Tuesday, August 27, 2013


A group in the UK called iwantgreatcare.org has been running a consumer evaluation website about doctors and hospitals.  Analogous to TripAdvisor, people can post quantitative rankings as well as qualitative comments.  It covers 100% of the NHS hospitals and over 200,000 doctors.  All information is absolutely transparent to the public, the clinicians, and the hospitals.

I can already hear the complaints:  "Our patients are sicker."  "People don't understand enough about medicine to properly judge us." "This is just going to be a complaint board."

Taking the last objection first, well, no.  It turns out that the vast majority of people are actually pleased with their medical care and use the site to send a positive, thankful message to their caregivers.  Here is a touching example:

Everybody finds the GU clinic a bit scary. It just is. For me it's a bit more than scary. I was sexually assaulted 10 years ago and find the examinations difficult after my experiences. After the assault I was examined by a male doctor... it was traumatic to say the least. Just to add insult to injury I have also had cells removed from my cervix (bear with me I am trying to build up a scenario) so I have been examined by various doctors, nurses, blah blah. The point is this. Dr [Robin] Bell is extraordinary. His approach, helpful manner and wit are second to none. I have NEVER ever felt so at 'ease' (relatively speaking) when having said examination. Having seen him twice now I can honestly say I will not see any other GU doctor unless I really have to. I was nervous the first time I went to his clinic; nervous about the examination and (wrongly so) the fact, he is of course, a man! Pah! No female has ever treated me with such tenderness. I would like to thank Dr Bell and I meant to say it today but after my last visit I called my mum (confidant and aide) and cried (for quite some time) about the fact it was ok, that a man had dealt with me and it had gone well. I cried that my fear was over; believe me the police examination was horrific. I can't recommend Dr Bell highly enough. I never ever thought I'd get the chance to conquer the fear of a male examiner... but I did and he's the best :-) Who is in control? His patient :-) 

But sometimes, there are complaints.  Here's one, along with the response by the doctor, posted within 24 hours:

Saw my mother after an examination of her bowel because her GP was worried about something serious. Spent more time talking to student doctor than to my mum and kept asking me questions instead of my mum. She wears hearing aides but isn't stupid! She was still worried about her stomach pains but all he cared about saying was that it wasn't cancer. He is very professional and smart and probably very clever and not rude but he didn't address my mother's worries and talked down to us both a bit. Would ask for a different doctor next time.

Response from Mr Oliver Warren 

Thanks for your feedback. I'm very sorry that you feel I didn't live up to the high standards of care I expect from myself and that we all strive for at Chelsea and Westminster Hospital. I would never presume that someone who requires hearing aids is stupid, and would never wish to give the impression of talking down to a patient or a relative; it can sometimes be really difficult to get the balance right between explaining things in a way that people understand and aren't too complicated, and oversimplifying. Likewise with reassurance; many of our patients are very much focused on cancer, and ensuring they don't have it. On this occasion I read the concerns of your mother and you incorrectly. We try to ensure that the medical students are fully involved and seen as part of the team at our teaching hospital. Balancing their educational needs with the needs of patients can also sometimes be fraught with difficulty in a busy clinic. I would be delighted to organise a second opinion with a colleague if this would be of any help or benefit and am grateful for your feedback.

I don't know, but I bet the information collected here is more useful than the kind collected by Press Ganey and other such patient evaluation services.  Yes, this site suffers from a self-selection bias, but it would be difficult to know in which direction the bias acts.  As mentioned, lots of the comments are laudatory and appear to give people a chance to show gratitude.  If I were running a hospital, I would be sharing these results broadly among my staff, looking to see where trouble areas might be occurring.  As the site notes: "Quantitative and qualitative feedback for organisations, departments, wards and clinics gives real insight with data that actually allow continuous improvement and is proven to engage front-line clinical teams."  I would also celebrate the success of consistently fine reviews.

The site makes no representation that it is evaluating clinical decision-making and outcomes.  That's not the point. It collects reactions from patients in three categories:  Trust, Listening, and Recommend.  You don't have to be a genius to understand that these characterizations are going to be made anyway by patients to their families, friends, and associates.  Doesn't it make sense to hear them directly if you are running a hospital or physician practice?


Barry Carol said...

It appears to me that our medical culture is unwilling to trust patients to be fair in this context and doesn’t think what patients have to say is worth hearing or listening to. Patients may also worry about the implications of negative comments in our litigious society.

At the same time the power of lobbyists for hospitals, doctors and commercial insurers continues to successfully resist eliminating the confidentiality agreements that preclude disclosure of actual contract reimbursement rates. How the healthcare industry can think that it’s acceptable to make it impossible or nearly so to find out what anything costs before services are rendered is beyond me. With the possible exception of defense, no other industry operates this way.

Gauri Kamath ‏@Apothecurry said...

From Twitter:

Thanks for this. This is an idea whose time has come. Of great need in India too where for-profit hospitals and doctors dominate.

Anonymous said...

Barry, I think your comment speaks to a point that is only now becoming clear to the public - the health care industry has been allowed to ignore with impunity many, many basic practices that exist in every other industry. Because we were thought to be 'different' and practitioners were revered. Time to take off the halo and bring it into line. It will take government, patients and insiders all working together to change this dangerous perception.

nonlocal MD

Anonymous said...

Yes, ratings are good, but we have RATEMDS , and help for Hospitals etc...my issue is hospitals, doctors, practice groups need to really respond to patient or patient advocate concerns- when things go wrong, and the patient's family is angry, and they are pointing out the missteps, mistakes, etc.. They should take pause and try to improve - rather than just listening but not looking further to analyze what happened and how can this be avoided. Obviously, I speak from experience, missteps in hospital care are frequent , and often times result in critical illness requiring ICU , log term acute care, which all could have been avoided if early staff, such as hospitality, specialists, nurses- really examined patient, health records, symptoms, rather running with a wrong, diagnosis which was suspected by admitting ER doc- happens over and over, and when patient is old and/or fragile the recovery is long, painful- and sometimes results in death. Reviewing or rating care doesn't help or offer much in my opinion- what does is listening to patient, their family, and practicing medicine by examining patient- and delivering carefully monitored care- rather than just following orders and prior reports of suspected diagnosis- and when family members express great concern over care or status of family-LISTEN and take it seriously- bring it up to chief attending, or Nursing manager, don't just listen to concerns and do nothing. No wonder health care costs keeps going up and quality goes down- unfortunately medicine is not always practiced in a very careful, passionate manner but rather carelessly. I hate to admit this is becoming more and more the case.