Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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rating sites as an educational tool
- chris harnden (19 March 2009)
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Feedback is good: iwantgreatcare.org is not
- Dominic H R Faux (22 March 2009)
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Web-based patient feedback is coming
- Paul K Hodgkin (23 March 2009)
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Nonsense
- Martin J Toal (23 March 2009)
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Simple problems, require simple solutions.
- David R Warriner (25 March 2009)
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Some doctors will avoid high-risk patients
- Nicos Kessaris (1 April 2009)
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It's better than no ratings
- C Fezziwig (1 April 2009)
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Basis for assessment
- Joan McClusky (2 April 2009)
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Patient feedback is important but
- Umesh Prabhu (3 April 2009)
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Are we ready?
- Sukhpal S Gill, Alana R. Cunningham, Final Year Medical Student, University of Birmingham (4 April 2009)
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chris harnden, gpep2 facilitator royal new zealand college of gps blenheim, new zealand
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In new Zealand patient satisfaction surveys are used routinely in the assessment process for attaining the FRNZCGP qualification. The average overall satisfaction score achieved is 86%. Doctors who score below 80% satisfaction ratings usually are found to have significant problems with their consultaton skills. Doctors in the fellowship training program are strongly encouraged to use and reflect on lessons learned using this tool and in my experience they find this a very useful tool. I believe quite strongly doctors need to be more open and honest about receiving feedback. Particularly as their performance comes from the best source, our patients. The experience from the patieint surveys is that patients are very honest about their assessment of a doctor's skill & in my experience they are usually right. Competing interests: None declared |
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Dominic H R Faux, General Practitioner Brierley Hill
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Doctors have plenty of sources of feedback. Patient satisfaction surveys are conducted regularly, clinical competence is regularly fed back via hospital letters, and if you work in partnership with others, then feedback is regular. Patients are also able to give feedback, and they do. Indeed if patients are unhappy they will see another doctor or register with another practice. There might be web-based ways of encouraging feedback that would be useful and valid, but iwantgreatcare.org is not it. Indeed the database is wildly inaccurate, with little connection with real life, and there are instances of retired doctors or those who have emigrated on the site. It also allows dead doctors to be reviewed. The possibility of anonymous feedback from disgruntled patients is endless (addicts who have been refused their benzodiazepines, those who have been refused certain lifestyle drugs), and there is no comeback available to the doctor who is unfairly criticised. There is a serious risk of vulnerable doctors to have their mental health damaged by negative feedback. Dr Bacon's site is not fit for purpose, and should be scrapped. Competing interests: None declared |
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Paul K Hodgkin, GP and Founder of Patient Opinion Patient Opinion, 53 Mowbray St, Sheffield S3 8EN
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For the last four years Patient Opinion has been running a feedback site where patients, carers and staff can share the story of their health care in the UK. Patient Opinion focuses on feedback about services rather than individuals doctors. We have learnt a lot about the benefits of this kind of feedback. In the light of this experience we obviously agree with Neil Bacon that web-based feedback from patients, carers and service users about health services is coming and will have an important role in the future. Exactly what that role will be is as yet unclear since, as Margaret McCartney points out, there is very little research on the effect of web- based feedback about individual either services or doctors. Given the fact that web-based communication such as email, blogging and twittering is known to differ significantly from traditional paper and speech-based communication it is probably unwise to extrapolate too much from studies about the utility of feedback that looked only at traditional survey and rating formats. Perhaps the most important thing to hold onto is that web-based feedback from patients is coming. How it is collected and the business model underlying the platform will almost certainly shape how effective it is. So given the rate at which the web is changing it is important that a range of providers are out there testing out which works best. Competing interests: I am a GP and founder of Patient Opinion |
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Martin J Toal, Medical Director Oncology Chroma Therapeutics, OX14 4RY
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Bacon's website will do nothing to help patient care. That is not its purpose. It is intended to make money for its owner apparently at the expense of the reputation of doctors. The posts put on the site can never be validated as accurate, and are therefore worthless. This is a problem in two directions. Vexatious posts by patients who were given good advice, but advice they did not like, may put critical comments. These comments are a poor reflection of the quality of care they received. Will a malingerer appreciate being denied another sick note, an addict painkillers or an obese patient weight loss drugs? Bacon would probably argue that the doctor should provide good advice and win the patient over to the appropriate treatment. In a 7 minute consultation? On the other side, if another Shipman had a post placed on IWGC to the effect 'This doctor killed my mother with an overdose of morphine', that post would be removed. Yet that information might be perfectly true. Interestingly, one doctor whose name is missing from IWGC is Dr Neil Bacon. I guess he is not an unqualified believer in the benefits of feedback and reflection. Competing interests: I do not see patients and successfully complained to the Information Commissioner to get my name off IWGC. |
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David R Warriner, CT1 Diabetes Northern General Hospital, Sheffield, S5 7AU
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At the risk of sounding trite, if we want feedback from a consultation, why don't we simply use what is in front of us, simply ask the patient. If you think it went badly or well, they may feel the same, this will not only confirm or refute our gut feeling but more importantly tell us why. This will provide contemporaneous constructive criticism, without hiding behind a facade of digital anonymity and allowing the patient and their opinion to feel valued. Everyone hates feedback, positive feedback makes us cringe and negative feedback makes us bitter. Yet feedback we must if we are to grow as physicians, put the patient first and stop letting history repeat itself. Competing interests: None declared |
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Nicos Kessaris, Consultant Renal and Transplant Surgeon Renal Unit, St George's Hospital, Blackshaw Road, London SW17 0QT
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I read Neil Beacon’s and Margaret McCartney’s articles with great interest.1,2 Such doctor rating sites must be approached with caution. First, there is evidence that the publication of ranking data does in fact risk causing doctors to avoid high-risk patients. For example, in a postal questionnaire involving general surgeons in the UK, 71 out of 289 consultants (24.6%) said they would avoid high-risk patients if surgeons’ performance tables were introduced.3 When a very similar questionnaire was sent to 57 cardiothoracic surgeons in the UK, 12 (21.1%) said they would avoid high-risk patients as well.4 Second, although patient feedback is extremely important, like all rating systems, it must be subject to strict quality controls if it is to be productive. 1 Bacon N. Will doctor rating sites improve standards of care? Yes. BMJ 2009; 338: b1030. 2 McCartney M. Will doctor rating sites improve the quality of care? No. BMJ 2009;338:b1033. 3 Kessaris N, Tekkis PP, Saunders MP, Boyle NH. Consultant views on surgeons' performance tables and sequential monitoring. Annals of the Royal College of Surgeons of England (Suppl) 2005;87:358-360. 4 Kessaris N, Tekkis PP, Perry-Kessaris A. Surgical performance assessment: a comparison of views from general surgical and cardiothoracic consultants. BJS 2005;92(Suppl 1):105. Competing interests: None declared |
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C Fezziwig, CEO M5E 4E3
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Patient rating websites like HealthcareReviews.eu are thriving because the medical establishment continues to operate without any serious scrutiny and oversight. They do not provide a ratings and reviews themselves for the public, usually do not even bother with internally available ratings and have the gall to oppose public rating websites. These websites fill a need for patients for public disclosure of a doctors abilities. Competing interests: None declared |
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Joan McClusky, Medical writer New York, NY 10003
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One problem with patients assessing doctors is the basis for determining who is "good" or not. And this is associated with the patient's emotional response as much as to the physician's clinical abilities. Some people don't like doctors who make they get weighed every time they go in, or who feel they are being "nagged' about things they don't consider important. People may not like a physician who doesn't agree with them that aromatherapy or magnets or yeast or radiowaves are harmful or helpful. If healthcare were all about machines--the patient as a machine with a problem and the physician as a glorified mechanic--then a ratings system might work. But the human factor--what we like, what we respond to, what we believe in -- is a huge and highly individual component. Competing interests: None declared |
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Umesh Prabhu, Consultant Paediatrician The Pennine Acute Hospitals NHS Trust
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Patients must always have a say and we as doctors should always listen to their feedback. However, an open forum where anyone can send anything in writing without revealing identity is a dangerous thing. Most doctors are not Shipman of this world. Most doctors work hard providing a good quality care to their patients and most errors are due to systems failure. Most of us may and probably will get good feedback even in an anonymised feedback. However, there is a good saying in my mother tongue ‘with human beings you do 10 good things they may not remember but you do one bad thing they won’t forget it. Medicine is a risky profession and as doctors we will make mistakes, we will not always be able to meet our patients’ expectations and patients may not like our advice about their life style, their weight, their smoking. Patients may get upset when we suggest that there may be Psycho- somatic reasons for their symptoms or worst of all patients may get upset when the doctor refuses to prescribe antibiotic for simple viral infection. They may then post some destructive messages on the website to take out their anger and frustration. As doctors we are very proud people and we have a tendency to take even one destructive comment much more seriously and if it is on the web then it is usually a permanent record which the whole world can see and this can destroy some very good doctors reputation for many years to come. So, I find it difficult to support these ventures which can destroy many innocent doctors’ lives. There is a simple solution and doctors can ask for feedback in any anonymised way after their consultation or management of the patients. Ask patients for any suggestions for improvement. Only the appraiser and the doctor must have an access to these feedbacks. Appraiser should discuss the feedback with the doctor and discuss the ways and means of improving the quality care, communication, patient involvement and so on. This would help doctors, patients and the NHS. Competing interests: None declared |
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Sukhpal S Gill, Final Year Medical Student School of Medicine, University of Birmingham, Alana R. Cunningham, Final Year Medical Student, University of Birmingham
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Anonymous public opinions of doctors via web-based platforms may provide key learning opportunities for clinicians, who are not appropriately addressing their patients’ concerns and expectations. However, the reality is that an inadequately health literate population impedes such a system from working properly. Patients who are fully aware of their health needs, knowledgeable about reasonable expectations and limitations of a doctor in addressing those needs, and able to set aside subjective feelings when reviewing their doctor, are well positioned to provide accurate and useful feedback. Low health literacy is as much a problem of developed countries as the developing world.[1] Surely, empowering patients by improving their health literacy is a logical pre-requisite, before we start asking them to judge their doctor. Reference: 1. Coulter A and Ellins J. Patient-focused interventions. A review of the evidence. Report by the Picker Institute August 2006. Available at http://www.pickereurope.org/Filestore/Downloads/QEI-Review-intro.pdf - accessed 04/04.2009 Competing interests: None declared |
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