"Dr N A
is a terrible doctor — tardy, uncaring, focused
on his own health, and a poor diagnostician who risks
the lives of his patients."
Such might
be the impression of a patient from reading a couple
of reviews of my performance on RateMDs.com,
the US-based doctor rating site that modestly claims
it's "changing the way the world looks at medicine."
As a lecturer
at the University of Waterloo I was aware of site founder
John Swapcesinski's other site RatemyProfessor.com.
The RateMDs site works similarly, rating docs on Punctuality,
Helpfulness and Knowledge. Unlike the professor site,
RateMDs doesn't have chilli pepper scores for doctors
who are 'hot.'
Rate MDs
has been hugely popular with patients but many doctors
understandably hate it. I myself found the idea intriguing.
It represents the democratizing effect of the internet
and has the potential to empower patients to participate
in their own care. But can it really tell you whether
a doctor's good or not?
Well, let's
have a look at one of the ratings of my performance
— specifically a bad one — to see what it
tells us.
A RateMDs
poster claims to have brought her 20-year-old son in
to see me for severe, disabling back pain My response,
she says, was to talk about myself, tell them the pain
was normal and give them "a story about Darwin's theory
of evaluation [sic]." An attempt to reassure a patient,
to explain that a majority of people, including myself,
have disabling low back pain at some point in our lives,
perhaps related to our evolution from quadruped to biped,
appears to have been perceived as self-absorption and
a dismissal of pain. Other than the quality of a doctor,
might this indicate a parent who didn't get the MRI
her child 'needed' for acute low back pain?
From what
I've seen, while it's definitely interesting, RateMDs
doesn't have the same use as say, Consumer Reports for
buying a car. Better knowledge about a doctor's competence
may be obtained from professional colleagues working
in the healthcare sector. If friends and family are
happy, the greater the chance you will be. What RateMDs
does have in spades is bias and personal opinion, with
a healthy dose of gossip and innuendo. Also, the US-orientation
of the site reflects a different cultural environment
in terms of free enterprise, choice and responsibility.
This doesn't mean that a better online rating system
can't be developed, but none can ever replace real life
doctor-patient interaction.
Unfortunately,
given the doctor shortage, it's extremely difficult
for dissatisfied patients to change doctors in Waterloo
and each doctor will have a few. So unlike my American
colleagues I'm not too worried about patients leaving
me. As with most doctors, I'm pretty sure that the vast
majority of my patients like and appreciate me. Patients
are influenced by affability and availability far more
than aptitude or ability, which is more difficult for
them, as non-healthcare professionals, to assess. Though
some people are more likely to be loved or hated, first
impressions and personal chemistry remain important.
What we call a 'good doctor' is more likely a 'good
fit.'
But in an
era of instant gratification, physicians who choose
to not follow a patient's agenda unquestioningly —
be it demands for tests, referrals or meds in the timeframe
deemed appropriate by the patient — clearly do
so at their own peril. With a majority of patients we
may be able to negotiate a mutually agreeable agenda,
but appearing to deny patients what they think they
need, even in situations of questionable efficacy, will
run us the risk of inciting the wrath of a small but
vocal minority who may be unhappy enough to write anonymously
on a website.
Doctors
who visit RateMDs must be prepared to see some of their
own warts and it may be an opportunity for self-reflection.
As for me, I'm still waiting for my first chilli pepper!
— Dr Neil Arya, Waterloo, ON
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