Time to Encourage Consumerism in Health Care
I was doing some Google searching on the best way to find a doctor, trying to put myself in the shoes of a member who might be looking for services, and one of the articles that popped up struck such a chord that I had to put pen to paper.
His premise is that online doctor ratings are worthless primarily because consumers are not qualified to offer an informed view of their health care provider.
Rating systems have been around as long as commerce (in some form) has existed. This concept is mostly conjecture on my part, but I imagine the first person who bartered for a sheep thousands of years ago had some opinion of the quality of the sheep he received. He just had limited means to tell others about his experience, whether positive or negative.
Fast forward to our present-day economy, and we have a multitude of ways to provide feedback. Almost everything we interact with has a way for us to provide feedback to the providers of the product or service. Amazon ratings, Yelp reviews, comments sections on articles – all provide readily accessible ways for an individual to provide feedback. And without any science to back me up, it seems to work. It is a product and service form of natural selection where only the strong survive (or get five stars).
Can consumers be informed when it comes to rating health care?
Niam Yaraghi, a fellow at the Brookings Institution, a venerated think tank, took a swipe at an individual’s ability to provide feedback on interactions with health care on a blog posted at U.S. News. His premise is that online doctor ratings are worthless primarily because consumers are not qualified to offer an informed view of their health care provider.
Similarly, health care providers are unlikely to be challenged on the basis of their clinical diagnoses (for good reason), but that should not imply they have only limited accountability to the persons who consume that health care.
Let me first stipulate that I generally agree that most people are not qualified to offer feedback on clinical pathways. Even actual doctors are probably biased when they themselves are patients. However, that in no way should eliminate feedback on health care providers.
Malcolm Gladwell (and others) wrote about guitarist and band leader Eddie Van Halen and his famous brown M&M’S®i. Van Halen added a single line in his band’s contracts requiring a bowl of M&M’S backstage with no brown ones (imagine that job, picking out only the brown M&M’S!). It was a brilliant yet simple signal for the band to determine whether the concert venue team read and followed every detail in the contract (brown M&M’S meant the venue likely cut corners elsewhere).
Evaluation can be in the signals
A similar concept is at work with doctor feedback; it’s all about signals. Think about the negative signals that are possible to receive in a doctor’s office: the office staff does not greet you by name or treat you as an individual; your nurse treats you like the next in a long line; your doctor is rushed or does not look you in the eye; your doctor’s body language or interview style is such that you withhold or alter information; you are not asked if you understand or have questions. All of these are critical factors in how we should evaluate health care providers.
Consider an everyday situation. If you were at a restaurant and the wait staff was rude or indifferent to you, if your server did not explain special dishes, and if you were rushed into a selection without your questions being answered, you would likely complain to the manager and probably never go back. Further, you would be unlikely to think the food was of high quality because the experience was so terrible.
It is especially important that we provide feedback in areas where we have limited knowledge. We want to know what auto body shop treats customers well since most of us have no idea how to evaluate car damage and repairs. Similarly, health care providers are unlikely to be challenged on the basis of their clinical diagnoses (for good reason), but that should not imply they have only limited accountability to the persons who consume that health care. Hopefully Yaraghi moderates his views and recognizes we all need feedback to be our best, even if we are not a technical expert.