Transparency, reporting, rating in health care

Transparency

Recently I came across an article in the Journal of the American Medical Association that reviewed the positive and negative effects of publicly reporting outcomes of percutaneous coronary intervention.[1] The reports included the name of the physicians involved in the procedure and the institutions where the procedure was carried out. The review found little evidence that reporting improves quality of care, or that patients actually use the data to decide where or by whom they would wish to have such a procedure performed. Importantly, it uncovered an unintended consequence of the reporting: clinicians felt pressure to avoid performing necessary risks involved with the procedure, fearing embarrassment or reduced referrals if poor outcomes were publicly disclosed.

This reference to embarrassment really caught my attention. It amounts to shaming the physician who performs the procedure if there is an unsatisfactory result. This is totally out of context of the whole clinical picture.

Fortunately, in our system we are cautious not to engage in publicly reporting individual physician’s out-of-context performance records in cardiac or other procedures, and we have the College of Physicians and Surgeons’ rigorous review procedures in case of specific complaints. 

Unfortunately, there is a troublesome trend of listing anonymous comments about local physicians on rate-your-MD websites, which in most instances amount to unspecific praising or explicit shaming of physicians. The so-called evaluations may be based on time spent in the doctor’s waiting room, the perceived attitude of the office staff, and the doctor’s manner and interest level. There are also lists of local physicians with unexplained or unspecified ratings from 1 to 10, and unsubstantiated lists of best and worst physicians in certain areas of the province. There is no escape for institutions either, with categories for comments about cleanliness, facilities, services, and the dollar value of various medical and surgical departments and emergency facilities.

Given the number of doctors in the province, and the number of patient visits per day, the reporting websites do not appear to be particularly well attended. The bothersome issue is that neither the good nor the shaming comments are helpful in contributing to the quality or availability of medical care. It is interesting, however, that both the praising and the debunking comments are mostly about the doctor’s interpersonal relationships, not the doctor’s diagnostic acumen or the success or failure of a recommended treatment regimen. 

In a CMAJ article from 2007, “RateMD.com nets ire of Canadian physicians,”[2] Brad Mackay reviewed the issue of anonymous comments on that website. Founded in 2004 by John Swapceinski in California, the website gained popularity after considerable media attention. Both the CMA and the Canadian Medical Protective Association have demanded the names of individuals who have posted defamatory remarks, but apparently declined commenting about the outcome of their efforts. In a 2012 CMAJ article by Roger Collier, “Professionalism: Logging on to tell your doctor off,”[3] Dr Mike Woo-Ming, a physician turned Internet business consultant and CEO of RepMD, comments that “Some comments are not worth responding to,” and adds that “Patient satisfaction is going to become even more important, and [doctors’] online reputation is going to be of greater importance. It is not going to go away….Doctors need to realize that they are in the customer support business.” Swapceinski says that “any doctor can be nice and polite if they want to, and I think they should. It does not cost them anything.”

I don’t know what to say.
—George Szasz, CM, MD

References
1. Wadhera RK, Bhatt DL. Taking the “public” out of public reporting of percutaneous coronary intervention. JAMA 2017;318:1439-1440.

2. Mackay B. RateMds.com nets ire of Canadian physicians. CMAJ 2007;176:754.

3. Collier R. Professionals: Logging on to tell your doctor off. CMAJ 2012;184:E629-E630.


This posting has not been peer reviewed by the BCMJ Editorial Board.


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