Rotten Tomatoes for Doctors

There's an interesting article on FoxNews.com about the controversy around doctors forcing patients to waive their right to post feedback on a number of "doctor review" websites. I can sympathize with both sides of this debate. One one hand, why should doctors be shielded from the right to provide publicly available customer service feedback the same way that any other consumer of a good or service can? If I go to eBay and somebody sells me an iPod which I find later on happens to have a volume control problem and has half the memory than promised, I have every right to skewer the seller in my rating so the next potential buyer can beware.

On the other hand, the doctors have two issues with such websites, one which I think is easily remedied and thus not completely legitimate and the other which I believe is more valid. First, doctors argue that people who are not truly patients of theirs (e.g. competing physicians, ex-wives, an angry medical school roommate) can write fraudulent negative reviews in an attempt to slander and hurt the doctor's practice. My retort is that by creating a incident survey system either managed by the managed care organization or the physician, you can provide safeguards which would ensure that feedback is solicited only from patients on a per appointment basis. An example of this is when you eat at a fast-food restaurant and the receipt lists a number for you to call or a website for your to visit along with a unique ID which you need to provide to give feedback. Problem solved.

The more legitimate concern for doctors is the same one voiced in the article by Dr. Wendy Mariner, who states, "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."

That's largely true. A patient isn't going to be able to provide the most important metrics around white-blood cell count, tumor shrinkage or lung capacity beyond a general sense of "how do I feel". An even greater issue that I see is that the doctor's "performance" is going to be largely tied into a patient's adherence to physician prescribed medicine and healthy living. If a patient gets constantly sick because he refuses to take his blood pressure medication, should that reflect negatively upon the physician?

Also, the reality is that people don't like to hear bad news or directives from the doctor, even when the doctor is right. We'll use the below exchange as an example. I have friends and family who are doctors, and I've heard the following exchange multiple times:

Joe Patient: Doc, I'm feeling tired all the time and I cough a lot.

Dr. Smiley: Well Joe, you might want to stop smoking with the help of a nicotine patch and watch what you eat. Your cholesterol is still way too high. If you can exercise just a few...

Joe Patient: (irritated) Eh, just give me some meds.

So Joe Patient goes home pissed because instead of giving him a clean of health and cheering him up, Dr. Smiley had the audacity to recommend some lifestyle changes that could save his life. What a downer. Joe Patient goes to his computer, logs onto RateMD.com, and skewers Dr. Smiley as an unfriendly dictatorial blowhard. That's clearly not fair, and God forbid we unintentionally incentivize physicians to be "well liked" at the expense of being truthful and effective. Naturally, the best doctors can be both.

But provided that you can ensure protection from fraudulent posts and limit feedback on things which are within the patient's ability to assess, I think it's a good idea. Lord knows that I've gone through some terrible physicians in my lifetime.