The View From Here

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Were you waiting to hear what ultimately happened with those emails? Are you dying to find out if the patient review was real or fake? 

Me, too. 

So is the physician who was targeted….

Doctors, because of HIPAA privacy laws, cannot fight back by replying to reviews like say a restaurant or store can: “This patient was belligerent, cussing out staff, throwing pasta, demanding large quantities of controlled substances….” 

Nor can we post the thank you notes we receive from patients.

Some doctors make their patients sign waivers that they will not post negative reviews online. Some require a waiver against posting any online reviews at all. One physician suggested screening patients at checkout and if they had a good experience, handing them an iPad with a review site loaded up, asking them to post a comment right there. 

The group I work for has made all of the physician reviews we receive through Press-Ganey visible to the public now online, thinking that would combat some of the online negativity that physicians were seeing. These reviews were intended for use internally for improvement purposes. Now they are visible to everyone.

The negativity onslaught is no doubt affecting physician moral, job satisfaction, burnout, and suicide rates. 

Are we all just pawns? Is there some bigger plan at play here? Take the some of the hardest working, brightest people in the world. Whittle away at their self confidence. Make them question themselves and their decision making capability. They are neutralized. What is the next step? 

World domination, perhaps?

What does that world look like? A world where bean counters and overpaid executives dictate every aspect of your care?

We should focus on improving the patient experience. I have written about this before. We are in the business of helping people. How do we measure that effectively? What exactly should we be studying? What really matters to patients? How do we improve patient satisfaction without making patients more likely to spend more on their healthcare or more likely to die? 

I don’t know how to fix it. I don’t have all of the answers. All that I can say is that this is one of the reasons why I blog, so we can all have a dialogue and maybe together come up with a solution. 

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83 thoughts on “The View From Here

  1. I go to a doctor in a corporate practice, and the first problem I see is getting to the doctor at all. After my first visit, she sent me a results letter that asked some questions, questions I thought were worth answering. The letter contained no contact information whatever. After some of the patient experiences you have reported, I can see why. So I called the main number. All I was offered was the opportunity to schedule another office visit. That’s silly. The best care comes from a provider who knows you, so if you make it impossible for the provider to know you, you’ll get less than the best of that provider.

    Liked by 3 people

    • This is why I hate the push by the government for physicians to send results electronically in letter format for “Meaningful Use” purposes. I still call my patients with their results. It is going to end up ultimately costing me thousands of dollars in income and penalties to keep doing it this way, but whatever. It is the right thing to do.

      Liked by 1 person

      • I had a follow up visit. I was with a Nurse Practitioner who wasn’t interested in those questions. They never got answered and I have not seen the doctor again. Put that together with the way they screwed up my appointments (changing one arbitrarily without telling me), and I’m ready to write a negative review—except that I would have to answer their damned survey to do it. I’m totally disenchanted, and it has nothing to do with the doctor.

        Liked by 1 person

    • I one rear a research saying patients give a good feedback if you are friendly. There is nothing wrong about friendly, but it is not the most important thing.
      The most important is your skill, and whether you care.
      ANd patients from Harold Shipman , the mass murderer adored him. He was probably friendly.
      BTW I am not saying poor bedside manner is OK, it just mustn’t be the sole reason for good rating of a physician.
      https://en.wikipedia.org/wiki/Harold_Shipman

      Liked by 1 person

  2. I wish I had an answer. Requiring people who leave messages to give their full names would be one way to go, but then, no one would leave messages.

    As to, ” Take the some of the hardest working, brightest people in the world. Whittle away at their self confidence. Make them question themselves and their decision making capability. They are neutralized. ” I have some familiarity with that…

    Liked by 1 person

    • I have patients who give me feedback during office visits or phone calls or will talk to my office manager when there is an issue so that we can fix it for them. This complaining anonymously I don’t think is all that helpful in the grand scheme of things. I cannot help someone who says they did not get all of their questions answered if I don’t know who they are.

      Liked by 2 people

      • Correct. And having the responsibility of “this is my name” attached to comments makes people think twice before going on a rampage. Without the anonymity, people are less likely to make any comment though.

        We are just not “wired” to receive this kind of scrutiny, all of the time.

        Liked by 2 people

  3. I despise this method of “improving” service. The primary reason being the kinds of anonymity enjoyed by the person posting the review. There is no way to know if that person is credible or a nut bar. A negative response could be because of who they are and have nothing to do with your ability as a doctor. And these assessments end up having a lor weight and power. A very frustrating situation.

    Liked by 1 person

    • An example of this was a couple of years ago a patient gave me zeros on everything on the in house corporate survey. It was anonymous but we managed to figure out who, back when they would let us. Turns out it was a patient who was in the midst of a psychotic breakdown. I tried to get that survey removed after the fact, the patient even wrote a letter asking to have it not count, but corporate refused.

      Liked by 1 person

  4. oh dear
    your system stinks
    ours is not quite at that level of craziness- people have to make an official “complaint” to be heard here by the powers that be, but read “rate your md” and anyone can say anything…two to three times if they like.
    I have no good answer….only to repeat what I said before, in my city, the only person with a 5-start review is the methadone doctor.

    Liked by 1 person

  5. As a non-medical person, all I can say is there may not be way to fix it. No matter the industry, there are going to be consumers who go out of their way to post negative reviews, while most of the happy consumers may relay their happiness to their friends and family but won’t go to the trouble of writing and posting a positive review. I’ve had clients claim that I am the laziest bitch on the face of the earth, while others (fortunately the majority of them) say I’m the hardest working, most considerate person they’ve ever met. So long as you know you’re doing the very best you can, I wouldn’t worry about those few patients who say bad things.

    Liked by 1 person

  6. In an impersonal world, where people don’t communicate face-to-face, things inevitably will boil over eventually. Just bide your time, doc. However, this internet rating issue brings to mind an issue that leaves me feeling a bit disgusted. I have occasionally received letters from doctors I’ve seen, informing me that soon I will receive a patient survey. They encourage me to answer every question by giving them the highest marks. This really seems cheesy, and a bit unethical to me. But I wonder why the doctors are so worried about receiving even the slightest positive mark below the best mark. Is the pressure on you guys that extreme?

    Liked by 1 person

  7. I agree with your concern about anonymous feedback being used as a coercive tool by bureaucrats. It’s a way to justify devaluing your worth whenever it’s convenient for them. You should not be devalued based on unvetted information. Such information could be useful to show overall trends and patient satisfaction aimed at process improvment.

    Liked by 2 people

  8. I don’t like the way your company is handling the negative feedback. It seems they could set up a special place for patients to comment that is private. That would give patients their say but it does not have to be a public review and the physicians would be required to read it. Kaiser has a feedback questionnaire they send out periodically and the patient can fill it out and mail it back in. It is not published for the public. I think it is not a good thing to make physicians so self-conscious as these public forums do. And it is unfair. So let the patients give you whatever feedback they want to but keep it private.

    Liked by 2 people

  9. I wish there were a solution that worked well for all. There are some docs that people need to be warned about but there are also as you know (because you are one) amazing docs that people need to hear about.

    Liked by 1 person

  10. So patient and physician relations at your practice are reduced to objective data based on subjective experiences that varies per situation and the data analysts tell you whether you are doing a good job because managers and policy makers like it when objective data reduces the need to actually understand what is going on in the practice?

    You are systematically objectified as a value generating human in the role of a medical professional. The progress of the 21st century is measurable for control and feedback needs.

    Reminds me of “After Ford” in Huxley’s “Brave New World” and yes my mind is going whisky tango foxtrot…

    Liked by 1 person

  11. So I thought possibly when you wrote about this was the account was hacked and someone got patient info and was sending crap. Then when you said it was immediate, I said what? Our stupid surveys are mailed and I get the list every month of the 250 names they went to. It is not hard to figure out who wrote what most times. But your survey is much different than ours. Only scores are publically published and the good always seem to outweigh the bad enough. Could we do better? Of course and a stupid survey filled out by one pissed off patient does not make a bad agency.
    I agree, get rid of them. Make a patient portal available where a dialogue can be created. I know people who fill out surveys just because they can be pissy and get away with it. They prove nothing, they are an expense the state could do without. Score our OASIS, look at our volume. That will tell more how we are doing the some 98 year old senile woman who fills the survey out backwards….. I have at least one a month. We teach them that bad pain is a 10 but on the survey a 9 or 10 is a good score. No problem there.
    Let send every voter one on each existing politians and they will be gone in a flash.!

    Liked by 1 person

  12. I had a summer holiday job years ago as a ganger on a railway crew. One of the guys on the crew was a doctor who had given up practice because the stresses were too great. It wasn’t the fact that patients complained it was that he set his own standards and it affected him if he didn’t meet them.
    You have to make sure you look after yourself. Ne illegitimi carborundum

    Liked by 1 person

    • This is why I have worked to insulate myself as much as possible. I don’t want to know what people are saying about me. I want to provide the best medical care possible in the most respectful, humane way possible. I adore patients who want to share with me ways to improve the experience but surveys and reviews are not the way. The first is ineffective and the second is not constructive.

      Like

  13. There can be no solution that works for all of us, all the time. I hate corporate execs as much as the next man, but that’s where the future is headed. Someone has to administrate and if we doctors don’t, it’ll be some oily kid with a MBA under his arm and a fake smile plastered on his face. What else is wrong and where we can improve, especially with regard to patient experience would take a full post, something I might try to attempt one of these days….It’s not about medicines and tests though, not about money at all.

    Liked by 1 person

  14. I’ve given this some thought Victo and I really do not think you will ever get away from some negative reviews. The issue isn’t the reviews, it’s how they are perceived and used. For instance last night after dialysis I traveled with a woman about my age who has both diabetes and kidney failure (not an uncommon combination). She was fairly new -8 weeks – in dialysis and she was upset at the doctor. She was scheduled for a procedure to install a fistula this morning at 6:30 am and she was so upset that she said she was going to refuse to go. I talked her out of that by explaining that a) it would cost about $10,000 in lost time for an operating room, surgeon, anesthesiologist, nurses, prep, cleaning, etc.. and b) she would piss of the doctors and get poorer attention from them in the future(they are only human).

    The reason for her anger? Well, she had an infection in her legs and was on dilaudid (4mg po) for pain. According to her she had been as high as 12mg po and was cutting back. Her legs started to hurt in dialysis last night (dialysis does stuff like that as it deals with blood circulation and will affect nerves and lungs and other body parts – especially peripherals) so she requested an increase in her dilaudid. The nurse contacted the on-call doctor about 8 pm and he said “No”. There are rotating doctors on call .evenings – they take about 3 week stretches split amongst about 5 doctors- and they do evening rounds every Monday. She had seen the doctor Monday but had not asked for an increase. The docs have remote access to patient records from home (we have an electronic records system for patient info and for nephrology).but she was new and many docs will not prescribe narcotics unless they personally have examined the patient. Sometimes the rules are bent a bit in dialysis because the procedure itself can cause some serious medical side effects -including nausea, restless legs, abdominal pain, low blood pressure, cardiac arrhythmia (had that one myself), loss of consciousness, and occasionally death (seen that one too). For that reason,if a doc on call thinks a patient needs attention, he/she will get a resident to come to the unit and do an assessment or, if the patient is known, will up narcotic prescriptions only while in dialysis and under the care of the nurses. The on-call last night did none of those – just said “No” and that was it.

    It is entirely possible that the patient had a history of abuse and was using dialysis as an excuse to increase the narcotics – I have no clue. What I do know is that she was upset. If she had access to a computer she would have gone home and written a nasty review of the doctor – and maybe the doc deserved it for not following through with options or maybe she was being unreasonable and the doc knew it. Either way, deserved or not she was unhappy. That said, it is apparent that the doc could have generated a bad review even though he may not have deserved it. That makes it clear that the review cannot be used as a means of judging the doctor because it could be valid or not – there is no way to determine that within Privacy laws (We call it PIPA -Personal Information Protection Act).

    That said, Victo, I really don’t think that stopping bad reviews is ever going to happen – I think the push should be to use them differently..As long as you are comfortable with the treatment you have given your patients then I do not think you should be concerned about reviews.- nor should your bosses. That should be the fight. As an aside (and I’m not sure how this could work in your profession but it’s interesting) my Mom was a professor and she used to have some of her classes taped and then review them to see how she did and occasionally she would have a peer review her tapes. Different professions use different means to assure and prove quality service delivery – you just have to figure out yours(obviously patient complaints are not a valid way to determine if you are doing a good job).

    In an unrelated matter, the same woman has MRSA acquired in a hospital stay. She currently lives in a residence where she shares a room with three other s and a washroom with others as well. The docs have spoken to the privately owned facility and told them that she should not share washroom facilities. According to the patient, the facility ignored the medical advice and have made no changes. How dangerous is this? .Should public health officials be notified?

    Liked by 1 person

    • I would never expect to get rid of negative reviews. As you say we need a new way of dealing with them that does not emphasize them so much. In this case, if there was a sound medical reason for that woman not being on more dilaudid, (such as she was having hypotension or respiratory suppression from over medication), if the doctor had been more focused on the negative review rather than good medical care, she would have gotten what she wanted. This is how high patient satisfaction can generate increased mortality. As for this woman’s MRSA, if she is no longer a carrier, if the infection is resolved, then she is no longer a threat and can use regular facilities.

      Liked by 1 person

  15. I’m not a fan of these reviews for anything. Only today I got requests to review virtually everything I bought in the last month — including a ream of paper I got for my printer at home. Seriously, do we need these.

    Reviews of doctors are important because we communicate only online these days. But I have no clue how to make them realistic, honest, or helpful to anyone. Most of the time folks write them when they’re mad — and that isn’t necessarily the doctor’s fault. Many people expect miracle cures from their doctors, and when they don’t get them, they are angry, disappointed. They learn they are flawed and worse, that they are mortal. Hard stuff to swallow for some folks.

    Wish I could give you some words of wisdom, though. Because this situation needs improvement.

    Liked by 1 person

    • We should care about how people feel and what they think. It just needs to be a more constructive format. I really love the online suggestion box idea from above. I am going to see if we can add that function to our website and direct patients to it.

      Liked by 1 person

  16. It truly seems we are at or arriving to the tipping point in this arena. How do we become true partners again – patient and physician – with a common goal? Working in the corporate side of things has soured me on the idea that corporatizing (if that’s even a word – well it is now) healthcare is ever a good idea.

    We do so much damage to each other because it’s easy to hide behind a keyboard and vent. We refuse to value the humanity of the physician and there are plenty of physicians who no longer view the humanity of the patient. Adding the layer of P&L driven oversight has really weakened our relationships.

    I wish I knew how to get back to the partnership I remember when I first entered the healthcare arena. It was about people not profit. I have no idea how it will end up. I feel for you, Doc. I wish you were just allowed to give of your gifts and that they would be accepted as they are – an attempt to inform, heal and help your fellow human beings.

    Liked by 1 person

      • I agree. We’re trapped it seems. It makes me sad though. I worked for a surgeon in the 70s who was shunned by his peers for taking patients who couldn’t afford to pay but $5 for an office visit. He refused to refuse patients based on money. It was a different time and he could afford to balance those patients with the ones who paid the full fee. We ran a totally lean ship with nothing extravagant but no one was denied.

        I don’t think it’s possible to do that anymore – costs are too high. From office space, salaries, every piece of equipment and every ancillary service required to fully diagnose. I don’t envy you having to balance reality with desire. But I totally admire you that the desire is evident and STRONG.

        We can dream still. It’s free.

        Liked by 1 person

  17. It’s really interesting to me how your experience parallels that of the teachers I know in this regard. Not only in the numbers ratings on themselves, but for their students. People, life, learning, experience, is more nuanced than that. Why is there a doctor shortage, a teacher shortage? Is it computers that have turned the way we see and relate to each other into numbers? I haven’t the slightest idea how we turn back either.

    Liked by 1 person

    • Education is the perfect parallel example! What makes students better, what forces them to learn, does not necessarily make them happy. I am sooooo glad my teachers were not interested in making me satisfied, they were interested in making me smarter if they had to drag me kicking and screaming to it. In a lot of ways, the two are mutually exclusive. Medicine had lost its way for a time. There was a huge need to refocus on the patients. That by itself was good, but the unintentional side effect of it was to increase costs for patients and make them more likely to die. That is a failure. That says we need to take a step back and again refocus our approach. Not that we should lose our focus in the patients, just change how we are looking at outcomes and emphasizing results.

      Liked by 1 person

      • I’m not sure that increased mortality is necessarily always a measure of failure. In general it is, yet there are areas of palliative care where patients are in constant pain and waiting to die where there is zero quality of life. In those cases, I sometimes wonder if increased mortality at patient request is perhaps a win not a loss.If the choice is continual pain or more pain killer that may cause a fatal reaction – and the patient understands and requests more pain killer – is it better to keep them alive against their will and in pain? Or is it better to administer the requested pain killer at patient request? Of course that goes into euthanasia, which by the way, Canada just made legal on a federal level this year, although no regulations have been drafted yet – the legal precedent has been made by our Supreme Court.

        Liked by 1 person

      • In the case of hospice and palliative care, the patient is not really able to give direct feedback after their care so I would doubt that is figured into those numbers. But I would think it safe to say that any physician, myself included, would put pain control above extending life in that sort of situation.

        Liked by 1 person

  18. Oh, dear, this is terrible. There’s too much negativity everywhere, and so many reviews are negative. The folks who have positive experiences are less likely to write a review. Good luck and I hope this gets better. I think you’re blog is amazing!

    Liked by 1 person

  19. I hate when people leave those perpetually nasty reviews, whether it is a restaurant, store, or doctor’s office. People don’t get they are messing with a person’s credibility and income- they just hide behind their accounts online while it trolls. Why not talk to someone in person before you go online and bash them??

    Liked by 1 person

  20. I think underneath each and every negative patient review which the docs are able to identify, the doctor should anonymously post a fake cloying, positive review with an eerily similar patient experience as the meanie. “Just had the best rectal exam! Not that I wanted to be prodded, but the physician was friendly, knowledgeable, and sympathetic to my embarrassment. If I ever have to get poked again, I’m definitely coming back here! Thanks, Dr. X!”

    Liked by 1 person

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