The Web Is Awash in Reviews, but Not for Doctors. Here’s the real reason why: most care isn’t actually documented (YET)

This New York Times article by Ron Lieber got me thinking:

For a moment imagine some other services weren’t documented and think how this would confuse customers and even the very best rating sites:


Imagine for a moment they had no websites or star ratings. Imagine you just arrived and took what you got: a hotel room. Brilliant! Look there’s even a shower in here!

Musical performance

Imagine there was no musical recordings? Is that original? How would we have any hope of recognising creative musical talent? Is this a performance of Mozart or is this Mozart?

Petrol Stations

Imagine no prices on the roadside, no digital display on the pumps, no idea how big your tank was (or how much was left in there). That’s one sure fire way of avoiding peak oil!


Imagine no pricing information on the products. Imagine they didn’t give you a receipt and you just found out at the end of the year how much had been taken from your bank account. Better just stick to the essentials…

Of course Doctors already have a very effective system for negative reviews

Imagine every time you had a complaint about a hotel you stayed in you could do to the General Hotel Council and all hotels had to pay for an indemnity insurance policy and be prepared to be called to close down the hotel for a day to go in front of their peers to justify what happened in your nights stay?

Then imagine that the General Hotel Council could haul hotels up to justify their actions and if they couldn’t they would be punished, fined, suspended, banned from practicing again. Imagine they could be brought infront of their peers by someone who didn’t even stay at the hotel (perhaps their nephew did and he told them about it).

With such an effective way of getting recourse do you think they’d be a market for Tripadvisor?

Now let’s look at the typical patient experience of an online Doctor rating site

First up if I can see past the banners of affiliate network pay per click adverts I’m asked to be an “opinion donor”. I really can’t be the only one that realises that only very disappointed/disgruntled genuine patients would go any further.

Also isn’t it a bit obvious if a Doctor was great that while I might tell all my friends and family about them I might not want the whole world beating a path to her door, because I quite like being able to get an appointment when I want one?

Then you get to the meat of it:

Overall Patient Rating 2.5 out of 4
The Overall Average Patient Rating of Dr. BLANK BLANK, MD is Good. Dr. BLANK has been reviewed by 10 patients. The rating is 2.5 out of 4 stars.

Wait Time
The average wait time to see Dr. BLANK according to patient reviews, is 10 minutes. By comparison, patients wait a national average of 21 minutes before seeing a doctor.

Patient Ratings
Dr. BLANK is rated “GOOD” in the following areas:
Ease of Appointment — 2.7
Promptness — 2.8

Dr. BLANK is rated “FAIR” in the following areas:
Courteous Staff — 2.3
Accurate Diagnosis — 1.0
Bedside Manner — 2.1
Spends Time with Me — 2.3
Follow Up — 2.0


If you lack trust in your Doctor how on earth are you going to want to place faith in the subjective opinions of these nameless strangers?

Is it meaningful?

Does somebody somewhere really think a patient is going to be thinking right I’ll go and see Doctor “2.3 spends time with me” because I basically know what I need so it doesn’t really concern me that he’s also apparently Doctor “1.0 Accurate Diagnosis”.

The starter gun for innovation in healthcare is better documentation

This is why ALL innovation in the Doctor-Patient relationship BEGINS with better documentation of the encounter. It’s not easy, we have to be open to trying it and we have to build not to get it perfect first time but so that it can continue to improve based on experiences of patients.

There is also lots of evidence of the benefits of this approach from some of the worlds most respected clinicians:

In my opinion if we really want quality improvements we need to forget about all the unproven “sounds right so it must be” approaches (eg. laborious CPD exercises that are taking practicing Doctors away from their families) and start with getting a handle on what’s actually happening during encounters.

Patient Power not Patient Ratings

Patients can of course help with this by voting with their feet for care providers who provide them with accessible healthcare records, who document their consultations and accept patient contributions to the content within their medical record.

It’s interesting that on all of the various Rate My Doctor websites I’ve checked out none of them have a field for this, probably shows how serious they are about being taken seriously.

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2 Responses to The Web Is Awash in Reviews, but Not for Doctors. Here’s the real reason why: most care isn’t actually documented (YET)

  1. We’ve been helping doctors with their online reputation, and agree – more accessibility to records, checking labs, will all help us be more proactive with our health.

  2. Pingback: Do Patients Make Poor Health-Care Consumers or does a lack of documentation just make choices too difficult? « mHealth Insight: the blog of 3G Doctor

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