Why, yes, patients are qualified to rate their care
July 14, 2015 in Medical Technology
“Patients are neither qualified nor capable of evaluating the quality of the medical services that they receive. How can a patient, with no medical expertise, know that the treatment option that he received was the best available one?”
These are the words of Niam Yaraghi, a fellow in the Brookings Institution’s Center for Technology Innovation. Last month the U.S. News World Report published Yaraghi’s blog post, titled “Don’t Yelp Your Doctor” – which drew a tsunami of angry outcries from patient advocates.
In short, those advocates, including Casey Quinlan, argued that it was wrong to discount the voice of the patient, who should be a physician’s most important collaborator. Both Quinlan and Yaraghi agree that current provider assessment tools are flawed. On this point I concur.
But my frustration – and anger – with Yaraghi’s words go beyond inefficient rating methods. My bigger concern is that Yaraghi’s words propagate the belief that “doctors know best” and patients should not question the wisdom and expertise of their physicians.
Maybe that attitude worked in Dr. Marcus Welby’s day, but today we mere patients have vast resources available to us at our fingertips and can quickly gain a basic understanding of our medical conditions and treatment options. In many cases we can also determine how experienced a provider might be in performing a particular procedure or whether he treats patients with our same conditions.
My experience is that doctors may be well-educated – but they are not infallible, and don’t always understand particular conditions as well as their patients.
Most patients, meanwhile, lack formal medical training but are eager to learn – especially when faced with a health crisis.
In general, I have little patience for arrogance. When dealing with doctors who believe MD stands for “medical deity,” I have a tendency to get on a bit of my own high horse. My bias against arrogant doctors is highly personal and has taught me the importance of questioning doctors who seemingly never question themselves.
Here’s the backstory. About 15 years ago I was pregnant. At about 16 weeks I went for a sonogram and was told the baby had fluid in her neck, heart, and lungs. The doctor believed it was a genetic condition called Turner’s Syndrome and told me very matter-of-factly that there was a 95-100 percent chance the baby would die in utero. Then she recommended I terminate the pregnancy.
There’s a bit more to the story but the short version is that my 15 year-old daughter beat some incredible odds. I may not be “qualified nor capable” of evaluating the quality of the medical services I received that day, but I am quite capable of realizing that if I had followed the doctor’s recommended course of action I would be the mother of one less child.
I’ve also become quite an expert on Turner’s Syndrome and have been fortunate enough to educate several medical professionals on the nuances of the condition. I’ll never know as much about orthopedics as my daughter’s orthopedic surgeon, but I guarantee he knows more about Turner’s Syndrome today than he did before my daughter and I first walked into his office.
So yes, let’s find a better way to evaluate physicians. Yaraghi suggests that rather than online rating sites, patients should rely on measures of medical expertise. The flaw here is that even the most expert clinicians occasionally make mistakes. In the end, isn’t what really matters is whether or not the patient was satisfied with the care he received?
Determining the best algorithm may be challenging but let’s leverage our vast technologies and come up with an evaluation system that takes into account physician experience, education, and outcomes, as well as patient satisfaction with the care process, with their physician’s ability to communicate, with the physician’s bedside manner, and other pertinent measures.
Meanwhile, it’s well past time to dismiss the notion that only doctors are capable of understanding what is best for the patient.