Concomitant with the metamorphosis of the practice of medicine into the business of healthcare delivery, patients have been transformed into customers. Healthcare providers compete not only on the basis of outcomes, best practices, centers of excellence, advanced technology and cost, but also on customer service. In fact, reimbursement is not influenced by all these criteria. Patients-- I mean, customers have the right for all medical personnel to address them with respect and courtesy, to be professional in dress and demeanor, to have their privacy protected and to be treated in a clean, accessible and comfortable environment. Most hospitals and clinics hire professional questionnaire solicitation to confidentially poll and quantitate how individuals and institutions meet these goals of customer satisfaction. This data is used for quality improvement and professional reward or chiding. The information remains outside public purview. The quibbling over terminology is trivial, but a more significant fear is that overemphasis on patient satisfaction has a hidden moral paradox. In the internet age, patients come armed with preconceived notions of appropriate care gleaned from unvetted information and physicians are perversely influenced to pander to their demands to get another Michelin star rather than firmly providing guidance for a more difficult, but perhaps safer and effective care plan. In total, however, I cannot say that there is a positive correlation between customer satisfaction and patient outcome.
In contradistinction, in this age of sharing, tweeting, liking, crowd sourcing and rating, physicians may be harmed by non-confidential, anecdotal, and unprofessional assessments made by patients posted on sites such as Yelp or Bing. We live in a time when people go online to find a gastroenterologist for a colonoscopy as if it were no different than hiring an electrician on Angie’s List. How many stars does your allergist have? The great conservative Edmund Burke could have had a more enlightened view of caveat emptor, but his statement was spot on, “In ascending order of treachery come lies, damn lies and statistical lies.” The unsolicited ratings on social media are gleaned from a skewed population of a physician’s practice and are no way accurately representative of how Dr. XX or XY provides medical care. Most social media ties are younger, healthier and less medically experienced than the Medicare population that has benefited in longevity and wellbeing from the long-time attentions of their physicians.
Online ratings are representative only of those who choose to post, not the multitude that, cannot do it, do not see any value in sharing, or do not have the vanity of etching their name and opinion in Yahoo-land. Many patients voice concern directly with their healthcare provider rather than tattling online. Is there help from Yelp, or does Yelp not help and in fact, besmirch the undeserving? As if medical practice was not cluttered enough with unremunerated busy-work, now we all need a new consultant: the social media spin doctor.
By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton