be a good idea. Well found this on trademe forum the other day, looks like its going to be a reality?
http://www.medrate.co.nz

Thanks
Steve

Sadly for Steve, I am generally not that much in favour of medical rating sites. In November 2008 I was mildly supportive of such a site. However, seeing how they have panned out overseas, I am now firmly of the opinion that they do not serve the purpose for which they were intended; namely, giving the public sufficient information to determine a suitable doctor to visit. I can think of four distinct reasons why these sites fail in this endeavor.

Firstly , they tend to become forums for the disaffected only. People with an axe to grind are far more likely to write on such sites than people who get good service. It is therefore uncommon for such sites to provide any worthwhile data, simply because most doctors have irritated at least SOME patients. As I pointed out in my 2008 post on this subject, most people gravitate towards the negative opinions, immediately colouring their view of the doctor. Imagine choosing a doctor despite a single negative horror story about a missed breast tumour (all the other reviews are good). After a year or so of excellent service from this doctor, you suddenly discover a breast lump. Do you suddenly start to distrust your doctor’s judgement. What is the consequence to the doctor-patient relationship of your sudden lack of trust? Can this doctor continue being your GP?

The second problem is that, while some people appear to have a genuine medical grievance, the vast majority of dissatisfied patients are unhappy because of personality clashes with the doctor or disagreements with the doctor that have nothing to do with clinical problems (like being made to wait, being charged “too much”, not being given certain drugs etc.). People are genuinely ill-equipped to judge medical expertise. A doctor may be a better clinician and say “no” to your script for antibiotics for your viral infection. You then go to another who gives you the script, inappropriately. Yet your report on the site may be that the first doctor is bad and the second good. This is not to say that people do not recognise clinical expertise, but that that assessment of expertise may be coloured by the patient’s often unrealistic expectations.

Thirdly, medicine is not an absolute science. It not only requires a degree of skill but also, to a certain extent, a degree of luck. Nobody wants to hear about the “but for the grace of God there go I” moments, but every doctor has a story of a patient that was treated completely by the book and still developed rare and terrible complications. In fact, my experience is that it is often patients for whom you go the extra mile, who do the worst. It would seem manifestly unfair to blacken a doctor’s name when the complication was both unforeseeable and unpreventable by NORMAL medical management (I stress “normal” because often some whizz-bang doctor with 20/20 hindsight will attempt to tell a patient that this could all have been prevented by this <insert non-standard, esoteric and expensive test here>).

Lastly, there is always the ugly possibility that some person may wage war against a doctor’s reputation, not for any of the reasons above, but purely for personal reasons. I have heard of an ex-wife assuming multiple internet identities and blacklisting her ex-husband into oblivion.

There are, of course ways that these problems could be addressed – including allowing a separate professionally-assessed database and logging MAC addresses to ensure no-one can duplicate entries. But, in reality, there is no particular need for such a site in New Zealand. We are a small country with a small community of doctors. If you really want to know who is a good doctor in your area you just ask around. Ask the local hospital nurses. Ask the local physio. Ask your neighbours. Chances are the nurses and physio will tell you the best clinicians and the neighbours will tell you who is the nicest. Pick one who is in both groups and you will probably be happy.

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  2. Medical Ratings
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