The New York Times has a feature (see first reference) that discusses why the number of Internet reviews of physicians is sparse and the quality is poor. The main contention is that people are too intimidated to rank physicians. The author ignores the profit motive of all the sites as a potential conflict of interest and leaps to the conclusion that the AMA speaks for most physicians even though only about 29% of physicians are members of the AMA. He also describes physicians as "untouchable" when in fact at least 20% of physicians can be expected to be sued for malpractice during their lifetime and malpractice lawsuits have resulted in entire specialties migrating from a particular state. That is hardly what I would describe as "untouchable". He is openly critical of the president of the AMA suggesting that anonymous, undocumented, and unverified reviews are probably not the best source for a physician recommendation. He quickly invalidates "disproportionately positive reviews" on some websites is the product of an "unquestioning mindset".
The worst part of the article is leaping ahead to the Medicare initiative and their physician report card. Nevermind the fact that the risk adjustment concern by the AMA is legitimate. Nevermind the fact that there is really no valid way to compare physicians at this point in time. Nevermind the fact that there are political interests at play in particular the managed-care industry and how they can potentially game the system in favor of their principles. The author basically is encouraging people to go full speed ahead.
The result of that experiment is fairly predictable. The only thing I am hoping is that Google will come up with a way to prioritize the relevant information about physicians such as where they really practice and how to get a hold of them instead of the pages and pages that you currently encounter when you are trying to find a physician.
The AMA doesn't give much better advice in their recent edition of the amednews. In a piece entitled "Physician rating website reveals formula for good reviews", their first suggestion was to not have a patient waiiting for more than 15 minutes and no more than 10 minutes in the exam room. I can't think of any practice where the physician has that kind of control over their schedule - even if they postpone all of the documentation and stay for several hours after the clinic closes to get it done. The business experts observed: "overall ratings were based on time in the waiting room and the exam room -- rather than perceived clinical quality". Keep that in mind when you are looking at online ratings of physicians.
I would suggest an experiment of my own that I have conducted several times with a high degree of success. Imagine that you have a serious medical condition that requires a high risk procedure and you want to find the best physician to help you. Your search process will involve the Internet, but it does not involve looking at any of the ratings you find when you search on a physician's name. What do you do?
I will come back and answer that at a later date and discuss how that needs to be modified when you are looking for a psychiatrist.
George Dawson, MD
Ron Lieber. The Web Is Awash in Reviews, but Not for Doctors area Here's Why. New York Times March 9, 2012
Pamela Louis Dolan. Physician rating website reveals formula for good reviews. amednews. Feb. 27, 2012
When it comes to surgical procedures, experience in terms of total number of procedures done and complication rate are considered relevant variables. In the literature some procedures have a threshold in terms of minimal number that a surgeon must do to be competent. I doubt that we will get to the point that there are scorecards comparing surgeon to surgeon and if there were, I would be skeptical that the data was collected in a uniform way. Another variable in this case is the technology. In the case of high tech surgery, there is often the observation that the complication rate goes down as the technology improves. I don't think anything beats an actual interview with the doctor and a second opinion and compare those risk/benefit discussions.
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