Wednesday, October 27, 2010

Kevin's thoughts about online MD ratings

Kevin Pho, MD, has a thoughtful article in USA Today about online ratings of doctors. Here are a few excerpts:

There are some good reasons consumers should be wary of the information they find online about doctors.

Most publicly available information on individual physicians — such as disciplinary actions, the number of malpractice payments, or years of experience — had little correlation with whether they adhered to the recommended medical guidelines. In other words, there's no easy way to research how well a doctor manages conditions such as heart disease or diabetes. That kind of relevant performance data are hidden from the public.

Objective performance data, such as how often doctors appropriately screen patients for cancer, or how many of their patients meet blood pressure or cholesterol targets, are often not revealed. They need to be made publicly available.


The Ratings Guy said...

Oh, come on! What's to be wary about? First, the requisite information that YOU think should be available isn't what patients or consumers think should be available. And since it isn't, THAT is what we should be wary about, why not?
Second, over 30 million consumers search for physician information each month. The popular Web sites see up to 7 million unique visitors each month, so they must be doing something right, n'est pas?
Third, having disciplinary action, ABMS Board Certification, malpractice information, languages spoken, office information including maps, directions, office hours, insurance accepted, accepting new patients, a picture are all useful tools when someone is selecting what SHOULD ALREADY be a qualified doctor. Would you see a physician specialist with a drug problem or nasty office staff?
I think it is the ASSUMED point that you bring up that worries me the most. So, doctors think we as consumers should be aware of cancer screening rates, etc etc? You mean doctors don't ALL comply with national guidelines? What should we be wary about?

So until doctors post their own performance on sites that allow physician input such as ( then we as consumers, patients and the income stream to practices and hospitals will use what we can get our hands on.

Quite frankly, most reviews, like HCAHPS ARE positive, so there is nothing to fear monger about those few patients with a grudge.

But "crowdsourcing" insights about what really makes for a good patient/physician relationship from other patients is a reasonable way to enhance the pre-qualification process. After all, it happens across the garden fence right now...and doctors know that.

I am not disappointed by what I see, and since it isn't available on physician, hospital or yellow page Web sites...and most of it is free, what is to criticise anyway? I think the good doctor needs to wake up to transparency.

Engineer on Medicare said...

My experience with PCPs (I have had bad and good) is that the the level of care is greatly affected by the degree to which the patient (in this case me) drives the relationship.

I am on statin and hypertension control program. I see my primary every 6 months. I hand him a sheet with all of the prescription and non-prescription meds(vitamins and aspirin) that I am taking, and a list of thing I want to talk about. He checks lungs, heart, and BP and orders labs. We discuss the issues that I have raised and anything else that he feels is significant.

My experience with second level facilities along the southern edge of NH is that they are OK for regular care but you want to go south if you have a real problem.

I have "referred" myself in 2 situations. When my local urologist called me on the phone to say that the biopsy showed prostate cancer he told me to pick up some literature on advanced prostate cancer from his secretary and that he had set me up with someone who was doing a trial on brachytherapy. Goodbye. End of conversation. I consulted with an oncologist I know who looked at the pathology report and recommended prostatectomy. I called the urology dept at a large clinic in Burlington and got it out. Eight years later my PSA is undetectable at 0.01.

Same community hospital, and a visit to ER with very scary heart rhythm problems. After a stress-echo the "cardiologist" reported finding premature contractions and "moderate valve damage". My PCP (now former PCP) suggested that I wait 6 months and check it again. I again "referred" myself to a heart specialist in Boston who looked at the stress-echo record and said there was no damage whatsoever. I also had a "premature contractions" episode while he was examining me (hadn't been resolved by the local cardiologist) and he dealt with it by medication.

I don't think that a computer rating could help me anticipate the kind if issues that I had with local physicians. The patient has to understand his health issues, ask questions of the PCP, and insist on referrals when there is uncertainty.

Cetus said...

The patient has to understand his health issues, ask questions of the PCP, and insist on referrals when there is uncertainty.

That's a lot to demand of most people, although perhaps not of an engineer. Kudos to you for maintaining a level head in the face of life-threatening cancer and that's wonderful news that you received successful treatment. Unfortunately, not everyone has your ability to stay calm and effective in a crisis -- even otherwise wonderful people.

Regional disparities in HC quality is a huge topic right now and very relevant to this discussion. I remember 20 years ago when the idea of physician ratings was floated and there were the same objections to publishing outcomes data because of unfairness to docs who got more high-risk referrals. But even back then there was a strong sense that this argument was also a smokescreen for fears that everyone would gravitate toward the major urban medical centers. IIRC, national CABG outcomes were part of the publicly released data.

CF said...

Objective professional reviews combined with online patient ratings at sites like is the best solution. It isn't an either or proposition.

Unfortunetely there's very few professional reviews because doctor lobby groups fight them tooth and nail, they've even tried shutting down online ratings and would if they could.

Doctors argue these sites are unfair but at the site mentioned above they can reply to or sensor patient reviews, there's really no good excuse to oppose online reviews in todays day and age.