PracticalDermatology

Patient: “I’m looking for a doctor”

Friend: “You mean provider? Just look on Yelp.”

Patient: “How do I know which is the right one?”

Friend: “Look at this one, he got four stars.”

Patient: “But that doesn’t mean he is the right doctor for me.”

Friend: “What are you going to do, look in the phone book? Here’s one to avoid, she got one star.”

Despite the mandates from the government that everyone has a right to healthcare, medical professionals have to subject ourselves to the rules of “customer service.” As illustrated in the conversation above, the old days of finding a doctor, or staying with one for that matter, have given way to the subjective review of patients who want to have the rights of paying customers. I am sure I am not the only one who has had patients tell me that they came to see me, or stopped seeing me, because of someone else’s review of my work.

But is it fair when the noncompliant patient bashes a doctor because part of the treatment plan had to involve some motivation, tough love, or a little scolding in the office? And what happens when the patient who has seen five other doctors finally gets better for something “complicated” that just took a few minutes of extra listening and the same prescription in a different vehicle? Is the criticism or compliment based on actual performance and on outcomes of improvement of the medical condition, or is it just revenge from a personal issue where the reviewer is getting the last shot in? And is there somewhere for physicians to rate the patients rating us? As physicians, it’s difficult to defend ourselves in public online forums because we are handcuffed by HIPAA regulations.

A colleague who conducts clinical trials recently told me about a scathing review posted online by a chronic study shopper who didn’t qualify for a trial. When the subject came for the screening visit, the skin to be photographed was too tan so the investigator postponed the screening to avoid having the subject fail. In response, the subject walked out shouting “nobody told me not to get tan” in the office, then took to the Internet to bash the investigator in a detailed rant. The same thing happened to another dermatologist after a skin cancer screening when a friend of the “patient” began asking a flurry of medical questions about herself and her kids. When the doctor politely replied that legally the physician could not answer the questions, the friend bashed the office on a review site as incompetent when she wasn’t even the patient.

Many dermatologists have noticed the same trend at conferences where the reviews and comments have become much more direct—and often personal. A constructive review should offer feedback that can lead to actual improvement. We have all been to a lecture where the speaker is in over his or her head, and conversely where the speaker is amazing and we learn a lot. Then there are the lectures where the speaker just has a bad day, despite the fact that a lot of time and effort went into preparing a lecture that is going to be given in front of several hundred peers. Committees organizing the meetings pay a lot of attention to the quality perceived by the audience, who are “paying customers” to attend the conference and expect high levels of performance on the stage. Just like with patient reviews, what is missing is disclosure of the conflict of interest of the reviewer.

I had one of my worst meetings as a teacher and speaker this year in San Francisco even though I wrote brand new lectures. I wasn’t happy with my delivery except during the last lecture, which was on a lighter subject (unlike my usual verbal flood of basic science that is good for a nap). But I had one of the best reviews when a dermatologist from Berkeley came up to me and said “Can I offer you some constructive criticism?” We sat for about 15 minutes and he gave me some points on what his experience was in the audience listening to me, for which I thanked him and learned a lot about what I needed to do better. It was an honest, constructive review of the performance and not a personal attack left by an anonymous attendee. Is this too much to ask of anyone who takes on the responsibility as a “reviewer?”

We live in a culture of “review then run” because it is easy to hide behind anonymity rather than actually stand by our words. “Freedom of Speech” was meant to be about protection from oppression but rather it is now the right to say, write, or post anything we want to. So send me your review of this and any other editorial to bhatiaharbor@gmail.com (My editorials already got good reviews from Dr. Peggy Fuller from Charlotte who found me at World Congress and made my day!). n

—Neal Bhatia, MD

Chief Medical Editor