4 ms·

The practice of medicine has always been an art, notwithstanding availability of advanced diagnostic and treatment technologies. Of course it's an art based in

by jrapdx3 10y ago

The practice of medicine has always been an art, notwithstanding availability of advanced diagnostic and treatment technologies. Of course it's an art based in science. However, in truth, the science is not fully developed in many if not most disorders, leaving providers to try to help with the limited tools at their disposal. Providing care is finding the delicate balance among sciences and arts, inevitably there are ambiguous tests, marginally effective treatments, rare/impossible to predict side-effects and frequent backtracking to try yet another option. Some patients will misconstrue this less than ideal algorithm as mistreatment even when informed it represents the imperfect state of the art. Certain perfectionistic individuals make unrealistic demands of care providers and may complain bitterly about less than optimum outcomes. Most patients aren't like that, but a few are. The notion that patients are "treated like dirt" these days is an unreasonably broad assertion that shouldn't be accepted without substantial evidence. No doubt there are occasional providers who are less than competent, notably unempathetic, mean-spirited, etc. There are ways to complain if it's warranted, medical societies and licensing bodies take these complaints very seriously. But by all means such instances deserve fair and dispassionate investigation. It may be hard to tell which Yelp "reviews" are authentic, and which may be authored by family members or friends just to rack up bad opinion about the doctor, or against any other service for that matter. OTOH it is unethical for a doctor to reveal anything about the patient without specific permission. I suppose write a review of the doctor's work is a tacit permission to respond, but it is always the patient's right to reveal info, but the doctor is limited in what can be said. That may be a reason health care providers are skittish about Yelp and the like. Because of confidentiality rules, ethical practitioners can't defend themselves against exaggerated, erroneous or even false claims made in a public listing. Anyone taking Yelp "reviews" seriously is probably accepting bad advice especially when it comes to seeking services as complex and nuanced as medical care. The arena of "reviews" by disgruntled customers seems like it's just starting to be explored by the courts. Physicians' organizations and licensing boards haven't yet addressed the questions about responding to unfair or inaccurate statements about physician or health care services. I imagine those discussions will indeed be lively.

ap22213 10y ago
When a doctor approaches their practice as a for-profit transactional business I believe they should be treated as any other similar business. If I go to a bakery and it is poorly run, or I am overcharged or mislead, or the product is of poor quality, I feel some duty to tell other potential customers. And, I feel even more strongly about for-profit doctors as well given what is at stake. In my particular case, the doctor was one of the 'top N in large metro area' doctors. After the visit, I realized that their placement in those rankings probably had more to do with how they spent money toward advertising and marketing than providing the best possible health care. Without public reviews, how else could a patient be able to anticipate the quality of care? Rely on boards of medicine? You have to understand that to many, the standards of those boards seems to have fallen into irrelevancy. Plus, they're not exactly impartial or unbiased anyway.
- jrapdx3 10y ago
  > When a doctor approaches their practice as a for-profit transactional business I believe they should be treated as any other similar business. What is a "for-profit" business in this domain? In the classic fee-for-service model, a patient asks for a service from a physician and pays for it. The physician needs the money to keep the practice running and to buy food and shelter. You could call it a "for-profit" business like a plumber and other craftsmen, that's fair enough, but for doctors money isn't the primary motive, they are only earning a living. One difference though, physicians practice under far stricter codes of ethics, and duty-bound to hold the relationship confidential. Furthermore, the physicians are sworn to place the interests of patients above financial gain when crucial to patients' life and limb. Most physicians strive to adhere to ethical standards. Of course not every physician lives up to the commitments made, some are greedy, and do look at practicing medicine as a means to accumulate wealth. Fraudulent billing is one path, exaggerated claims, huge marketing efforts and so on are also ways to get there. But these actions aren't common. And there is incompetence, which differs from the normal ambiguities of diagnosis or dead-ends of treatments that don't work. No disagreement, there can be reasons to complain, but not all complaints reflect physician error or misconduct, or actual adversity to the patient. However, health care is a team effort. There are poor patients as well as poor doctors. Asymmetrically, patients can openly write anything about a doctor justified or not. But unlike services like AirBnB or EBay, doctors can't respond in an open forum to set the record straight. Remember, patients can also grossly misbehave. What constraints are in place to prevent it, or from shifting blame for poor outcomes to the practitioner who was consulted? Having been involved in "quality assurance" of patient care including financial misbehavior, I can positively assert complaints are taken seriously. If patients submit complaints to medical societies, hospitals, licensing boards, there's a very high probability the complaint will be investigated. Believe me, such investigations are despised by physicians much more that Yelp reviews. BTW in the state in which I practice, proceeds of the medical board are public documents. You can find out about actions taken against physicians and physician assistants quite easily. Much more interesting and informative than Yelp reviews.

by jrapdx3 10y ago

ap22213 10y ago

When a doctor approaches their practice as a for-profit transactional business I believe they should be treated as any other similar business. If I go to a bakery and it is poorly run, or I am overcharged or mislead, or the product is of poor quality, I feel some duty to tell other potential customers. And, I feel even more strongly about for-profit doctors as well given what is at stake. In my particular case, the doctor was one of the 'top N in large metro area' doctors. After the visit, I realized that their placement in those rankings probably had more to do with how they spent money toward advertising and marketing than providing the best possible health care. Without public reviews, how else could a patient be able to anticipate the quality of care? Rely on boards of medicine? You have to understand that to many, the standards of those boards seems to have fallen into irrelevancy. Plus, they're not exactly impartial or unbiased anyway.

jrapdx3 10y ago
> When a doctor approaches their practice as a for-profit transactional business I believe they should be treated as any other similar business. What is a "for-profit" business in this domain? In the classic fee-for-service model, a patient asks for a service from a physician and pays for it. The physician needs the money to keep the practice running and to buy food and shelter. You could call it a "for-profit" business like a plumber and other craftsmen, that's fair enough, but for doctors money isn't the primary motive, they are only earning a living. One difference though, physicians practice under far stricter codes of ethics, and duty-bound to hold the relationship confidential. Furthermore, the physicians are sworn to place the interests of patients above financial gain when crucial to patients' life and limb. Most physicians strive to adhere to ethical standards. Of course not every physician lives up to the commitments made, some are greedy, and do look at practicing medicine as a means to accumulate wealth. Fraudulent billing is one path, exaggerated claims, huge marketing efforts and so on are also ways to get there. But these actions aren't common. And there is incompetence, which differs from the normal ambiguities of diagnosis or dead-ends of treatments that don't work. No disagreement, there can be reasons to complain, but not all complaints reflect physician error or misconduct, or actual adversity to the patient. However, health care is a team effort. There are poor patients as well as poor doctors. Asymmetrically, patients can openly write anything about a doctor justified or not. But unlike services like AirBnB or EBay, doctors can't respond in an open forum to set the record straight. Remember, patients can also grossly misbehave. What constraints are in place to prevent it, or from shifting blame for poor outcomes to the practitioner who was consulted? Having been involved in "quality assurance" of patient care including financial misbehavior, I can positively assert complaints are taken seriously. If patients submit complaints to medical societies, hospitals, licensing boards, there's a very high probability the complaint will be investigated. Believe me, such investigations are despised by physicians much more that Yelp reviews. BTW in the state in which I practice, proceeds of the medical board are public documents. You can find out about actions taken against physicians and physician assistants quite easily. Much more interesting and informative than Yelp reviews.