What makes a five-star physician?

 

Throughout medical school I was told to strive towards becoming a five-star physician: clinician, educator, manager, researcher and social mobilizer. And so this is what I measure myself against when I turn introspective now on New Year’s eve. What have I accomplished as a clinician, educator, manager, researcher and social mobilizer in 2014? How can I become a better five-star physician in 2015?

The last #HealthXPh tweet chat for 2014 was about planning changes in healthcare for 2015. From moving forward, I now pause and look inward. How do I rate myself? As one would evaluate an app, a restaurant or a tourist spot – five stars?

I haven’t come across a local physician rating website here in the Philippines. Please feel free to leave a comment if such a site exists. But certainly, there are such physician rating websites outside of the Philippines like –

  1. Healthgrades.com
  2. RateMDs.com
  3. Vitals.com

Let’s talk about online physician rating at the first #HealthXPh tweet chat for 2015 on Saturday Jan 3 9 pm Manila (8 am EST).

 

T1 Have you rated your healthcare provider (HCP) online? As an HCP, have you checked your online ratings? Why or why not?

An article in JAMA “Public Awareness, Perception and Use of Online Physician Rating Sites,” last February 2014 has some statistics.

A study by Gao et al, “A Changing Landscape of Physician Quality Reporting: Analysis of Patients’ Online Ratings of their Physicians over a 5-year Period” in JMIR 2012 found that –

… 1 in 6 practicing US physicians received an online review by January 2010. Obstetrician/gynecologists were twice as likely to be rated (P < .001) as other physicians.

 

T2 As an HCP, are you worried about online ratings? As a patient, will you be worried if your HCP had mixed reviews?

A survey found that more Americans are visiting doctor-rating websites, but that the ratings may be skewed. From “More Patients are Checking Doctor-Rating Websites, Study Finds”

One problem is that many doctors might have only a few patients who completed surveys, which could skew their ratings. One patient who has a bad experience could send a doctor’s rating into the basement, for example.

In “Online Physician Reviews: What’s to be Done?” by the Canadian Medical Protective Association, some strategies to monitor online reviews are suggested.

While many physicians may be reluctant to search for comments about themselves by using search engines such as Google or Bing, doing so can be valuable. Physicians may want to occasionally monitor what is written about them on the web, and pay particular attention to physician rating sites. These sites are generally not intended to harm physicians’ reputations. In fact, most physician rating sites allow doctors to update and correct their profile information, and many sites have terms of use requiring only truthful, non-libelous, and relevant postings. Some sites also allow physicians to respond to comments if they choose.

 

T3 Along what parameters should healthcare providers be evaluated in rating websites? Are online ratings trustworthy?

Dr. Kevin Pho wrote in his column “Be wary of doctor-rating sites” last September:

Doctor ratings generally focus on more subjective issues, such as patient wait times, time spent with the doctor, and physician courtesy. Those are obviously important issues, but they paint an incomplete picture. Doctors with stellar interpersonal skills may not be the best at controlling patients’ blood pressures or managing their diabetes.

Becky Ham & Kelly Malcolm suggests asking the following questions when evaluating physician rating sites in “Using Physician Rating Websites”:

  • Who owns the site? Is it a nonprofit or for-profit site?
  • Do doctors pay for their own reviews?
  • Are reviews or ratings anonymous? Is there any way to tell if a reviewer is a patient?
  • Is the information complete? Do you notice any missing doctors in your area?
  • Does the website have an indication of how often information is updated? If a physician’s data is out of date, you may miss important updates to their certification or disciplinary actions.
  • How many ratings does a doctor have? If a doctor has one positive and one negative rating, how much do you really know about his or her performance?

The #HealthXPh tweet chat is turning 1 year old in January 2015! See you!

 

What Patient Stories Tell Us

 

The #HealthXPh team is working on the Philippine Summit on Social Media and Healthcare next year. One of the tracks for this meeting is Patient Stories on Social Media.

Patients have been telling stories and sharing their journeys long before social media existed. Social media can amplify these narratives in powerful ways.

This Saturday, November 29 at 9 pm Manila time, the #HealthXPh tweet chat will explore how patient stories are changing the healthcare landscape. I solicited chat questions via Twitter.

My most vivid memories of patient stories as a medical student was hearing them told at mortality audit conferences. These were invariably narratives of diagnoses missed, therapy-changing lab tests unordered or medicine given too late in the patient’s course.  This after all is what an audit is about, learning from one’s mistakes. Similar stories are shared on Patientstories.org.uk

PATIENTSTORIES uses digital, broadcast and social media approaches to provoke debate about quality issues in healthcare.

At these audits, as the pathologist said the last word on what actually led to the patient’s demise, I often wondered if doing right whatever had been done wrong could have saved the patient’s life. Mostly it was sepsis, heart attacks, cancer, lupus or tuberculosis. I didn’t realize how much of a negative impression it had on me until I went into my outpatient rotation and felt genuinely relieved to meet patients who had survived a heart attack or even cancer. I think these stories of triumph and hope should be told as often if not heard more often – and yet there are no conferences to celebrate such.

And so I ask,

T1. How can patient stories inform medical education?

This question was suggested by Marie Ennis-O’Connor (@JBBC). Thanks Marie! A similar question was also suggested by Deirdre Bonnycastle (@bonnycastle). Thanks Deirdre!

T2. What can doctors learn from patient stories?

This question was also suggested by Marie. I thought it made a good T2. Both medical students and full-fledged physicians can learn from patient stories but what they learn or take away from even the same story can be quite different. Try listening to Aryanna at Inside Stories

an oral narratives project which invites medical students to share their experiences in medical school in the form of brief podcasts published and archived on in-Training. The project aims to provide a means of personal healing, self-realization and empowerment through the sharing and receiving of personal stories, as well as to cultivate community among students in the often isolating medical school environment.

In her account, Aryanna remembers a patient who appreciated her efforts to listen even as she was just a junior member of the healthcare team who didn’t know enough to contribute to the patient’s care. It is a story that would have resonated to my younger medical student self – the feelings of inadequacy and being in the way of the nurses and attending physicians were all too familiar. But hearing it now nudges me to recall when I had actually sat down as I made rounds on patients in the hospital. Had I become one of what Aryanna had described as great physicians who didn’t have time to spend with the patients?

The last question is specific to Twitter and was suggested by Dr. Janey Peterson (@drjaneypeterson). I have modified it to limit it to patients only.

T3. How do patients on Twitter promote positive or negative role modeling?

I have met many patients (not my own) on Twitter and at various times been awed, saddened and even scared of experiences they have shared.  I sometimes wish a tweet had more than a 140 characters to express more empathy or to offer comfort. I’ve also learned valuable lessons from interacting with patients on Twitter even as I have sometimes felt uncomfortable with their justified expressions of disappointment or anger directed to their healthcare providers. And so I think I understand what Janey means that there can be positive or negative role modeling.

See you at the next #HealthXPh tweet chat!

 

 

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