I’ve never logged onto Angie’s List, but I might be on it. Physicians are now routinely rated on various internet sites that the public can view before making appointments, or just as a parlor game. You can look up doctors just as you would check ratings on toaster ovens, snow blowers, cars and restaurants.
Are these sites truly useful?
Can a grading site inform the public about a physician’s medical quality?
Can a visitor to the site be confident that the view expressed is true and objective?
I’ve thought deeply on the issue of medical quality since I was a medical intern in 1985. Indeed, it was my preoccupation with this subject that led to the birth of this blog years ago. Review the blog’s categories at the right of your screen and note how many labels include the term ‘quality’. A recurrent theme here is how difficult it is to measure medical quality, even for medical insiders who know the blood and guts of the business. Pay-for-performance is an example of the government’s feeble effort to measure medical quality. I have devoted several posts to exposing this sham and explaining its systemic flaws.
If physicians and health care experts can’t define and measure medical quality, then I am deeply skeptical that on-line rating sites can succeed where the medical profession has failed. That this sites are filled with advertising communicates that their true mi$$ion may be unstated.
Nevertheless, these programs are here to stay and we can expect more competitors to materialize. Let’s face it. The public loves rating everything. Each year, parents of high-schoolers race for the U.S. News and World Report annual college ratings, even though seasoned educators know that this is a poor resource for choosing quality higher education. Throughout the country, there are lists of our best doctors, hospitals, athletes, musicians and chefs. Sometimes, these lists defy logic. How many #1 cardiologists can one city have?
Just google the phrase “list of the 100 best” and see what pops up.
Doctor rating sites are likely to be sites where disgruntled patients express themselves. This creates an indelible stain on the reputation of the doctor, who cannot expunge the false claim. It is well accepted that dissatisfied customers are more likely to speak out, which creates an unbalanced record of performance for doctors and various businesses. I acknowledge that some on line criticisms may be valid, but others may false and defamatory. How can a reader discern the truth?
Consider the following hypothetical criticisms:
Keep away from this doctor. He’s only in it for the money.
Perhaps, this is a patient who wouldn’t pay his bill.
I’ve never seen a doctor so insensitive to my pain. After seeing him, I had to go to the emergency room for some relief.
Perhaps, this a patient who demanded narcotics, and the doctor declined to accommodate this request.
Warning! This doc is in the pocket of insurance companies. He was pushing me to try a different medication.
Perhaps, this patient was offered an inexpensive alternative that was medically equivalent.
Remember, one thing that on-line grading sites do not offer is both sides of the story. Readers are counseled to assume there is another side, which may be where the truth lies.
New companies are emerging that promise to combat on-line attacks against physicians and others. A component of their strategies is to encourage favorable comments to be added to the sites to provide balance and to suggest that a negative comment is an outlier. All this sounds more like a game to me than true quality assessment.
Who’s grading the grading sites? Will Angie take this on?
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.