An idea that appears to be constantly winning favour is the idea of patients taking firm control of the care they receive. I have no disagreement to increased patient autonomy in medicine but when it comes to health poor decisions can cause an unbelievable amount of damage just look at the MMR scandal. Any decision in medicine needs to be clearly thought through especially those that affect how patients interact with there doctors.
The website iWantGreatCare was set up in 2008 by the renal special Dr. Neil Bacon and allows patient to rate the doctors who treat them. The site has recently joined up the HIV charity: The Terence Higgins Trust. The site aims to be a “TripAdviser” for health putting consumers not regulators in charge of the health care system. As a change in the doctor-patient relationship it promises to be a significant one. The site is probably not the only one of its kind I just pick it as an example for a more general movement where patients control the care they receive.
I have many reasons to be very dubious of the worth of such a radical change. I fear the system will be too open to abuse and misuse. I have so many worries I resorted to listing them:
- Do patient make rational decisions on how the doctor was or are they just angry at waiting times or unfortunate accidents?
- Are patients qualified judge how well a professional carries out an often complicated and difficult job?
- Is patient satisfaction actually a good measure of how good a doctor is? I personally would prefer a competent but antisocial doctor that makes good decisions to a charismatic doctor that harms his patients through bad decisions.
- Will the system be abused by doctors trying to further their own private careers?
- Will the system ruin lives and livelihoods? Would one bad review ruin your reputation and spell the end for the medical career? iWantGreatCare claims to have sophisticated systems in place to detect a remove unfair comments made by patients but I cannot believe that any system like this is completely effective.
- Does patient rating put too much pressure on patients? What do you do if you are not entirely satisfied with the care you received but don’t want to seem ungrateful?
- I think any such system would be rife with selection bias. Only people either extremely satisfied or dissatisfied with their care would bother to make a review whilst the vast majority of people in the middle would not. Would a rather chaotic mix of reviews result showing dividing doctors into the good and then bad and ignoring the fact that doctor quality probably follows a normal distribution.
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| Would the system only show doctors on the wings of the data? |
For these reasons I am doubtful that patient ratings is the best way to allow patients a better understanding of the care they receive. I cannot provide evidence to justify my fears instead I will treat them as hypotheses to be proved or disproved if such a system ever becomes universally accepted and used. History has shown us that the doctor-patient relationship is a fragile thing built upon the framework of ethics and the concept of disease and medical treatment at the time. I would mess with it unless we were certain we knew what the consequences would be.
I would recommend looking at Dr. Bacon’s arguments for patient rating at:
Personally they do little to calm my doubts.
