Wednesday, March 11, 2009

New Bedside Manners

Tell Me – Not the Internet – How You Feel
I haven’t conducted a formal survey but I’d be willing to pull some money out from under my mattress and bet that two of the most often-used words these days in the worlds of business and politics are transparency and accountability. There’s been little choice, if you think about it. The collision between out-of-control companies and politicians with public outrage and instant communication tools has sparked unprecedented demands for truth and openness.

The push to expand transparency and accountability has given rise to numerous rating sites on the internet – everything from food to teachers to virtually any product. This long list includes about 40 web sites where one can rate their healthcare provider.

In an AP story last week, “Docs seek gag orders to stop patients' reviews,” Lindsey Tanner reported how some physicians are coping with anonymous, negative patient commentaries on sites like Intrigued, I went to the web site and saw that over 185,000 “doctors” were rated, but this includes acupuncturists, chiropractors, podiatrists, psychologists and dentists. I clicked on the most reviewed doctors and found that the top four are ob/gyns and number five is a cosmetic/plastic surgeon. (Number six, I must note, is the fictitious Dr. Gregory House.)

It’s not a big surprise that women, the most influential healthcare decision makers in the family unit, are the most vocal. Randomly scrolling through, I found some posts to be reverential and others to be scathing. These comments are a one-way street, however. The doctor’s name is used but not the patient’s and, because of rules protecting patient confidentiality, there’s no way for the doctor to respond.

Here’s where a company called Medical Justice comes in. For a fee, they offer physicians a service that monitors the internet for patient comments and a contract (“mutual privacy agreements”) for their patients to sign where they “agree not to post about their doctor on the Web without the doctor's permission.” In addressing First Amendment rights, the site states that “Patients are free to discuss their care with other doctors, family, friends, licensing boards, attorneys, and any number of institutions. Mutual privacy agreements do not create a choice between healthcare and one's right to free speech (as some have erroneously claimed).”

So, on one hand we have sites that allow unfettered forums for blasting (or praising) health care providers. On the other hand, we have an effort to limit where patients can express their views. Here are a few thoughts:

Health care providers need to accept the reality of our information society. Telling someone they can’t do something is a sure-fire way to promote the opposite of what is intended.

Entering into a contractual arrangement with a patient over issues of speech may raise questions about the doctor’s motives, potentially damage the relationship and erect a barrier that decreases communication.

If women are using this medium most frequently, then some special attention needs to be paid to their concerns and communication preferences. There should be an office environment where concerns can be aired before they hit the internet. And, if face-to-face commentary is uncomfortable, perhaps an anonymous mail-in survey should be made available.

While both sides have legitimate positions, I think we require a third hand. What’s needed is a forum where patients can post justifiable comments, where those who read them can have some assurance that no axes are being grinded. Health care providers need assurance that inaccurate, reputation-killing commentary is kept off the web, where it’s so difficult to excise.

Patient advocates and organized medicine should collaborate on setting standards and policies – a code – for responsible, ethical rating sites. Both patients and their doctors need to get on the same side of the fence on this issue. When it comes to your health and wellness, I can’t think of an issue where it’s more important for all the parties to act as a team.

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