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Attack on unfair

The attack on is, to borrow a quote from Ian Powell, Executive director of the Association of Salaried Medical Specialist, is "unfair". In defence of customers of medical specialists, I feel compelled to take a look at this criticism and wonder at some of the issues. You can check out the comments as reported by TVNZ One News at this link.

The union representing New Zealand doctors has labeled a new website which allows members of the pubic to rate doctors as setting a "dubious precedent" which does not guarantee "greater transparency or improved quality of care".

This is a strange standard to hold the service to. No one 'guarantees' these things. People or organisations may only contribute to them.

"What happens if a doctor initiates child protection proceedings because they are concerned about a child's well-being, and one of the parents involved subsequently rates the doctor poorly or posts negative comments?" executive director of ASMS Ian Powell said.

All doctor's behaviour, whether approved or not by clients, whether good or bad, is always subject to the opinions of others. This is simply a fact of life. That this information may be shared quickly is a fact of the digital world. This question could be framed in a different way: imagine a doctor behaves badly and no-one was permitted to share that information, would that be a preferable outcome? Dealing solely in extremes also makes this dreadfully loaded - as most interactions with ratings sites are far more likely to comment on simple matters like manner, parking, wait times for appointments, and the experienced quality of outcomes. Sharing more of those things would help many consumers. Besides, is the current method of selecting specialists ideal? I have heard one medical professional say "the specialist system is broken". So plainly not everyone thinks that what we have right now works as well as it should. Experimentation might be just what we need.

"There are circumstances in which comments posted on the website could post an actual danger to the doctor's safety, for example when doctors perform abortions or carry out other treatment or procedures that some individuals or groups find contentious."

This is also an argument against any website listings of services, or entries in old media like phone books, or any free speech. In essence it says we cannot share opinions because there are violent lunatics in society. I think most of us want a world in which we can share opinions and violent lunatics are prevented from taking extreme action.

"It's also important to make the point that popularity and charm in a health professional does not automatically mean a higher standard of clinical practice or better outcomes of care – for example, Dr Harold Shipman was loved by his patients!" Mr Powell said.

Are we only safe from murderers if we don't talk about them? That's a curious proposition. It also suggests that the only feedback a customer might give is on how 'charming' a specialist is - which is simply not the case. It is true that clients may comment on matters of great or little importance. This theme, that clients, or patients are incapable of perceiving the higher functions of their caregivers, pervades all the comments:

"They are not choosing between different types of vacuum cleaners; they need compassionate, qualified expert medical care, not the latest brand. And that type of treatment is usually delivered by teams of health professionals, rather than a single doctor.

I don't think anyone would disagree with that statement. But to believe that means no client should be permitted to share their view is strange. Does the patient have no say over their treatment? Can the patient have no legitimate concerns or requirements? Can no patient view be valid? Given the power imbalance between patient and doctor that already exist, helping to rectify that even a little has got to be a good thing. Comparisons aren't just for vacuum cleaners, they can - and are - applied to professionals of all kinds. In fact, the more complex the advice process the more information is useful and important.


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J-P Hale

Thanks Russell. I support increased visibility with health care.

The often experienced circle the wagons approach to medicine when a colleague has not done quite as well as they should have needs to be addressed. Protecting those in the field that regularly screw up or cause harm need to be flushed out.

I get that there will be negative comments made about good Dr's, they are human and have bad days too, but we've seen on the most part the approach to transparency with ratings result in a positive improvement rather than the extremes.

When I experience conversations with Dr's that won't specifically confirm or deny the quality of services of another medical professional, I often turn it around to would you refer your client suffering from condition x to this specialist? The answer won't necessarily be a no, it will more likely be a "I would use ABC for that treatment"

The number of cases I've seen with poor co-ordination of patient care, the lack of bedside manner leaving patients in limbo, and general lack of communication, means patients have poorer outcomes, even if the surgeon was brilliant because their recovery and rehab is left completely to chance.

Part of the reason people end up in the medical system in the first place.

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