Silent treatment
Tuesday, March 3 2009
In this recent post, I concluded that health care comparison tools aren’t very useful to patients: “It’s not that we don’t want the information: we do. It’s just not there.”
The main reason the information is so spotty is that the medical profession has a vested interest in avoiding that sort of transparency. Maybe part of this is due to fear of lawsuits, but a substantial part of it is simply the anti-competitive tendencies of the medical establishment.
As further evidence, some doctors are requiring their patients to sign waivers promising not to post online reviews:
Consumer-oriented Web sites like RateMDs and Vitals.com give Web users a chance to recommend and review physicians and hospitals nationwide. But some doctors now are telling their patients to censor themselves — or find another physician. [...]
Dr. Jeffrey Segal, a former neurosurgeon who founded Medical Justice to help doctors fight off lawsuits, said he robustly supports the sites in theory, but in practice they aren’t properly monitored and can do irreparable harm to a doctor’s reputation — especially when people pretending to be former patients write phony reviews.
Note the extremely patronizing attitude beneath this argument. People have been writing online reviews of nearly every other industry for at least a decade – books, hotels, restaurants, movies, computer products, car repair, and so on. I suspect most people who use these reviews regularly have a pretty solid understanding of which reviews are bogus and which are reliable. But Dr. Segal still thinks patients are too dumb to know the difference:
Segal and other medical experts say that while the ratings sites may have good intentions, little of the information they impart is of use, as the most important indicators of clinical care can only be judged by experts. The rest, they say, is just “random discussion.”
“I think the real problem is that the info may not be all that useful,” said Dr. Wendy Mariner, a law professor and director of the Patients’ Rights Program at Boston University. “Patients may be able to evaluate whether a physician is responsive, courteous, on time, provides useful info to the patient,” she said, but they cannot judge the most important issues concerning medical care.
Contra Dr. Segal and (juris?) Dr. Mariner, I happen to think that being responsive, courteous, timely, and useful are crucial issues in medical care. And having been sick with the same disease for 15 years, I’m a better than average judge (and better than some doctors, too) of the “most important issues” concerning my care.
Given the paucity of information out there, online rating tools – like RateMD – are really the only option for patients looking for or looking to share information about quality of care. These tools may be deeply flawed, but they’re better than nothing. (On a related note, I think Angie’s List’s new health care review service will be a tremendous help, once it gets some momentum. Right now there are just too few reviews, at least in my area.) If Dr. Segal wants to help patients, he should work to make more and better information available – and stop trying to shut us up.
(news item via Insureblog)
Contra Dr. Segal and (juris?) Dr. Mariner, I happen to think that being responsive, courteous, timely, and useful are crucial issues in medical care. And having been sick with the same disease for 15 years, I’m a better than average judge (and better than some doctors, too) of the “most important issues” concerning my care.
No they’re not. I can find the nicest, sweetest, high school girl in the world who will be the most pleasant, conversant individual you’ve ever interacted with, but if she doesnt know anything about Crohn’s disease then its a worthless encounter from a medical perspective.
Medical knowledge is #1. Personal skills comes in at a distant 2nd.
I’m not talking about nice and sweet. If you don’t see how responsive, courteous, timely, and useful are medical skills, I’d wager you’ve had very little experience with medicine as a patient. Knowledge and skills are necessarily complementary; one without the other is neither.