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HEAD TO HEAD: Margaret McCartney Will doctor rating sites improve the quality of care? No BMJ 2009; 338: b1033 [Full text]

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My doctor is better than your doctor. Can being rated average ever be great?

H. G. El-Sayeh   (1 April 2009)

My doctor is better than your doctor. Can being rated average ever be great? 1 April 2009
H. G. El-Sayeh, Consultant Psychiatrist North Yorkshire and York PCT, HG2 7SX Send response to journal: Re: My doctor is better than your doctor. Can being rated average ever be great?	I was most interested in a recent article on doctor rating sites and the role that they could play in influencing standards of medical care (1). Whilst I can fully see the merits of the ‘servicesectorcomparison.com’ culture that we all now live in, I concur with the view held by McCartney that the application of these sites to medicine is ‘untested and potentially dangerous.’ I, like the author, am very concerned that some specialties will fare worse than others within these rating systems by virtue of their inherent nature. I believe that these online ratings will act as a surrogate marker for the specialty and not accurately reflect the professionalism of an individual doctor. In psychiatry for example, much of the work involves difficult-to- engage and marginalised patient groups. As I can testify from my own experiences, I have probably received more thank-you cards and gifts during my pre-registration house officer year than in my entire psychiatric career to date. This either makes me a lousy psychiatrist (or an exceptional house doctor) or that there may be a fundamental difference in the way that patients within the different specialties register their approval of doctors. For example, are detained patients with severe personality disorders more likely than not to report a wholly positive experience at the hands of their treating team? I doubt it. Likewise, are patients with severe dementias likely to be able to report a strongly negative experience of care? Again, I am sceptical. Having aroused my curiosity, I conducted a brief straw poll on the iwantgreatcare.com site. The average scores on doctors from 3 specialties in the London area were calculated. Both emergency medicine and cardiology returned an emphatic 100% approval rating whereas psychiatry lagged at 94%. Again, this could be related to differing clinician performances,or as I allude to above, the specialty itself. The fact remains that looking for a doctor is never and will never be as simple as switching to a different electricity or broadband provider. The folly of this reductionist approach to healthcare will be to the detriment of patients and doctors alike. References 1. McCartney, M. Will doctor rating sites improve standards of care? BMJ 2009; 338: b1033 Competing interests: None declared