Anonymous Doctor

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.