A Zagat Guide for doctors? Bring it on!


 For years I have bemoaned the fact that there is no accountability for doctors in the way that they treat patients. Make patients wait for 2 hours for a scheduled appointment? Who cares? Offer only clipped, curt answers to questions? Why not? Rush patients through as if they were cattle? What are they going to do about?

I have periodically joked about the need for a Zagat guide to doctors, where patients could contribute evaluations of the doctor’s bedside manner, office policies, and overall treatment of patients. Evidently someone else had the same idea. As a matter of fact, Zagat itself had the same idea.

As reported in today’s New York Times, Zagat has partnered with the insurance company WellPoint to bring WellPoint customers a new guide rating doctors. Predictably, the reaction from doctors has ranged from anger to outrage. As a physician myself, I want to go on record as applauding the move. It is long over due.

The doctors’ criticism can be summed up as the claim that patient evaluations do not take into account the diagnostic and clinical skills of the doctor. A patient with an excellent bedside manner can be an incompetent practitioner, and a nasty doctor can be an excellent clinician. That claim is true, but it is beside the point. Patients are not being asked to evaluate their doctor based on his clinical skills; they are evaluating the doctor on how he treats patients as human beings. The Times quotes Nina Zagat:

Ms. Zagat, who founded the Zagat Survey company with her husband, Tim, said the reviews were not meant to be the main factor in the choice of a doctor. Rather, she said, they could help a patient choose among specialists recommended by her primary physician.

“One patient might say I care more about communications skills,” she said. “To somebody else, having a very modern, attractive office may lead to a different choice.”

The doctors’ whining is depressingly predictable:

“It is curious that they would go to a company that had no experience in health care to try to find out how good a doctor is,” said Dr. William Handelman, a kidney specialist in Torrington who is president of the Connecticut State Medical Society. “It certainly is very subjective.”

In addition, the doctors preemptively blame patients for bad ratings that a physician might receive:

“Patients notoriously ignore their doctor’s advice to eat well and exercise,” he said. “Often they quit taking their pills when they’re feeling better. They usually don’t understand the technologies and skills needed for treatment.”

Those complaints are, in the words of a classic expression, “true, true and unrelated.” Yes, Zagat has no experience in healthcare, but they have tremendous experience in collecting, collating, and disseminating customer opinions. Yes, patients often ignore the advice of doctors, but that has no bearing on whether they are entitled to have an opinion about the manner in which the doctor treated them.

The sad fact is that at this moment, patients currently have no way to evaluate doctors. Internal evaluations by insurance companies and rating agencies tend to be useless for everyone involved. Evaluating doctors by whether they order enough Pap smears, but not too many doesn’t tell us who is a good doctor and who is incompetent. It also doesn’t tell us who is a compassionate caring physician, and who is a mean SOB.

The Zagat rating system will not provide much information about the diagnostic and clinical skills of physicians, but then it is not designed to do that. It will provide information about the other factors that matter a great deal to patients and often seem to be of no consequence to physicians.

Make patients wait for 2 hours for a scheduled appointment? That’s inexcusable and reflects and complete disregard for the value of the patient’s time. A Zagat guide to doctors will let patients know who cares enough to create a realistic daily schedule and who has no idea or interest in how long patients wait.

Offer only clipped, curt answers to patients’ questions? That’s simply unacceptable, and it has a major impact on whether patients comply with their treatment, not to mention a major impact on how patients experience their care. If doctors knew that their behavior would be broadcast to all potential patients, they would give more thought to their responses.

Rush patients through as if they were cattle? Now they will be able to do something about it; they will be able to tell other potential patients. For the first time ever, there will be real consequences for physician actions.

I have a great deal of sympathy for the terrible time pressure under which doctors operate, and I understand how that leads to long waits and short tempers. But there should be consequences for doctors in how they treat their patients. At the very least, it will cause them to take notice of something they now routinely ignore.

A Zagat Guide for doctors? This doctor says, “Bring it on!”