Thursday, November 21, 2013

Subjectivity



Dr. Grumpy is rude. His staff is rude. His wait time is always over an hour. He's incompetent. He's malicious.

Well, it's hard for me to objectively address most of these charges, but I can say that the longest I've ever kept a patient waiting is 23 minutes.

I hate sites where you can anonymously rate doctors. Anyone can put up a scathing review, even if they didn't actually see you. Maybe they're pissed off that you don't take their insurance, or wouldn't give them the extra 40 Percocets they wanted.

The sites don't check to make sure that they really saw you. For all you know you're being rated by a person angry that your kid beat theirs in the school spelling bee (don't tell me people aren't that petty. They are.). And because we're doctors, we can't really defend ourselves. After all, we took an oath to keep your health concerns in confidence.

Let's look at this the other way: what if I were to create an online public forum where doctors could rate patients by name. Of course, while we'd be encouraged to write only about our own patients, who's to make us do so? What if you're someone who dinged my car at Costco this weekend, or the barista who can never get my order right? I could use the site just for the hell of it.


"Probably a drug seeker. I wouldn't touch her."

"Very whiny and needy. Calls staff all the time."

"Dumb as a rock. Can't remember his meds."

"Argues incessantly about his crappy $15 co-pay".

"Needs to buy a toothbrush and some deodorant."


Best of all, we doctors could put it up anonymously. You'd have absolutely no way to know who wrote it (you could guess). In fact, even if I never saw you, and say, just didn't like you based on meeting you somewhere, I could write whatever I wanted. And you'd have absolutely no legal recourse. Sure, you could post something in your own defense, but, do you have time for that?

Of course, that would never happen. Besides being unethical, it's frankly illegal for a doctor to do that. Patients, however, have a free reign to anonymously say whatever the hell they want about us. Even if they've never actually seen you and are making it all up.

The other problem that affects these rating sites is simply human nature. When something goes well, we expect it and say nothing. But when something goes wrong, we get angry and want the world to know. So the reviews are predominantly written by people pissed-off enough to take the time to find a ratings site, create an account (maybe several), and write one or more bad reviews. The people who thought the doctor was awesome may outnumber them 100 to 1, but won't write anything. So, as in everything else, a small but vocal minority can drown out the truth.

Besides, it's so much more fun to write a bad review than a good one. Most of us learned this in high school, whether through writing a book report, gossiping about others, or reading Perez Hilton.

For these sites, and those who contribute to them, I think we have to keep in mind the words of the finest restaurant critic in history, Mr. Anton Ego:

"In many ways, the work of a critic is easy. We risk very little, yet enjoy a position over those who offer up their work and theirselves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is more meaningful than our criticism designating it so."


32 comments:

Anonymous said...

I feel your pain, Dr G. It's the equivalent of those d***ned Press-Ganey patient satisfaction surveys that are all about hotel services and not about quality and safety of care.

KevinMD writes about protecting your online presence, and i think he has a few good tips. Can you respond to any of those online ratings sites?

Yelp allows anything rated (professionals in private practice, businesses, etc) to respond to any review.

I have found Yelp in my area to be fairly on target overall w/ reviews of hospitals/EDs.

You might want to "own" your practice on Yelp and encourage your patients to review. My PT has a huge sign over their "torture" machines aka stationary bikes w/ Twitter, Facebook and Yelp links and a request to follow, like and review, respectively. I looked up the Yelp reviews, and they were all 5 stars - I agree so far and plan to review at the end of therapy. The reviews listed the competence of the PTs and staff, the therapy itself, the site, and the overall impression. They also included photos - very helpful, too.

Anonymous said...

In the words of Bill Clinton (Yikes), "I feel your pain". As a teacher, this happens to us all the time. There are teacher and professor rating websites out there where students can leave comments and rate us. If we get on social media and say anything about a student---we are disciplined. It is irritating.

If it makes you feel better, I have never rated a doctor and I try not to be a PITA to my doctors.

Elissa

Diana said...

I never read these sites on reviewing doctors or vets. I think Im smart enough to make up my own mind when I go in and see a doctor. I would listen to a friend tell me about their experience. And Ive waited 3 hours to see an ENT for my kids when they were young. Why, because I felt he was worth it.

Mary said...

I make it a point to go online and write positive reviews when warranted for docs, mechanics, restaurants, etc. if there is a problem, I try to resolve it before writing a review and consequently have never needed to write anything but positive reviews of any service provider I hired.

Anonymous said...

Frankly, (and honestly), Dr. G, as a pharmacist, I'm surprised that physicians read these things at all, although they're on the internet for a purpose, one supposes.

I'm not in the world of retail pharmacy, but have heard many stories of those in the trenches that've lost jobs, and experienced considerable grief when a patient 'customer' dials the 1-800 number at the bottom of their prescription to complain to drugstore management (provided so handily by the MBAs at the PBM for the benefit of 'patient' customers and of which NOT usually any one of those managers, not one of 'em pharmacists except in North Dakota where pharmacies are required to be owned by pharmacists) about the rude/ignorant/refusenik/greedy/authoritarian/mealy-mouthed (take your pick) druggist that refused to comply with wishes by the 'patient/customer' for complete happiness at the corner drugstore.

Moose said...

Eh. I know they're galling and annoying to read, but experienced people on review sites get a feel for what's real and what's bullshit.

On Yelp, the reviews with an agenda, or that are pure bullshit, become clear after a while. They are usually by people who only have a handful of reviews, total. Their reviews are either all 5 or 1 star; sometimes, because they think they're being clever, it's a mix of both. Yelp has a filtering system that often catches these out, but it's not perfect.

After a while you start seeing patterns in the way the reviews roll in.

I admit that I did, once, leave a review for a doctor that was quite negative, and it was on a doctor review site. It was a for a "pain management" doctor. Now, I understand that this specialty can be full of problems, from drug seekers looking for an excuse to be on Oxy to doctors who become pill mills. But the reviews for this doctor all mentioned the same thing, which had happened to me. (In my intake interview the doctor added to my chart a disease/condition that I did not have, over my protests that I didn't have it.) So I spoke up and added my experience as well.

On the other hand, frankly, I can completely understand the anger reviews. My current health care provider just informed me that I'm not really disabled. Never mind that she's never conducted an exam that has anything to do with mobility, or discussed my situation, or that, gee, the federal government thinks I'm disabled. Apparently I'm a lazy faker. She can tell it with her mind!

Tracker said...

I almost fell into this cyber maligning myself this past year. I was diagnosed with a rare spinal tumor, a chordoma and my first few dealings with the ortho doc left me feeling frustrated, but then I realized most of my feelings were probably fear. I decided to wait until after treatment to judge, and I have to say this man and the other 3 specialists who operated on me are all gods and I am forever grateful to them. I have posted all positive comments about all of them. And yes sometimes the wait times seemed like hours but I bet the longest I really had to wait was maybe 45 minutes. Learned to always take a good book with me and relax and mellow out.

Jennifer McDonald said...

When I write reviews, it could be either positive or negative but never neutral. But if I write a negative review (restaurant, hair salon, whatever) I always provide specific examples of why I'm giving a negative review. Example: my most recent negative review was for an Indian restaurant. Not because I hate Indians, but because I went there, waited 60 minutes for my food to arrive to my table, and when it finally did the order was wrong. I would think anyone else of sane mind would read that and think to themselves "hey, she had a legit bad experience at a restaurant. That makes sense to give a bad review". But I see stuff like "FOOD TOO SPICY I HATE LIFE AND EVERYTHING IN IT RESTAURANT THE WORST EVER CREATED!!!!" all the time on food review sites. Drives me bonkers. I can only imagine the kind of crap that shows up on doctor review sites.

That being said, I know EXACTLY what it feels like to be given a terrible review by someone who has no grounds other than they didn't study for my test so they failed. I have had 4 scathing reviews on ratemyprofessor.com in 3 days (gee, could it possibly have been the same person?!). I can't go on there and be all high and mighty and come back with "you can't even spell in your negative review of me. Why on Earth do you think you should get a good grade in my class? And when all you do is ask me for answers, what makes you think you have the right to call me 'confusing' when I refuse to give them to you?! Go away." I hate that stupid website. And yet I know it's used to evaluate potential candidates for teaching jobs. Life is stupid.

Packer said...

I always tell my children, Love thy neighbors as thyself. Then I really screw them up as I add, do not love your neighbor more than yourself, better than yourself or instead of yourself. Love your yourself too. They have heard it so often that they know exactly what I am talking about. Love yourself Grumpy.

I learned to do that later in life, right about the same time I learned that all my warts were not going to keep me from living.

pe2pa said...

Anyone who wants to bitch about a doctor being late should spend at least one day shadowing them to get a feel for their day.

So you come in for that "first appointment of the day" in clinic at 10:00 am. You're thinking to yourself, "wow, must be NICE to roll in at 10:00 in the morning and make loads of cash! Real people like me have to work the 8-5 for a fraction of what you do."

In the meantime, the physician might have actually started his day at the hospital around 0700 or so, rounding on patients/consults. And maybe, just maybe one of his patients had a serious problem that required the physician's attention and, like the doctor does for all his patients he takes his time and carefully reviews the case, combing through labs, scans, notes, whatever to make sure that he is ordering the correct tests, treatments, labs, meds and doses, etc. He may be spending time with the worried patient or family member, educating and explaining, reassuring and providing compassion. And that could just be ONE patient on his list that morning! In the meantime, he could be getting paged left and right on new consults or patients of his that have been admitted.

So by the time he shows up to your appointment at 10:30 and you're FUMING angry that he's so late and swearing you're going to get back at him by writing a poor review on some website or giving bad P-G ratings, think to yourself "Maybe he's late because, if I were in the same position as one of his patients earlier in the morning, he would afford ME the same level of care and concern in my time of dire need" instead of doing a quick, half-ass job just so he can be to clinic on time to deal with patients with (probable) non-emergency needs.

Yes, it is a pain in the butt when you make an appointment and the provider is running late. Yes, the front desk staff should let you know that your doctor might be running behind (and don't bug the crap out of them...no matter who awful you are to them, all the bitching in the world isn't going to get the doctor there faster, plus you're punishing someone who has no control over the situation). Yes, the doctor should apologize for running behind.

But, maybe try to think about how perhaps...just this time...the world isn't revolving around you for a change.

(I shadowed several doctors on rounds and in clinic and I now know why they're so skinny: barely any time to sit and eat and we were constantly walking around the wards, taking the steps up and down, etc.)

awesomesauciness said...

You want reviews that are enlightening and entertaining? Go to Amazon and check out the reviews for things like canned unicorn, uranium, a ladies only pen, and my favorite - though I can't remember the product - a depilatory apparently made from lava.

Anonymous said...

I like to borrow other people's computers, visit those sites, and give myself insane ratings. Beat them at their own game, I say. I also like to leave bizarre comments: "I've never been to a neurologist with such a big hammer!".

bunkywise said...

It is absolutely an epidemic for people to spew venom anonymously. I don't mind hearing celebrity venom...the celebrities know it comes with the territory (and I will admit that I enjoy Kardashian bashing although I don't participate.) But for people to mess with livelihoods and reputations for no valid reason should be a crime. Actually, I'm sure it is but since you are able to post anonymously, it's pretty hard to prosecute. Sorry, Dr. G. I think it is awful, too.

Anonymous said...

On the other hand if you see many comments from many people who indicate that there is always an hour plus wait, then that tells you something.

VetGirl20 said...

Amen Dr. Grumpy! Too true in the veterinary profession also. Sometimes people just suck...and it sucks that the one bad apple sometimes overshadows the 20 other amazing clients you just saw!

pe2pa said...

awesomesauciness (and Dr. Grumpy and your other readers):

Google Hutzler 571 Banana Slicer for some absolutely hilarious reviews.

RehabRN said...

Grumpy:

Bubba went to the orthodontist today and the doc was almost an hour late. The case before us went long and the staff apologized. He also did, too.

I made sure Bubba knew that he'd want that doc to spend time with him too, if he needed it, not just because someone is next. If you're in a hurry, you have to make the decision to leave and reschedule, like a grownup should.

I have never left a doctor rating because I'm not impressed with most of the systems. I'm very aware that they are often gamed.

PediNP said...

And so goes healthcare. Science? Meh. Anecdotes? yay! Free samples? Great provider!

Jess said...

My dad is a doctor, and he got an awful review one time criticizing his demeanor, medical knowledge, and thick accent (which really isn't thick, he's studied and lived in the States for 30+ years). It turns out the patient who left the review was someone who would take the medication Dad was prescribing to him and then sell it on the street. Dad found out about this and reported him, prompting the patient to write the scathing review.

Just Me said...

When comments are anonymous the 20 comments about the same issue - are often the same people. I can't even check myself out because it will just make me mad and I can't do anything about it.

Anonymous said...

The worst thing about these review sites is that they publish docs' personal info. Happened to me and my husband, and according to a consumer review site, to many, many other docs who complained. Our HOME addresses and phone numbers were listed. I have no idea where they get this stuff, but it's important for every doc to go on these sites and make sure their personal info is not there. If you notify the site, they ignore you. Or, if they respond, they tell you you can change it yourself if you sign in (which means agreeing to their ridiculous terms of use). Finally, for one site, some creative googling got me the CEO's office number. I called his AA daily and said I'd continue to call and waste her time, just as the site was wasting my time and potential patients' time (I was no longer in practice by then, but the site listed my personal info saying I was taking new patients - I only found out I was listed b/c potential new patients were calling my cell phone). That finally got my listing taken down.

Charles said...

Why bother reading such "review" sites? The way I see it reviews fall into one of two categories:

The first category is, as you say, someone with an axe to grind; and, so, they are not rational, nor honest, about it.

The second category is someone with an agenda to promote the business, the teacher, the doctor, etc. and they also are not rational, nor honest, about it.

So, as I say, why bother reading such sites - nope, better to read YOUR site with your interesting and entertaining stories. (none of which are made up, right?)

CathiefromCanada said...

I worked for a doctor once and remember the day I had to explain to a room full of patients that he was busy delivering a baby and so everyone would have to wait a little longer until he was finished with the new mother, or rebook the appointment.
A woman asked me in a very snotty tone "You mean she's more important to the doctor than I am?" and I said, "No, just more urgent".

The Bad Yogi said...

I have never reviewed a doctor, and don't intend to start now, but for the love of all that's good and holy, would you ask your staffs to call and let us know when the doc is running over an hour late? I'll happily reschedule, which will make your day easier, and mine too!

Oh, and if I try to tell you that your front desk just slagged off an elderly patient for being slow, don't blow me off. You have mostly no idea what goes on in the front (being obviously busy in the back, yes?)

Veronica Reilly said...

It is far easier to criticize than it is to say something nice. Our society has lost its way and rudeness rules the day. I'm sorry that you have to be raked over the coals, however; those of us who DON'T read these types of reviews, know to judge you ourselves and not let petty crap be the judge. :)
Happy Thanksgiving Grumpy Family!

Steeny Lou said...

Fourth attempt at leaving a comment. Sick of Google and its inconsistencies that approach the magnitude of those of facebook (small f intentional).

Just wanted to say I appreciate seeing Anton Ego getting some recognition. Ratatouille is a favorite of mine, even if I can't consistently spell it correctly.

Vicki said...

I've written many letters or filled out surveys for the members' services at Kaiser, where I have my HMO. I've made a point to write special letters and reviews for great doctors and not just bad ones. Unfortunately for me, I suspect two such letters were influential in my wonderful PCPs getting promoted to head other facilities. But I do make a point to try to let the administration know about the amazing doctors and not just bad ones.

They take it seriously too, as when I was able to document clearly how badly I was treated by one neuro, who even yelled at me suicide was preferable to my going to the ER when my migraine got so out of hand I was ready to kill myself, especially since she refused to give me any meds for pain control. My PCP kept an eye on her case (after members services called me several times to follow up on it!) and learned that my letter was just the latest in a series of many similar ones, and it wasn't too much later before she was fired. Good riddance! Suicide being better than the ER!

pkd said...

Of course there are problems with reviews. People with negative experiences are more likely to leave reviews, not to mention those out for revenge. On the other hand, there are unscrupulous providers who will put up their own positive reviews, and there are some sites that offer to remove negative reviews--for a price.

But if you can't get a recommendation from a living person, the reviews are tad better than the Yellow Pages.

Anonymous said...

My ob/gyn is a fellow by the name of Dr Steven Cattanach. I normally wouldn't say his name, but it's worth googling him. He's part of a landmark case where he was sued, and lost, for the birth of a healthy baby. There's lots on the internet about it, and it makes him sound incompetent.

I went with him anyway, because I like to make sound judgements like that (and trusted my referring doctor implicitly).

He saved my daughter's life. No exaggeration, if it wasn't for his skills, she would be buried now.

It turns out he, and his pediatric team, are heroes in the premmie/ high risk community, but when you first google him, it's hard to know that, because of all the bad stuff.

I take every opportunity to say how wonderful he was. And wholeheartedly agree with the terrible nature of online doctor reviews.

Anonymous said...

I've written good and bad reviews, as were warranted. I zinged a pediatrician who signed off on and filed away an abnormal lab result that caused my daughter's growth hormone treatment to be delayed by over a year. The best part? She had never even seen my child as a patient, just signed off on the lab as one of the docs at the clinic. No call to me, no call to treating physician.

I also went out of my way to leave positive reviews of the docs I encountered who were competent and caring. No, I don't have an MD but I do know good care when I encounter it. Our particular area was/is hard to get people to live, work and stay in (remote, very remote) so the ratio of good:bad was skewed and the community talked about who knew what they were doing and who was just there to collect a check.

Anonymous said...

As a nurse, I recently transferred to a procedural area, and I was scared of working with one particular doctor based on the things staff members had said about him. He is now one of my favorites to work with. Always take what people say with a grain of salt, I learned that a long time ago getting nursing reports about patients. Usually the bad ones were not so bad after all.

Plus you need to look at it another way, if a person is easily swayed by these online reviews, its probably a patient you don't want in your office to begin with.

Anonymous said...

I like leaving good reviews. I love sharing something great that happened to me, and it's something I can do to reward whoever it was for being awesome, as something I can afford and they can accept.

I avoid reviews that all sound similar, have multiple spelling/grammar issues (not the occasional typo, but lack of ability to write in an readily readable manner), that spit bile, or that talk about how bad something was without specifying.

I pay attention to reviews, good and bad, that have different 'voices', explain what happened and why they feel the way they do, and address the issue rather than attacking the people.

 
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