09 Aug 2011 03:43

The American Medical Association (a solely physicians’ body) published a news report recently (here) about physicians being unhappy with negative reviews from patients and their families. Of course, this is not a problem in the UK, where patients have no powers to comment publicly or openly about the quality of the services they receive, because of the risible libel laws that exist in the UK (here). If we did, then I would have words to say about several neurologists whose competence I have serious questions about, both as a patient and as a clinician myself. The AMA poses this as an ethical debate and it is part of a larger ethical debate about providing private medical services that are not comprehensive and that therefore can not expect to deliver adequate outcomes in chronic illness care, at least. If one is going to promote medical consumerism by providing only privatised and balkanised services, using advertising and market-competition, then such problems as using social media to display “patient satisfaction” in the guise of rating physicians’ performance are to be expected. Consumerist providers are asking for trouble and they are getting it.

In the Tuke Institute’s consultation document on Participative Medical Governance (here), I advocate for the use of online reviews of clinicians’ performance but in a moderated way. They should be about rating a clinician’s ability to deliver health-outcomes, not “patient satisfaction”, and in reference to specific variables that are known to be essential to delivering them. Then, instead of these star-rating systems for hospitals, we will have realistic, individualised, and relevant data on which to judge performance in the specific and the aggregate. With participative practice in health-services, it’s not that difficult. Until providers are willing to do this, then they will suffer from unwanted reviews by web-savvy public.