Deborah Cohen: I want great care

Deborah Cohen We’re used to checking out the internet for the lowdown on our holiday destinations or theatre review, but what about finding yourself a good doc? Tapping into the government’s Choice agenda (see Michael Cross’ BMJ feature), the website is the brainchild of founder and former hospital doctor, Dr Neil Bacon. According to Bacon, its aim is to empower: “patients to share their experience, knowledge and opinions [so] we can drive changes and improvements in the health service that will benefit all”.

It’s a slightly different beast to the NHS Choices website—rather less emphasis on objective “hard nosed” outcome measures, as the NHS’s medical director, Sir Bruce Keogh, might say—and offers an opportunity “for doctor’s patients, patients’ carers and relatives and colleagues” to rate doctors using “objective criteria derived from the evidence base for patient satisfaction”.

These measurements are sliding scales rating trust, listening ability and one measuring how highly the user recommends the doctor. There’s also a free text box asking the user to share their experience in as much detail as possible. It asks the user to mention what’s great about their doctor and what they could do to improve. So how do these objective criteria really measure up? Answers at the end of this blog, please.

Except for the sound of silence from government ranks and the odd plaudit from a political pundit, such as the Health Services Journal and Guardian columnist Michael White—“The British Medical Association was quick to condemn the idea—so it can’t be all bad”— its arrival amongst the pages of other ratings websites has been greeted with a hostile response.

The tables have been turned on Dr Bacon himself. Dr Rant has posted up a screengrab featuring Bacon with a 0% rating and another site ridiculing the concept has sprung up:

Harsh, perhaps. But with all the vitriol spewed out daily on, what did he really expect? The site where the failed Glasgow bombers were called “beardy weirdies” and paediatricians list their favourite “chav baby names”. He was hardly going to get a mild rebuke from the 5% of doctors he claims are not behind the project.

Away from the specialist medical bloggers and press, Shinyred, which focuses on new media, points out, reviewing is slightly different with doctors—choosing your doctor is a longer term commitment and your health is pretty important to boot.

But another blogger on the same site is dismissive of the criticism. “People exercise human judgment on reviews shown, if a doctor has ridiculously flattering reviews from EVERYONE it would be pretty suspect,” he says. “Likewise with BAD reviews, we as human users can actually make a judgment. What happens in the real world? We listen to other opinions but we don’t just blindly follow them do we? So lets embrace these types of resources they can only make it better for us all in the long run.”

And why shouldn’t patients have the right to know who the failing or bad doctors are? And shouldn’t doctors be as accountable to the public as anyone else paid for by the national purse? This in itself is central to the Darzi mantra of openness and accountability.

But it’s doubtful if the website will provide any meaningful data and will drive up performance. The ferret fancier says: “Those like myself who work on the front line are already very accountable for our actions, it is remarkably easy for a patient to complain given the mechanisms in place, the argument that Iwantgreatcare will improve patient care is disingenuous”. The likelihood with a website such as this is it’ll attract those with a major crush on their doctor or those with an axe to grind – which will no doubt subsequently be removed when the doctor in question lodges a complaint or libel action.

Which is what has the BMA up in arms—doctors are bound by different codes of conduct. Other people or companies have the option to respond if they see fit. But doctors are bound by confidentiality and if they get a stinging review by a patient—and it’s unfounded—a doctor can’t respond. It’s much the same as already happens in the press—allegation from a patient, doctor can’t comment.

The BMA’s concern is that the site could leave doctors open to abuse, libel and even personal attack. One group of doctors has already sought legal advice to block it and Dr Crippen is keeping a blog of all defamatory comments made about doctors. The goal? Maybe one libel action will force the site to close.

What the end result will be remains to be seen. Whether this site will drive up standards is uncertain, but it will bolstering the coffers of media lawyers. If the glut of doctors rating sites in the US and Germany is anything to go by, it’ll be bad news for doctors and good news for lawyers. So what do you think? Will this affect your clinical practice? Or have you dismissed it as a money spinner for one former hospital doctor with an eye for a headline?

Deborah Cohen is Features Editori, BMJ