Ratings System

Yesterday, I read Trisha Torrey’s post about the ratingsystem. More specifically, how someone named Dr. Young has protested about his patients rating (judging) his services, calling some of them unfair. He also felt that people who didn't "get over it" are "bad patients." Trisha asks that since patients rate doctors, should doctors rate patients, too? I left a comment on her post, but feel the need to rant in more detail.

First, doctors judge patients all the time. None of them – even the best ones — are unbiased paragons of service to humanity. Every time they reassure you that your symptoms are caused by stress, it's a judgment. Every time they refuse to give you a prescription for painkillers because they feel you don't need it, it's a judgment. Every time they dismiss your anxiety as catastrophizing," it's a judgment. The judgments are big or small, innocuous or have the potential to cause damage, but they're there. Because that's what humans do. And sometimes, certain parts of the medical profession immortalize judgments in psychiatric definitions, thus tying this post neatly into the apparent theme of the week.

But there's more to it with this rating system. There are doctors out there who get so discombobulated by being rated that they make their patients sign an agreement that they will not engage in such behavior on websites such as RateMD or risk losing care. Yep, seriously. And in my view — and this is when I start intermittently quoting myself again — there's something that the above-mentioned Dr. Young and many other doctors seem to be forgetting.

Doctors are service providers in much the same way as a plumber, a painter or a caterer is. They are paid to provider service, in this case the medical care. As their customers, we absolutely have a right to rate the service they provide (and to go elsewhere, if it is below expectations). Being a patient is changing — we are becoming increasingly empowered, engaged and knowledgeable and that creates a certain set of expectations about the service you receive. It is disconcerting to a profession that is used to being in charge and in control of what happens in the relationship between themselves and their patients, to the point where they decide what someone else does with their life. The language used reflects this mindset: doctors don't give recommendations, they give orders. If you don't follow their orders, you are "non-compliant." The words build expectations about roles and relationship dynamics. Expectations that doctors know better, that we should just mindlessly put ourselves in their hands and all will be well.

But it won't. Because they're not the ones living within the illness. They're not the ones who have to make it work, who have to find a way to cope and manage. And, perhaps, putting yourselves in your doctor’s hands and blindly following orders can work if you have a sprained ankle or a fractured elbow, but certainly not when you have more long-term problems. But whether you are generally healthy or have a chronic illness, it is reasonable to expect good care and a professional demeanor.

I think this brouhaha is a symptom (if you will) of this long-standing perception that doctors are somehow semi-divine, certainly different and deserving of being put on pedestals. They’re not. They are paid experts and very important experts, but at the end of the day, they are paid — either directly by the patient or indirectly through insurance or government subsidy — by the person in their office. I think it behooves the medical profession to start thinking in terms of customer service, rather than getting upset that uppity patients are starting to hold them accountable for being professional when they provide their service.

Because that's it, isn't it? If we are not professional at work, we can be disciplined up to and including dismissal. We are held accountable by the people we serve, be they the public or specific customers or clients. If we are rude or unprofessional, if we provide bad service, then we can be rated in various ways. That can include a review on the Internet, a complaint to our employer or telling our friends to avoid a particular business. This does not label us as "bad customers." Customers have a right to expect a certain standard and to complain when this doesn't happen. Businesses seek out good reviews and do so by pursuing excellence in their services. When their customers complain, they don't blame the problem on the customers or dismiss the issue by calling the complainant a "bad customer" (well, not publicly, anyway) — good businesses listen, learn and change.

Maybe it's time that doctors do, too.

I should end this discussion by saying that there are many fantastic doctors out there. I'm in the lucky position of having met a bunch of them. I have also met about an equal number of doctors who were not. My rating system was to not go back or to tell my GP to not refer me (or anyone else) to a particular doctor. If clinics or hospitals had a customer service survey, I would fill it out. For both the bad and the good doctors. Because good feedback breeds even better service.