* * Anonymous Doc

Wednesday, September 28, 2011

My current attending is a terrible doctor.

Or at least the Internet thinks so.

I don't usually Google the attendings I'm working with. It just never crosses my mind. I don't know where most of them went to med school, or did their residencies, or what they did before they came here. I don't know how much teaching they do, or much about their personal lives unless they happen to mention something. But I happened to Google the guy I'm currently working with.

And he has like 15 reviews on Vitals.com, a half-dozen on Yelp, and almost all of them are pretty darn terrible. And consistent in the kinds of things they say.

Obviously, Internet reviews of doctors have limited utility. One patient's experience is likely to be vastly different from another's, depending in part on expectations and temperament and what the medical problem is. Some patients get worse, no matter what the doctor does. Some get better even if the doctor is terrible. Some people need more hand-holding than others. Some people want their doctor to be decisive and confident, even if the best treatment isn't necessarily clear. Some people expect more than a doctor can provide-- in terms of treatment when there isn't one, or instant availability when there are dozens of other patients waiting as well.

And I'd imagine that the patients most likely to write a review on the Internet are the ones who are upset with their care, not the ones who are satisfied.

[Or at least I assumed that, until I checked some other doctors, who largely had very positive reviews. I don't know what moves people to review a doctor on the Internet, I really don't. (Anyone who wants to tell me, the comments are all yours...)]

Fortunately, I don't yet pop up in any online review systems-- frankly, I think it would be a major bummer to read something negative about my doctoring, although it probably would help to change behavior, if I really think about it. If a couple of people said I was [anything-- hard to reach, wrong about their diagnosis, unfriendly, etc], I would probably work pretty hard to do better. And I think lots of my colleagues of this generation would act similarly. We grew up with online reviews of all sorts of things. It is a little weird and a little disturbing to think that one day in the not-too-distant future, I will probably be able to Google myself and find anonymous patient reviews out there. And just from a business sense, I assume it helps get patients to want to see you if there aren't dozens negative reviews out there telling them not to*.

But I expect my middle-aged attending is (probably) not Googling himself, and if he is, and finds these reviews, I expect he's probably dismissing them as cranks and outliers. This world we live in, where everything gets written up on the Internet, is a little scary. It must be horrible for people who own restaurants, who are trying to serve good food, to constantly read negative things about what they're doing. And I assume they read these things. And I assume most of them want to make customers happy. Yet they do tend to be fairly consistent. And yet the food doesn't ever seem to change. My local Thai place has mostly one- and two- star reviews on Yelp. The food sucks. I've tried it two or three times, because it's convenient. It sucks each time. What is stopping them from either telling their chef to make better food, or hiring a better chef? I assume it's because most people don't read or don't care, and they have enough business that they're making money. Or that getting better would cost money that they don't want to spend. But "the food sucks" is a fixable problem, at least.

"My mom went to this doctor and then she died," unfortunately, is not a fixable problem, and not necessarily the doctor's fault. I understand why that son or daughter would feel powerless, and ultimately might decide to tell the Internet not to go to that doctor, but so much of what a doctor does won't affect outcome. If someone is choosing, say, whether to anticoagulate a patient, and she falls and bleeds and dies, he gets blamed for that decision even though maybe she would have had a stroke if the decision went the other way. If your doctor pushes chemo and radiation and the cancer comes back despite the better odds, it's easy to want to blame the doctor, but the doctor didn't necessarily do anything wrong. Except perhaps explain things well, be upfront about the odds, and the decision process, and make you aware that the outcome isn't always positive even when the decision is the right one. Some patients can understand that, and some patients maybe can't. Intellectually they can. Emotionally no one is really going to be able to understand why they did everything right and the cancer came back anyway. You want someone to blame. And the doctor is an easy target.

All this, from Googling my attending and realizing all of his patients hate him. Or at least some of his patients hate him. I hope my patients don't hate me.

* Although I have never read a doctor review before seeing them, and never thought to search for one. I've looked up where they've gone to medical school and did their residency, and absolutely made choices about doctors based on their education, but I don't actually think Yelp or Vitals or any of those sites ever popped up when I was looking for information, and so I'd honestly never read a doctor review before today. Do people read these things? Do people know about these things? I have no idea.


  1. I was thinking about this recently. I had a procedure done and, thinking it over afterward, despite the fact that I was pretty happy with my doctor in lots of ways (availability, affability), I wasn't convinced I'd needed a stent (for a kidney stone under 1 cm, extracorporeal shockwave lithotripsy).

    I'm in a different position than most patients--I'm well-educated with a research background and a healthy interest in Neuroscience and therefore anatomy and physiology--so I took myself over to PubMed and looked at papers on the subject. And, lo and behold, I get the impression from the literature that placing a preventative stent with a kidney stone as small as mine is pretty rare.

    Now, do I assume that this means he's a terrible urologist? I'd already written him a good review on a website. I'm not a doctor. I can't say with anything resembling certainty that it was inappropriate to place a stent. And yet, I'm kind of ticked off, because he made it sound like an incredibly common thing and like I was guaranteed excruciating pain if I didn't have it. When the evidence appears to be about one study showing decreased hospitalization rates with preventative stenting in stones larger than 1 cm.

    So--even when I can maybe judge quality a little bit, I still can't. I really liked this guy until this. He's courteous, talks fast, gets my jokes. But I spent a week with a stent causing me an enormous amount of pain and frustration, and the removal is no picnic either, and maybe I didn't need it, and maybe it made him money or maybe it's a liability thing or maybe he really believes I'd end up in the ER in the middle of the night with uncontrolled pain if I didn't have one placed preventatively. I don't know. And you can guess how thrilled I am at the prospect of bringing it up at follow-up. What good would it do? What if his reasons still sound fishy to me?

    But it soured our relationship on my end. And the online rating I left just sits there, unchanged, because I don't even know what to say about my suspicions. God help me if he tries to put me on a low-oxalate diet despite the much better track record of DASH dietary guidelines.

  2. I've looked at the RateMyProfessor type sites, but interestingly I've never looked at MD ratings and reviews. Might be worth looking at, though. How many times have I gone to someone based on a happy friend or family member? Why not base it on happy or unhappy strangers? Pros and cons to it, I guess.

  3. What do you think? Is he a good doctor?

  4. I love our family doctor, and I have left him positive reviews on sites, mainly because he's awesome and I hope he googles himself and finds out that enough of his patients care about him and appreciate him to leave good/great reviews (I'm not the only one - all his reviews are excellent).

    I work in a very thankless job (bookkeeper for my husband's small business) so I have almost NO opportunity to receive feedback - whether good, bad or indifferent - about my work. I guess I am quick to give good reviews to all kinds of people/places, because I wish others had the opportunity to do so for me. I know how much a kind word or a "thank you" means, and I receive them very infrequently. And I'm a mom when I'm not at work, which is the most thankless job there is, so it goes double.

    I do write a blog, and I occasionally get positive feedback there, and it sustains me. Thank goodness.

  5. When I was researching PCPs a few years ago, I narrowed down the pool via objective info -- where they trained, hospital privileges -- but reviews came up in the Google results, and at the end of the day I chose my PCP (from the pool) because of numerous glowing reviews from a broad range of patients over a period of years.

  6. I read the doctors reviews, sometimes I look at where they went to school.

    My Mom looks at where they went to school, and if it is a foreign country she usually is like *sarcastically*GREAT.... *sigh* that doesn't always mean they are bad.