Are these websites useful for patients? For docs?

[margaritaboy]

Consider these websites for doc reviews:

www.healthgrades.com

www.vitals.com

Reviews seem sparse and very few in number per provider. Some tend to be complaints that are not related to care, but rather to wait times or red tape. There are also some on yelp and google.

Are these websites useful for patients or docs? And if so, what value are the getting from them? Does anyone inside healthcare pay attention to them?

At my last position in AZ, there was a brief period of time were the hospital administration was trying to get reviews on Yelp for the medical center, but were not focused on the docs themselves. At my current job, I don't think anyone in leadership gives it much thought.

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[VA Hopeful Dr]

No

 

[GH253]

Many doctors don’t like these websites because members of their own group are the ones being reviewed, when they want a legal monopoly on the ability to regulate and everything and everyone else. Sites like this imply that people are best off when they can make their own decisions, which is simply intolerable to left-doctors.

 

[VA Hopeful Dr]

Many doctors don’t like these websites because members of their own group are the ones being reviewed, when they want a legal monopoly on the ability to regulate and everything and everyone else. Sites like this imply that people are best off when they can make their own decisions, which is simply intolerable to left-doctors.

Or maybe its because we have evidence that higher satisfaction scores leads to worse outcomes.

 

[margaritaboy]

Or maybe its because we have evidence that higher satisfaction scores leads to worse outcomes.

Do we? I haven't looked into it myself, but would be interested if someone has a reference or citation.

There was an NPR story (Patients Give Doctors High Marks For Prescribing Antibiotics For Common Sniffles) about how Rx for antibiotics did increase satisfaction, even if the Rx was inappropriate.

Is there an inverse correlation between patient satisfaction and quality of care? There is definitely some tension between the two, though again a reference would be nice.

 

[VA Hopeful Dr]

Do we? I haven't looked into it myself, but would be interested if someone has a reference or citation.

There was an NPR story (Patients Give Doctors High Marks For Prescribing Antibiotics For Common Sniffles) about how Rx for antibiotics did increase satisfaction, even if the Rx was inappropriate.

Is there an inverse correlation between patient satisfaction and quality of care? There is definitely some tension between the two, though again a reference would be nice.

Yes, we do:

The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality - PubMed

In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

pubmed.ncbi.nlm.nih.gov

 

[margaritaboy]

Nice! Thanks for the link.

It seems that many (NCQA, health plans, and the public) agree that patient satisfaction is important, but how is this reconciled with the article that @VA Hopeful linked above? Patient satisfaction alone would seem to lead to an incomplete and erroneous conclusion, though it is also correlated with better compliance and lower ED usage.

On the opposite end of the spectrum, I've heard of some docs 'promoting' themselves or their colleagues through reviews, or even paying for people to drop favorable reviews in social media etc.

Is there a better, simpler, and more accurate way to evaluate healthcare and physicians?

 

[GH253]

Or maybe its because we have evidence that higher satisfaction scores leads to worse outcomes.

Circular reasoning. In your judgment higher satisfaction scores correlate to worse outcomes. Your judgment is precisely what’s under review, which is why you’re mad.

 

[VA Hopeful Dr]

Circular reasoning. In your judgment higher satisfaction scores correlate to worse outcomes. You judgment is precisely what’s under review, which is why you’re mad.

No it's not my judgement, it's the result of research published in a peer reviewed journal.

 

[GH253]

No it's not my judgement, it's the result of research published in a peer reviewed journal.

...whose conclusions are valid in your judgment and whose performance is also under view on these websites. There is a huge conflict of interest there, because the peers in review don't want there to be anything above them and their opinions. In fact, there is: the customer's opinion is the ultimate arbiter of the service you're selling. Your ability to win patients in a free, unregulated market determines whether you deserve to exist as a going concern selling your medical skills, not whether you can convince sleazebag politicians to give your trade group a monopoly on the field.

 

[VA Hopeful Dr]

...whose conclusions are valid in your judgment and whose performance is also under view on these websites. There is a huge conflict of interest there, because the peers in review don't want there to be anything above them and their opinions. In fact, there is: the customer's opinion is the ultimate arbiter of the service you're selling. Your ability to win patients in a free, unregulated market determines whether you deserve to exist as a going concern selling your medical skills, not whether you can convince sleazebag politicians to give your trade group a monopoly on the field.

Well sure. If you have any issues with the article I posted feel free to post them and we can discuss them in detail. But do keep in mind that physicians will routinely publish articles that harm their fields.

There's been a lot of data in the last 10 years that says the annual physical does not actually really help anyone. I make between 80 and $100 per physical and currently have around 1600 patients. If I insisted that they all came in once a year for a physical that would earn me a staggering amount of money, but I don't because the evidence doesn't support doing that.

Medicine, for good and ill, is neither a free market nor a monopoly. We could certainly debate the merits of going further in either direction, but judging by your posting style I don't think that's actually what you're interested in.

 

[margaritaboy]

@GH253 : To clarify the peer review process: Reviewers are selected by the editor and blinded to the authorship of the work that is submitted. We are not compensated or given any citation for the review. Also, we are blinded to one another so reviewers do not know who else is reviewing the same article. While no system will eliminate bias...

I would agree with @VA Hopeful Dr that medicine is not an unfettered free market. There is significant regulatory oversight (CMS, FDA, The Joint Commission, State Licensing and Health Authorities) that exert significant influence over the circumstances that medicine can be practiced. There are also non governmental oversight bodies (NCQA) that grades quality of care, and then makes that performance data open to the public.

I do think the patient perspective is very important. However, using patient perspective alone would seem to push healthcare in an unfavorable direction, as per the references that myself and @VA Hopeful Dr have posted above. The question is how is this perspective integrated with other data to give a fair and complete picture?