A person can rate almost anything on the internet; restaurants, books, movies, hotels…and doctors.
I have used internet ratings to decide where to eat or stay in a city I’m not familiar with but can the same ratings be used to identify the right doctor to see? I’m not so sure.
Medicare withholds as much as $964 million in payments to hospitals that fail to meet various quality metrics, with patient satisfaction being a significant component. Doctors are rated by their patients about the perception of care provided. I don’t have any problem with getting feedback from patients about doctors but I am concerned about a patient’s ability to rate care versus interpersonal skills.
Doctors with stellar interpersonal skills might not be the best at controlling patients’ blood pressures or managing their diabetes. Moreover, a doctor’s quest for ratings perfection can influence medical decisions because patient satisfaction increasingly affects a doctor’s salary.
But doing what’s best for patients won’t necessarily make them happy. Denying antibiotics for viral infections or saying no to routine MRIs for patients with back pain are both sound medical decisions, but they can anger patients who then give their doctor a poor rating. It’s no wonder many physicians give in to patient requests.
It seems that concerns about rating doctors are gaining steam. In fact, Senators Dianne Feinstein, D-Calif., and Charles Grassley, R-Iowa, wrote a letter to Marilyn Tavenner, administrator of the Centers for Medicaid and Medicare Services, saying that “there is growing anecdotal evidence that (patient satisfaction) surveys may be having the unintended effect of encouraging practitioners to prescribe opioid pain relievers unnecessarily and improperly.”
Extra tests and treatments are expensive and can hurt patients. A JAMA Internal Medicine study analyzed more than 50,000 patient satisfaction surveys from 2000 through 2007, and though the data predate online ratings, it found that patients who were more satisfied with their doctors had higher health care costs, more hospitalizations and higher death rates compared with less satisfied patients.
Now I’m not saying that doctors with lower patient satisfaction are more effective. I believe a balance can be reached and often that balance can be achieved by more communication between the physician and patient so that the patient understands why a physician is choosing to go a specific route with the care they’re providing.
Everyone in health care should be held to a high standard and doctors should be graded, but ratings need to include objective measures of medical care, such as a surgeon’s operation complication rate or some other outcome measure. A measure that evaluates the effectiveness of the care the provider prescribes and evidence based measures is as important, if not more important, than the patient’s perception of the care provided. At this point most physician measures are subjective and simply take into account the patient’s perception of care and have nothing to do with the most important aspect of care – was the care appropriate and did the patient get better.
In the end results matter and when you’re dealing with illness the most important result is – did the person get better.