News/Commentary

By Cheree Cleghorn, Editor

We have taken our dogs to one vet for some 20 years, a practice headed by a man who is revered by other doctors and those who bring their pets to him.

His practice includes a mix of bright young vets learning from a master, whom he mentors and sends off to set up their own practices. They are fun to watch as they gain experience under his, and his other senior staff’s, guidance.

Our vet says, “A dog is the only true love money can buy.”  “Cats teach us all how to be more independent.” (He never has explained what gerbils teach us.)

He once called the NIH to help him treat a two-year-old cocker spaniel with kidney cancer.

He once offered to keep our elderly, increasingly frail gentleman terrier, at no cost, when I was taking my mother to a teaching hospital for cancer care. “It would be too much right now to come home and find him gone. I find that when my patients have older dogs, they have older parents. Leave him with us.” I did that several times. The frail gentleman loved the techs, wagging his tail madly every time we went there. I was grateful beyond words, for the kindness and the concern he had for me and our dog.

I watched one day as a man, obviously working on a green card and newly arrived in this country, make a payment to the staff. He turned to those of us in the waiting room. “These good people…these good people…they saved our cat. I could not pay then. They let me pay as I could. We thank you.” He and his wife, and the cat who now looked frisky, took their leave. (Many doctors will make payment arrangements if discussed in advance.)

Why are you reading this?

Because when I misplaced his telephone number and went online to look it up, I found one posting about this vet.

“Never, never go to the _________.  Avoid this doctor.”

A man whose hands have felt, by now, too many thousands of bellies, ribs and paws to count, who has peered into countless ears, is rated by one person, an angry one, who dismissed this good man in a sentence which says too much and too little. It sounds ominous, doesn’t it? Never, never… And yet, what happened? The writer does not say.

In the scheme of consumer ratings, it is assumed that the truth arrives via the “wisdom of crowds.” Whether it is a computer, a meal, a car, a book, get enough “reviews” and you will have information to guide a purchase, a night out or a good read.

However, happy patients, unlike happy consumers, go on their way. Trouble dealt with. Over. Back to normal. They do not go looking for ways to spread the word as, say, Apple computer owners do.

It is the unhappy patient in health care who does so much of the talking. There is an informal rule of thumb. The happy patient will tell those closest to him or her. The unhappy patient will tell a minimum of 10 people. This was before the Internet, of course.

That unhappy patient can now tell thousands and thousands of patients.

No practice is perfect. It may be that the person who warned everyone else off this one vet had cause.  We will never know.

The flaw in this anonymous kind of reporting, however, is that none of the thousands of happy humans (to say nothing of their pets who cannot type), were heard from. They had no idea their beloved doctor was under attack. Why would they?

The story excerpt below is about consumer sites which now rate doctors as well as plumbers, restaurants and landscapers. Some doctors are making efforts to protect themselves. Counter-cries of “First Amendment” rights are heard by site sponsors as doctors seek to find ways to protect themselves from anonymous attacks.

If someone wants to start a company which lets “consumers” (not patients, but consumers) post negative comments about doctors, that is a business decision.

Let’s leave constitutional law out of this.

Patients have the right of free speech by walking out the door and not coming back. Sure, the doctor has more power in the exam room or in being able to pick up a prescription pad but the patient has the power of the pocketbook.  If enough leave, the doctor’s income drops. That is a lot of power.

Writing anonymous complaints on consumer sites must make those posting feel as if they are evening things out in this power battle, but they are the losers.

What Can You Do?

If you go to a doctor whose practice style does not fit your needs, go elsewhere.

If you have a problem with the way your doctor—one you like—-handled your recent medical problem, ask if you can talk about it. Doctors often are surprised by what upsets patients. Most are more than willing to talk it through if they believe the patient is sincere. (There are patients who change doctors constantly because, for whatever reason, they cannot find one who satisfies. We are not talking about those patients.)

If you feel too shy, or it just is not your style to deal with problems face-to-face, write to the doctor. Explain that you are not satisfied with what happened and why. Feel free to say that you find face-to-face conflict hard to handle but that you would like to work this out between you. The doctor can, having been alerted to how conflict-averse you are (and that likely is not news to the doctor), take the lead in completing the conversation, on paper or in person.

That is what they are trained to do. Work with you where you are, not from where they are. Obviously, some are not good at this and they have patients who leave.  You owe it to yourself to try communications first.

For patients who have a family doctor or internist, those doctors who know you best can help work out problems with specialists. They can help prevent them, at times, by making a referral to a specialist you probably will like if asked. Not all primary care doctors do this any more. It is very time consuming. If yours does, you are ahead by getting names from someone who treats you already.

I have, on behalf of family members and friends, both helped work things out when care issues arose and I have helped patients change doctors when it was clear I always turn to our internist first when it is my husband because our internist is an ideal problem-solver. He is fair but he moves fast. No nonsense.We have had problems with specialists very rarely, but when they occur, he has been superb at helping us work it out or said that it was time for us to make a change.

If your issue is with your own regular doctor, of course, then the only thing to do is discuss it, agree or disagree and you can decide to stay or go.

Our own internist thinks three visits, max, is enough to know whether a patient has found a “fit” with a doctor. “If it doesn’t work by then, it is not going to work,” he advises.

Go! Find another doctor by checking with people whom you know and whose judgments you trust. Every doctor is not right for every patient—-as that post about our vet showed.

Writing anonymous comments, however, is not the act of a responsible patient. It is not the work of someone who knows that being a patient and being a doctor are challenging roles, at times, and it takes cooperation if the care partnership is to work.

Yes, patients and doctors have a partnership. The question is: How is it working out for you two?

A doctor can advise you. You decide whether to take the advice or not.

The physician’s power is on the front end. Assessing, diagnosing, ordering tests or treatment.

The patient’s power is on the back end.  The power to ask questions. The power to follow the care plan or not. The power to get other medical opinions. The power to change doctors.

Drive-by postings are not done by empowered patients, which all of us should want to be.

Don’t believe that they are for one minute.

Go to the phone. Go to the office. Go to your computer and write your doctor. You have everything to gain by trying.

If it doesn’t work, you can move on, having learned from the experience.

Empowerment is about facing and solving problems in a style which works for you.

One of the best civil liberties lawyers of the 20th century, the late Charles Morgan, told me once that, “My job is to help people learn how to help themselves make the system work for them. If they feel I ‘rescued’ them then I failed in my role in representing them. I just know the Latin and the way to the court house. A case is about their lives. I want them to emerge stronger afterward, knowing their voices were heard.”

If he were still alive, I am confident he would offer the same advice about these anonymous routes to expressing anything from unhappiness to rage.

How is your life better if you do use such a system?

Speak for yourself or get a family member who is comfortable speaking for you to do it.

Washington Post

“The anonymous comment on the Web site RateMDs.com was unsparing: “Very unhelpful, arrogant,” it said of a doctor. “Did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people.” Such reviews are becoming more common as consumer ratings services like Zagat’s and Angie’s List expand beyond restaurants and plumbers to medical care, and some doctors are fighting back.

“They’re asking patients to agree to what amounts to a gag order that bars them from posting negative comments online.

“Consumers and patients are hungry for good information” about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism.”

…”Segal said such postings say nothing about what should really matter to patients _ a doctor’s medical skills _ and privacy laws and medical ethics prevent leave doctors powerless to do anything it.”

Source:  Washington Post, March 4, 2009