This is a special “numbers-lite” post, with apologies. Despite this, I hope it will provide a basepoint for some significant new numbers during 2009. Bear with me.
I’m inspired by the news today that the UK Government will introduce public ratings of doctors by patients on Government websites. Ratings…you know what we mean: “dr spock wuz a crap doctor / removed my arm when he shld have prescribed antibodes / cold stetherscop / I had to wait too long / receptionist is a babe” etc etc etc
The drive comes from Government bods Ben Bradshaw (the Minister of State for Health Services) and Professor the Lord Darzi of Denham (Parliamentary Under Secretary of State at the Department of Health) who expressed their enthusiasm for doctor rankings in various forms during 2008, most notably with their support of the iwantgreatcare.org website launched in the year.
The news came from The Guardian which reported that Bradshaw has “asked the NHS” to get the software up and running to make it happen. Positive step. It also reports that Bradshaw hopes it will “do for healthcare what Amazon has done for the book trade and Trip Adviser for the travel industry: providing positive and negative feedback, warts and all, from consumers”. (The underlining is mine – the effects of those words are deeply profound, coming from a Government)
This is exciting news. Government on the front foot. Doing the right thing. Impact on the NHS – huge. Impact for other professionals outside the NHS (at least lawyers and accountants to start with) HUGE. Read HUGE. Yes, I said HUGE. Professional Rankings will be a MASSIVE theme for all Professional Services Firms in 2009 and beyond. It’s only just starting and I’ve already run out of expletives!
Range of Choice
There are 247,930 doctors registered to practice medicine in the UK according to the List of Registered Medical Practitioners maintained by the body responsible for registering doctors in the UK, the General Medical Council (December 12th 2008 data). Of this 247,930, there are 42,876 GPs (latest figures from the Royal College of General Practitioners in their annual Profile of UK General Practitioners – sadly only July 2006). You can visit the NHS Choices website to find which of these 42,876 GPs suits you best – all the data is there, fantastic, like a Facebook or LinkedIn. But there’s no patient feedback. Yet.
Ranksites
iwantgreatcare follows in the footsteps of other sites such as RateMDs, DrScore, DoctorScorecard, Book of Doctors, MyDocHub and Vitals. There are emerging (i.e. newly established and growing but not yet full or definitive) sites such as LawyerRatingz, AccountantRatingz and RateMyTeachers, as well as standard “Yellow Pages” directory services such as Angie’s List which provide feedback and views on doctors in a local area, alongside those for plumbers and gardeners.
The big noise on this subject possibly started when US healthcare firm WellPoint announced way back in October 2007 that it would launch a doctors’ feedback service in January 2008 (Company Press Release), which it then duly did – not public but for it’s paying customers. This was done in conjunction with the restaurant rating service, Zagat, and scores doctors on four criteria: trust, communication, availability and office environment.
Negative Counterattack
There’s massive backlach to this type of feedback and it’s worth noting the substance and tone. Future efforts to rate professionals in professional firms will face the same rampant hostility. The dominant complaint is against anonymous comment and in this, the complainants are absolutely right – anonymity shouldn’t be part of any rating system. All comments must be open. The next major issue is the threat and fear of legal action brought by professionals who are “libelled” in customer feedback.
Here’s a taste of the critique (though the sources are generic, not specifically selected for their importance):
- “there is a significant possibility of it being used in a malicious way” (from the BMA, 138,000 members at the end of 2007 according to the BMA 2008 Annual Report and quoted in Pulse)
- “disgruntled patients are more likely to submit a survey than happy ones” (from US physician James King, Board Chair of the American Academy of Family Physicians quoted in
- “a silly idea” as quoted in the FT’s McCartney Blog written by Glasgow-based GP and FT Weekend columnist Margaret McCartney
- “self selecting feedback (where extremes of views are most common) are hardly going to give a realistic view” (McCartney)
- “anyone can pitch up and say anything, with no need to declare who they are”,
- “very non-evidence based” (McCartney)
- “possibly even dangerous thing” (McCartney)
- “anonymous, untraceable criticism will [not] have a beneficial effect on a doctors practice” (McCartney)
- “…could cause distress that has serious consequence” (McCartney)
- “have the potential to sour already strained relationships between the nation’s patients and physicians” says pundit Delia Chiaramonte (2 recommendations on LinkedIn) quoted in USA Today
- “there’s a significant possibility of it being used in a malicious way” said Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPC committee quoted in the Guardian newspaper
- “leaving [Doctors] open to potential abuse from individuals with a vendetta” (Vautrey)
- “it would be of great concern if any doctor was put in jeopardy through a malicious campaign, maybe through viral email, to attack or undermine a doctor at a hospital or GP’s practice” (Vautrey)
- “anonymous online ratings and rants can ruin reputations and destroy trust” Nancy Nielsen, president of the American Medical Association (240,000 members according to their 2007 Annual Report and quoted in USA Today
- “wise doctors…will either grow very thick skins…or studiously ignore the sites altogether….in both cases the sites loose any wider value” from the Patient Opinion’s team blog
- “in the long run sites like this will devolve to serving the lowest common denominator of outrage” (Patient’s Opinion again)
- “a website on which people can slander or praise irresponsibly is the wrong approach” said Laurence Buckman (on Facebook but not on LinkedIn), chairman of the British Medical Association’s GPC committee
- “temptation for doctors to game the system” (Buckman)
- “this is not the way professionals should interact with their patients” (Buckman)
- “it has a great potential to be misleading” (Buckman)
But big respect to Professor Chris Bulstrode, of Oxford University, a consultant orthopaedic surgeon and member of the GMC, who said: ‘This website is a great idea and will put the cat among the pigeons with the medical profession, which is just what’s needed. Doctors will feel threatened, and rightly, as one or two will find their trousers round their ankles.’
Rating System
It’s worth a quick look at how medical professionals are ranked….on what criteria:
- Book of Doctors ranks on: Waiting Room Time, Doctor Availability, Returns Calls in a Timely Fashion, Personal Attention During Visit, Shows Caring & Compassion, Ability to Communicate, Explanation/Coordination of Medications, Willingness to Make Referrals, Quality of Referrals, Professionalism of Staff, Accuracy of Billing, Cleanliness of Office
- DrScore uses a single 0 (worst possible care) to 10 (best possible care) scale
- HealthGrades provides a ratings system
- DoctorScorecard uses an overall score out of 10 with Nursing Staff, Office Staff, Cost, media Equipment, Office Waiting Time and Appointment Availability as criteria.
- Jameda uses the typical German “Gesamtnote” system for scoring on satisfaction, clarity of communication, trust, time spent by the doctor and how friendly the doctor was.
- Vitals uses: ease in getting an appointment, waiting time during a visit, courtesy and professionalism of office staff, accuracy in diagnosing a problem, bedside manner, spending enough time with me, following up as needed after my visit
- iwantgratecare takes three criteria: Do you trust them? Did they listen to you? and Would you recommend them?
Sample ratings from the German jameda.de and Book of Doctors:
