Giles Maskell takes a satirical look at providing feedback for doctors

Rating websites are big business these days. Would you book a hotel, restaurant or holiday without first checking the online reviews and finding out what others have thought of it? If you would, you are in a minority.

It has seemed inevitable for a while that this would spread to healthcare. Sites inviting patients to submit “reviews” of individual doctors have been around for about a decade but so far uptake seems to have been slow. Doctors are understandably wary of giving the occasional disgruntled or grieving patient a public platform on which to vent their frustrations at an individual practitioner and it appears that patients also recognise that a clinical encounter is significantly different from other transactions.

For obvious reasons, radiology doesn’t feature highly amongst the online reviews—most of the time our primary relationship is with the referring clinician rather than directly with the patient. That may of course change in the future, but for now it might point the way to a different approach to rating in healthcare settings.

It is widely agreed that feedback is the way to improve and radiologists suffer from a dearth of it. The analogy of playing golf in the dark, popularised by Matthew Syed in Black Box Thinking, works rather well in the case of radiology—we send out thousands of reports every year and only rarely find out whether they hit the mark. As a result, most of the time we have no idea whether our interpretation is right or wrong and therefore have no possibility of changing our practice to improve our performance. 

So let me propose a new concept: Rad-u-Like. I must stress that this is a figment of my imagination and any resemblance to a product already available or in development is purely coincidental. In my proposal, every report issued by a radiologist would include a request for a review from the referrer. Before being permitted to close the report after reading it, the clinician would be prompted to rate the report on a scale which might range from “highly useful” to “unhelpful or wrong”.  

I can feel the hackles rising among my colleagues—why would I want to submit myself to this process? Why should I make it even easier for the clinician to pass critical comment on my work, with the patient in front of him and all the benefits of hindsight bias? This is where the second part of my proposal comes in. As the radiologist completes each report and prepares to verify it, they would be offered a reciprocal opportunity to rate the referrer by answering the question: “How useful was the clinical information provided with this request?” The scale of responses might range from “very helpful” to “inaccurate or frankly misleading”.  This rating of course would not appear on the report which goes to the clinician but could be collated and analysed separately. Out of that would come a wealth of data which could be fed back to the referrers and more importantly, perhaps a stimulus to improve the quality of information provided to the reporter which could only be to the benefit of patients.

Notwithstanding the excellent work previously published on the desirable structure and content of a radiological report, Rad-U-Like would in a very short space of time allow us once and for all to answer those thorny questions about just how long the ideal report should be and even whether certain words or phrases automatically devalue the report in the eye of the reader.

And if this works in radiology, why not extend it to other groups of doctors who work closely together? What about surgeons and anaesthetists rating each other after every operation? Or, extending it across professions, doctors and nurses rating each other after a ward round, a case conference, a multidisciplinary meeting? 

Am I joking? Not entirely. Radiologists are not the only doctors who could benefit from a lot more feedback. The current system of sending a questionnaire to chosen colleagues once in every five years, as part of the revalidation cycle, does not seem likely to encourage the incremental changes in practice which might actually improve patient care. If our instinct is to recoil from a proposal like this, it’s probably because we fear the impact of critical comment, but that is to ignore the hugely beneficial effect when the feedback is positive. For this reason, my proposal would include a process of specific recognition for those who give—and not just receive—the most positive feedback. All of us and our patients would stand to benefit from a system genuinely designed to provide mutual encouragement. What’s not to Rad-u-Like?

Giles Maskell is a radiologist in Truro. He is past president of the Royal College of Radiologists.

Competing interests: None declared.