I posted a little over a week ago about Rate MDs, an open access, free for all consumer website where anyone can anonymously say just about anything about a physician. Then I heard via Clinical Cases and Images that the author of MSSP Nexus Blog opined thusly: “This site, or others like it that follow, will no doubt begin to be checked as part of a routine credentialing process, so the implications to healthcare providers are considerable.”
Well, that’s scary----opening up the credentialing process to last week’s disgruntled drug seeker or patients of this ilk. Heck, why not just invite ‘em to attend the credentials committee? By any reasonable standard the evidentiary quality of sites like this is somewhere below garbage in this blogger’s opinion.
Wednesday, November 15, 2006
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29 comments:
My assumption is that you are a Medical Doctor. I am not, call me a consumer. If one needs the help of an unknown medical doctor it would be nice to have a way of establishing some credentials but there is nothing. The website appearing is a start. It can, of course, be srutinized by the Medical Doctors themselves and if there is something not right it will be removed. A quick glance shows that the majority gets very good ratings so that is a plus.
The item you refer to about someone nearly killing a doctor, has in my humble opinion, no connection to the website ratemds.com. Sadly enough anyone who deals with the public is open to abuse, whether it be the gas station attendant or the medical profession.
Blogger604,
Thanks for your comment. My understanding of the way the web site is set up is that doctors have no way to get objectionable material removed. Moreover there's no way to verify stuff for accuracy.
I have no objection to people exercising free speech. But protected speech does not equal acceptable data quality, and it concerns me that an expert on medical staff credentialing predicts that such material will be used in the credentialing process.
When you get right down to it some of the comments on Rate MDs are no doubt true, others false and many represent half truths and distorted patient perceptions, while NONE are verifiable. That said, from a data quality perspective it remains my considered opinion that the level of evidence represented there is somewhere below *garbage*.
I had emergency surgery earlier this year, the surgeon was someone I'd never met before and he had no recent medical history on me because I hadn't seen a doctor for over 10 years. I was, and am, very grateful for his expert care, and when I read not long ago about ratedoctors, I went to the site and rated him at the highest level. In addition to thanking him personally, and paying my bills promptly, this was a way of publicly acknowledging my gratitude to him. However, I do know there are people who will take any opportunity to badmouth anyone, which is too bad.
It sounds like a good idea until you start thinking about the personal vendettas that could play out on the web site.
MJ
Dr. Donnell,
I agree with much of what you say about sites like RateMDs. The potential for abuse and unfair attack is considerable.
A colleague of mine found a rather offensive comment about a physician that she knew. It appeared to her that a fellow physician who was angry about perceived mistreatment was the one who had submitted it. She contacted RateMDs and asked for a review and the comment was removed within 24 hours.
As you noted, I made the statement that a check of sites like these will no doubt begin to be part of a routine credentialing process, and I believe that is happening. That does not mean that every word is being taken at face value.
Credentialers request numerous references, and often perform a general internet search on a physician's name to see what appears. They, and the medical staff leadership that review credentials applications "consider the source" of all those items.
I advise everyone to perform the occasional internet search on their names - it can be surprising what pops up.
Rita Schwab, CPCS, CPMSM
http://msspnexus.blogs.com
I think the idea of rating a physician on bedside manner is a good one, but the ratemds.com system can be easily taken advantage of. In an ideal world, it would be better to know what other physicians think of your potential physician, and not what Joe Schmoe thinks - because while Dr. X while may have wonderful bedside manner, it doesn't help if he's medically not up to par.
We should not be surprised but then we always are. Word of mouth goes global! Just a few thoughts from an Ontario OB/GYN:
1. Rate MDs ( and the inevitable copy cat sites that will come)are here to stay and will no doubt become popular, especially with the mainstream media picking it up. Like it or not, we will have to live with it.
2. Checking the Canadian part of the site many or most of the comments are favourable! I am not rated myself just yet but am tempted to write a few reviews just to get a head start on my colleagues. Also the guy that took my parking space last week may get an entry. Seriously, I wonder if we are overreacting a little.
3. No other profession I can think of is subjected to this kind of process. Rate my lawyer/hairdresser/mechanic? As physicians we are already subject to various forms of scrutiny, from medical audit committees, credentialling committees, professional bodies, and of course the legal profession. Furthermore patients who have a complaint about a physician already have recourse to lodge complaints with our own professional bodies, to the institutions we work in and of course through the legal system. The system is by no means perfect but no other profession has these processes in place (try making a complaint about a lawyer!)
4. Only comparison I can think of is the ebay feedback system where each transaction gets a response from both buyer and seller and a dispute resolution process is in place to resolve conflicts.
5. Biggest problem I have with this site is that it is anonymous, nothing is verifiable and there is no right of response. There may be a potential usefulness to a site like this, but at the very least the posts cannot be anonymous; some accountability for what is posted in public is needed, and a user name and email address would go some way toward reducing misuse.
6. We have thousands of patient/doctor interactions in a year. No matter how good a physician is, no matter how hard he/she may try not all of these encounters will be positive ones. Whoever looks at these ratings should be aware of this. I would urge rateMDs to include some type of introduction that explains the realities of medical practice to the layperson.By the way, I cannot imagine that a credentialling committee would consider rateMDs information as it stands. Anonymous and unverifiable, no right of response?
7. Going back to points 1 and 2 we will have to live with this. As comfort, in every survey that I know of physicians are the most trusted and respected of the professionals. If you do your best for your patients perhaps we should have confidence in how our patients judge us. Perhaps we should use sites like rateMDs for our own benefit (as in "if you like our service tell rateMDs;if you do not like it tell us". Put a terminal in your waiting room? It could happen!
Doctors usually have the luxury of knowing who is the *best* of the field when they or their families need help. Often, there is also collegiality in referrals- a quid pro quo- that occurs, which does not help the consumer/patient at all. I think rating sites are excellent and would never go on the site and give malicious information. What MD's should be afraid of is a site where nurses rate them. They are in a position to know.
The idea that doctors have the opportunity to respond directly to negative posts or clarify a situation is a joke. Remember HIPAA? Anonymous patients can say whatever they want about the encounter, but doctors cannot legally say anything specific without breaking confidentiality.
I will say up front that I'm a dis-satisfied consumer of the health industry. As more and more industries have to put up with "consumer ratings" (everyone can have their say about any product on Amazon.com) the health industry will have to respond to what consumers want - more information about doctors. If they don't respond pro-actively, then the internet will do it for them, and they probably won't like the results.
Consider this article
http://www.boston.com/business/globe/articles/2006/01/22/just_what_the_patient_ordered/
which talks about finding a doctor. It mentions a web site
http://www.mhqp.org/
I don't know how long this web site has been up, but it's basically useless. I'm in the market for a new Primary Care Physician - and it's really hard to find a new doctor, I think. If you can find one that's taking new patients, then you have to pay for a physical or an appointment. Just as important to me as scientific training are people skills. And my last doctor may have been very good at his trade, but he
was typically indifferent, in a hurry, and came pretty close to being rude in my opinion. And I have spoken to others who share that opinion. The medical profession has a problem - and I hope the younger generation of doctors can see that. There's hope I think because I've heard that medical schools are now teaching bedside manners. That's nice, since every job I've ever had, making much less money than a doctor, required me to be polite to my customers. If you don't want to deal with people, work in a lab.
The problem with Rate MDs is that doctors can submit glowing ratings themselves (friends, family) and boost a low opinion. This doesn't help the public.
The site is questionable in that regard.
I wondering if it isn't some sort of "scheme" whereby to launder doctors who have committed crimes. There are a lot of those.
I was a health care provider and was married to a M.D. for years. I can tell you that Medicine has changed for the worse in the last 20 years. Also, I know firsthand that there are bad Doctors as well as those who are arrogant and do not really care what happens to their patients. So Physicians, clean your own house so no one else had to try to do it for you!
blogger604 said...
That people may express their opinions about their doctors is the most welcome: we live in a free speech society. There is one for college professors, and one does not start to be paranoid.
I don't think this site should be part of the credentialling process. That said, I think it provides a valuable service to patients looking for new doctors.
I have 4 MDs and one in training in my family. I am familiar with the over-inflated opinions that doctors have of themselves. So, I'm sure that most doctors will find this type of site threatening to their self-image.
Customer service is very much part of the medical process. Most doctors don't want to hear that, but it is true. You can be board certified in 15 specialties, but if you routinely keep people waiting forever, don't communicate well and are rude to them, it is not a positive experience for the patients, and it can have medical consequences in terms of compliance, follow-up, etc.
This site can help provide that kind of information, saving the patient and the insurance companies time and money.
Oh, and there are equivalent sites for other professions (teachers and college professors come to mind), so please don't feel so put-upon.
The site
http://www.iratemds.com
rates Star Trek doctors.
As someone who HATES doctors for the most part, due to attitudes mostly, I love the site. I left a bad review for a doctor that, while acknowledging the fact that she was competent, had no bedside manner and was rude even beyond what I expect of doctors (which is pretty darn rude). Then I turned and left a glowing review of a doctor who is not only competent, but to let others know, in spite of his gruff exterior is extremely caring of his patients. I want that doctor rewarded with MORE patients, and I want other patients to have THAT doctor.
I see the potential for abuse, but any intelligent person will look at ALL the reviews and can easily figure out who's a jerk looking to cause trouble and who's actually complaining about substandard service. I hope the doctors look at it and understand that there are some things that they need work on. I think it can be beneficial, but I don't think it should be used for credentials. To me rateMDs is great for word of mouth type advertising.
As far as asking your MD who he'd use...how one treats a colleague or his/her family is sometimes much different than how they'd treat Joe Schmoe.
Currently, the only way I can find a doctor is to look at my health plan and ask some friends. I think Rate MDs just expands the number of "friends" I can consult with. I look at all of the comments and determine whether to make an appointment based on several factors. I have found, the majority of the time, the comments to be fair and balanced. When I was "stuck" with a particular provider because he/she was in my plan--and the comments on Rate MDs were negative--I found out just how accurate a lot of those comments were and wished I'd stayed home. The point is that there is good and bad with any rating system, but maybe if more information was readily available, consumers could rely on a variety of sources and make better, more informed decisions. I can tell you more about the car I want to buy than I can about the person doing my surgery--and that's just wrong. Instead of bashing sites like Rate MDs, why not develop alternative sites for consumers to visit?
I couldn't stomach being able to read all of the comments. I am sorry for the dr. that feels "consumers" may mistreat dr.'s on the RateMd's website. However, Dr's for years have had the privilege of slandering patients due to a personality clash or for whatever they perceive about a person and to put it in a patients medical file of which the patient usually has no right to read, doesn't know how to go about requesting their records and who do NOT have the (same) right to have something wrong, untrue or just plain nasty removed from their record! Unlike RateMd's, from what I was able to read, dr.'s have the right to have certain comments removed, unlike patients whose medical records follow them from one dr to an other and who have NO right to have things removed! and talk about taking it where it comes from? consider the source? yes, dr.'s can always say well, that person just wanted drugs and i refused to give them and that's why he/she said such and such. and medical people will be like, oh yes you're so right! but what does a dr.'s nasty, mean and slanderous words do to a patient? a huge amount of harm! because other dr.'s do consider the source! most of all from an other dr. and what? dr.'s never lie? they never mistreat a patient? dr.'s too distort truths and tell half truths. most of all when it comes to doing no harm to themselves first and foremost above and beyond treating a patient and going the extra mile to help! i have a friend who had a dr. treat her very badly one year and she cried and cried. he wrote some real harmful things about her on a personal level in her file! he tore her up! 12 years later she went back, unknowingly, to the same dr. this time he adored her, wrote kind and considerate things in her new file, thank goodness it had been so long that her old file was not available. she came over that night shaking, crying and wondering if he recognized her from years before. couldn't sleep and then she found out that he had wrote pleasantries about her this time around. gee, maybe he was just in a plain rotten mood the first time he saw her? because i have known her all my life and i cannot think of one reason why anyone, most of all a dr., would say or write anything nasty about my friend. she confronted him at her next visit and he said he was sorry and that we all make mistakes!?! his mistake caused my friend to suffer with a stomach ulcer for over ten years before she could trust a dr. again! so, you are worried about the "boys club"? you guys have always managed to survive and i am sorry that it may be coming to a point where patients have the right to be heard when they feel that they have been abused and that patients will be SILENT NO LONGER! like someone else said, i am sure the people who give credentials to dr.'s will afford dr.'s with the common sense of "take it where it comes from" i think you underestimate the credential people to be able to make those distinctions! i think you are just upset that patients at last have a voice and that you are afraid they will be heard! how seriously could a place that sets credentials for dr.'s take "off the cuff" comments from anonymous people ... when the State Board of Licensure would be the appropriate place to look for actual maltreatments of patients? ratemds allows average people who do not have the time, energy, strength, stamina or yes even intelligence to go to the board to be able to vent rather the venting are truths or half truths. i have found in my life that people normally do NOT go out of their way to make things up and to slam dr.'s or to do it just for the "fun" of it. i do think you are afraid, and it's silly, i am sure you are still all powerful. you just want to blame (natural human behavior on) people who may have actual chronic pain and yes have had or do have a drug use history for making defiant complaints against a group or industry that has gone without being questioned for generations... for risking the idea that dr.'s may be denied credentials. i think you are afraid that your demigod like ego may be at risk. i am sorry if you disagree with me and if i myself sound defiant. i dated a dr. for years and one reason i left him was because i couldn't stand how he would talk about his patients. dr.'s are people too and not beyond being human. also, i see a dr. who i adore w/all my heart and he likes me as a person too. yet, someone i met about a year ago said my dr. treated him horribly and my friend doesn't like him. see? it is all about perception. so, why so worried?
PS: i apologize for the poor grammar was emotionally flared and also very very tired. as i read my post i caught errors, most of all at the end, when i became really tired. please bare w/me as the end does make actual sense if you can just put in the punctuation for me. thanx. and thank you so very much to the dr. who let himself be heard and then in return afforded me the same right. for this alone, i can see you are a person of honor. rather we agree or not i do not judge you as a person. being a dr. does not define you just as myself being a patient does not define me. thanks again.
so you don't like being rated? after all those years in medical school, a bad opinion, and often fairly just gets to you? Grow a thick skin loser. Seriously, you sound like a whiny little child. There are thousands if not millions of people with bad experience from those from various sectors of the health industry. No they are not "disgruntled drug addicts" as you say. they are people who have been done wrong by, and they want to speak up about it because the words should be OUT about such "doctors". You've listed off the category's of unfair appraisals from certain sectors of society. What about those people who have had genuinely bad experiences? No we're not being asked to be put on any stupid committee. At the end of the day, rightly so, the public decides whether your ass should be taking care of us or not. If we don't like it we walk and put you out of employment. Those who don't have any position to walk away so easily, can have some form of a voice in this website.
Anonymous 9:36 pm----
I think your comment is misdirected. I haven't been rated.
I think the quality of the site speaks for itself.
I DO agree with you that patients can (to an extent) and should vote with their feet. That's what I like about the free market system.
My comment isn't misdirect. I do not base that opinion on whether or not you've been 'rated'. I based it on your response to the site, it's purpose and those it's directed at. The patients, the audience, the most "point" of your work at the end of the day. I think the way you judged those who do rate was "slightly skewed" to say the least. There are genuine people out there who have bad experiences and who want some kind of, any form of voice that the website gives them. Those that fall under this category deserve an a distinction apart from and an acknowledgement that all patients do not fall under what you classed the respondents as "disgruntled drug addicts". It illustrates my point about the ignorance from the medical community: Those patients who have been done wrong by do not deserve such premature judgement nor such far reaching statements that to me essentially mean "what's next, these nuts are going to be on the medical committe". Keep your pants on, no one's going on any comittee. It's an internet sight to patients what you already promised them in your oath: a voice. That's it, the rest - we decide.
The reason I thought your comment was misdirected was that you opened with "so you don't like being rated?" and my post had nothing to do with me being rated.
My criticism of the site is its overall evidentiary quality and nothing about individual commenters. The low evidentiary quality, in fact, has little to do with the commenters themselves, many of whom are offering legitimate complaints. Rather, it is that the commenters are immune from responsibility for what they say because they are anonymous. As a result no allegations can be verified by direct evidence.
If such a site is to be used in credentialing the commenters should have to give their names.
"The reason I thought your comment was misdirected was that you opened with "so you don't like being rated?" and my post had nothing to do with me being rated."
To me, with the tone of your original post that seemed to be half of what you were sensitive about – you and your colleagues being rated - that's the way I read it. It also wasn't meant for just you, it was directed at the medical community in general.
"My criticism of the site is its overall evidentiary quality and nothing about individual commenters. "
I can't half tell that in between the breaths of "last week’s disgruntled drug seeker or patients of this ilk." Sorry but I replied to what you wrote, not what you clarified your focus is in your later posts.
"The low evidentiary quality, in fact, has little to do with the commenters themselves, many of whom are offering legitimate complaints."
The somewhat changed tone about it all acknowledging important things about patients and their experiences and showing compassion for them - I didn't really draw that from the original post as below.
"where anyone can anonymously say just about anything about a physician." "Well, that’s scary----opening up the credentialing process to last week’s disgruntled drug seeker or patients of this ilk. Heck, why not just invite ‘em to attend the credentials committee?"
as opposed to the later comments made:
"Rather, it is that the commenters are immune from responsibility for what they say because they are anonymous. As a result no allegations can be verified by direct evidence.
If such a site is to be used in credentialing the commenters should have to give their names."
The only form of "credentially" that as I understand can occur from that site, is what people decide within themselves, amongst themselves, already anyway: form opinions. If doctor's were to be seriously taken up on some misdoing, by the appropriate board or legally, then it's part of the complaint process to give your name, that's fair enough. On such a website on the internet it's fair game. It's just an opinion that really can't go anywhere at the end of the day. So whether you provide a name or not, to me, does not make a huge amount of difference. No one's joining any committee, I can't even laugh at that, it's too much of a sad over done comment type reaction for a site that like many other simple things in life, has it's purpose and it's down sides. If you didn't underestimate you're audience as much as your previous statements have, you'll see the majority of us can put it into perspective and no decent quack will be out of a job as a result of an odd comment or two.
At the end of the day anyone's reputation and career is not in a person's hands or a committee's, it's all decided by God.
I personally love the website and have used it to post honest opinions about doctors I have encountered. I have given great ratings to doctors I have used who have deserved it, and some terrible ratings to doctors who were also deserving. Every rating I have given has been followed by a clear explanation as to why the doctor received that particular rating. I believe as long as you read each rating's comments an take in to account the statements made by the reviewer that the information can be very beneficial. I know there will always be a few crazy people who will use this site to vent about unimportant issues; however you can not disregard the site because there are unintelligent people who use it. That issue encompasses everything in life.
I am glad this site exists there are not many other ways to get others opinions on a doctor. I beleive people should always take in to account the comments made with the rating and determine whether there is substantial information provided by the reviewer to support their opinion.
I hope this site continues and more people leave objective reviews about the medical care they receive. Information is knowledge.
In NC, our physicians are policed by the NC Medical Board which is composed primarily of physicians. The Board maintains a website that supposedly lists doctors who have been in trouble with the board. Unfortunately, if a physician is turned into the board and completes the course of action that they suggest to correct their "problem", their names are never put on the website. I know a physican who was turned into the board for "disruptive behavior" several times. He did what the board told him and was not put on the website. He is dangerous. I looked on RateMD and he had one negative comment and several very positive comments. Nowhere is the information that he was fired from his practice after being suspended, that he was turned into the medical board, nor that he failed to fill out required paperwork or charts for two years. He damaged people's lives. I know of one patient who couldn't get the medical help she needed from other physicians because he "lost" her chart. He wasn't supposed to take it out of the office (another reason he was fired.) There are a lot of very good physicians out there, but they need to police themselves properly. I finally decided to do the right thing and put the information on RateMDs that he was fired; something not many people know. I believe that the practice was so concerned about getting sued by his patients that they agreed to keep it quiet so there is a good chance that this information can't or won't be confirmed by the practice, another example of physicians covering for each other. This physician has the ability to get the information taken off the website. The patients that he has hurt and will hurt in the future don't have the opportunity to get their health back.
All I know is several comments/ratings are removed for no other reason than they are negative. What good is it if people cannot get uncensored information when looking for good and decent care. The sight is unreliable.
if a patient feels so strongly about his/her care then maybe that person should report that doctor to the licensing board and not hide behide this website being anonymous. If you have a legitimate complaint then you should have no trouble giving your name especially if the comment boarders on being slander.
The only people that the webmasters want there are doctor haters/bashers
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