When a doctor friend of mine recently heard a radio ad for a Web site where patients could rate their doctors, he almost drove off the road.
"I can't believe they've added doctors to the list," he said of the site, Angie's List, perhaps best known for its user-generated report cards on local contractors. "Why do patients want to assess my relationship with them in the same way they evaluate a roofing job?" he asked, shaking his head over what he interpreted to be more evidence of the disintegrating doctor-patient relationship.
I agreed with my friend and, not long after our conversation, curiosity piqued, I paid for a subscription to the site.
The pages seemed to overflow with information. There were reviews of roofers, childcare providers, dog walkers and tattoo and piercing shops. One of the newest and most popular categories was doctors, where reviewers could grade their doctors by answering the site's specific questions and elaborate with additional comments.
Doctors, like every other business, service, and facility listed, were evaluated using the same generic report card. Everyone received a grade for each of five categories — price, quality, responsiveness, punctuality, and professionalism — as well as an answer to the all-important bottom line question: Hire again?
So much for Marcus Welby, I thought, after going through a couple of the reviews.
But the more I read, the more I realized that there was a correlation between good grades and attentiveness. Reviewers gave less-than-passing, and even failing, grades to those physicians who seemed rushed, brusque or distracted; and they uniformly gave "A's" and "B's" to doctors who were warm, concerned and focused.
Even more could be gleaned from what went unsaid. Amongst the many comments I read, I found almost no mention of a doctor's actual medical skill.
That was not the case with roofers, for example, where in addition to grades, reviewers' comments offered great specifics — and even photographs — regarding the quality of the handiwork, the types of supplies used and the aesthetics of the finished product. All the detailed commentaries fleshed out each company's final grades, and it was easy to get a pretty good sense of an individual roofer's skill and craftsmanship.
With doctors, however, there were no detailed descriptions of medical skill beyond the overall grade. Instead, the playing field seemed oddly level. One surgeon, it appeared, could operate much like another; pediatricians and internists could diagnose and manage with similar abilities; and obstetricians could deliver babies regardless of shape, size, or form. All doctors, whatever their grades, seemed to possess similar and interchangeable skills that they could then apply to you. You just might not like the way they treated you in the process.
I found this extraordinary degree of trust astonishing. When I look for a doctor, of course I am concerned about how that doctor relates to me as a patient. But there are a whole host of other issues I consider as well, such as the physician's training, board certification, experience, membership in a respected professional society, safety records and hospital affiliations. And I admit that I don't feel comfortable as a patient in another doctor's hands until I learn the answers to at least some of my questions.
But as it turns out, most patients don't feel the same way. And many of them are just as trusting when it comes to treatment specifics.
Earlier this year, the American College of Surgeons, the national scientific and educational organization of surgeons, conducted a nationwide survey that found that the average patient devotes an hour or less to researching his or her surgery or surgeon. While prospective patients worry about the costs or complications of an operation, they don't necessarily look for information that would address their concerns.
In fact, more than a third of patients who had an operation in the last five years never reviewed the credentials of the surgeon who operated. Patients are more likely to spend time researching a job change (on average, about 10 hours) or a new car (8 hours) than the operation they are about to submit to or the surgeon who wields the knife. And many patients are satisfied with the answers they receive from their surgeon or primary care doctor, whoever those individuals happen to be.
I was intrigued by the survey, so I called Dr. Thomas Russell, executive director of the American College of Surgeons. "There is a tendency, probably more so now than in the era of Marcus Welby, for patients not to get particularly involved and not to feel compelled to look into their surgery or surgeons," he told me.
There are consequences to that kind of blind trust. "Today, medicine and surgery are really team sports," Dr. Russell continued, "and the patient, as the ultimate decision maker, is the most important member of the team. Mistakes can happen, and patients have to be educated and must understand what is going on."
Dr. Russell has made it part of his personal mission to educate patients and recently wrote a book, "I Need an Operation...Now What? A Patient's Guide to a Safe and Successful Outcome," as a response to the survey. "Patients and their families need to be armed with the fortitude and the right questions in order to find the best doctors for their problems," he said.
In other words, a healthy doctor-patient relationship does not simply entail good bedside manners and responsible office management on the part of the doctor. It also requires that patients come to the relationship educated about their doctors, their illnesses and their treatment.
"If we are truly going to reform the health care system in the U.S.," Dr. Russell said, "everybody has to participate actively and must educate themselves. That means doctors, nurses, other health care professionals, lawyers, pharmaceutical companies, and insurance companies. But most of all, it means the patient."
Trust is important. But as Sir Francis Bacon, who was among the first to understand the importance of gathering data in science, once observed, knowledge is power.
