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Q&A with one doctor worried about patient feedback

November 1, 2011

Below is my reply to the concerns of one consultant when he was asked by a colleague if he’d like to use iWantGreatCare.org to harness direct patient experience.

On 31 Oct 2011, at 23:27, [doctor] wrote:

Neil,

I have put forward your website to my colleagues and one response is below.
I know that we will all be using the internet for information on medical matters in the future but you are at an early stage and I need more information to get them on board.

Begin forwarded message:

>>No way!

It is understood that a minority of doctors are strongly opposed to any form of open, transparent feedback on their performance. IWGC is not for this group, rather it is designed for those doctors who realise the benefits to themselves and their patients of harnessing patient experience in an open, direct and transparent manner. Patient experience is known to correlate with, and predict, better clinical outcomes: http://content.nejm.org/cgi/content/full/359/18/1921?query=TOC

Moreover, patient experience is now a formal measure of the quality of care in the NHS and it is impossible for doctors to say they are delivering high quality care without systematically measuring (in a comparative manner) their performance in this respect.

>>Reasons: 1. We can easily do our own feedback. Surveymonkey is the easiest to use, but Bluespier can do it also. I regularly already collect feedback for appraisal from NHS and PP. It is very simple.

Of course it is easy to get simple feedback. If all that colleagues want is occasional feedback (which they have total control over) then simple paper-form will do the job.
However, this is very different to the iWantGreatCare system, and the benefits that this already delivers to doctors across the country.

a. Collecting feedback by survey monkey etc is indeed very simple but will not meet needs of GMC revalidation. I’ve met with GMC number of times and they have confirmed IWGC is fully compliant.
b. IWGC delivers the transparency that is needed to build real trust with patients and commissioners. A “secret survey” can never do this, and suffers from numerous systematic biases.
c. Using IWGC to systematically collect feedback has been proven to dramatically increase private practice and referrals to doctors using the system. This is due to its open nature and the fact that the doctor profiles have high ranking in Google and other search engines. This of course can never be delivered by any form of internal survey.
d. Great doctors need comparative, quantitative data on which to assess their performance. IWGC provides a robust, standardised methodology to provide such metrics for patient experience, allowing doctors and their patients to directly compare with others in the same speciality.

>>2. He has been trying for ages to get that site going

IWGC has been in operation for three years and has steadily grown in that time – number of reviews, number of doctors using the service and number of Trusts and organisations making it part of their QI systems.
It is planned (and funded) as a ten to fifteen year project and has already expanded into dentists, nursing homes and pharmacy services.
As pointed out, it does indeed take a lot of hard work to deliver such a change.

>>…and like most other internet feedback sites it will only generate poor reviews, not good ones.

It would be helpful to see the evidence for his statement.

The reality with IWGC is the complete opposite of this:
96% of reviews are highly positive about the doctor and the care delivered.
There is some bias as the doctors who have already embraced this approach and now ask all their patients to provide feedback are probably at one end of the quality spectrum. But this is helping patients make informed choices about the care they expect for themselves and their families.
(Interestingly TripAdvisor, Yelp and a whole range of consumer rating sites also show a majority of positive reviews. If the care/service is good, then people will take the time and effort to provide fair, open and warm feedback. Indeed, the research shows that NHS patients want more ways to provide positive feedback and say thank you for great care they receive – as well as to highlight where things could be improved.

>>What happens if you receive an unfair poor review, but the owners of the site feel it should stay? Who decides what feedback is included?

There are clear terms and conditions, the majority of which are concerned with protecting the doctor from unfair comments.
The huge difference with IWGC is that it is owned and run by a clinician, who has first hand experience of the issues and challenges – I fully appreciate the subtleties in this respect.
We have never refused a request from a doctor to remove a review that breached the terms and conditions.

>>Who vets it? Once material is added, even if it is removed there is an electronic trail. etc. etc. etc.

There is a sophisticated system that vets reviews – both on content and to detect any abnormal patterns or gaming of the system. Majority of such reviews never even make it to the system, as they are automatically screened and rejected.
Additionally, users monitor the system and can report any review.
Doctors can set up free “alerts” that send an email every time they are reviewed – this ensures that the doctor is the first to know, and prevents the need for the individual clinician to monitor the site for new reviews.

There is of course an electronic trail – fully compliant with the Data Protection Act.

>> Although they have a nice official ‘Terms of Use’ it is typically ‘legal’ and if you don’t like something posted about you, it could be very hard (and expensive) to have it removed. (see point 4 below)

The Terms of Usage are “legal” because that is the only way to do such things properly and to give full, robust protection to all parties.
Please see above response about how is not hard to have unfair comments removed. It does not cost anything.

Reality is that patients are writing about their doctors on the web – good and bad – and this is increasing rapidly. It is happening all the time on Facebook, Twitter etc etc – with doctors having no way at all to either be informed when they are written about and with zero chance of having anything removed. IWGC provides a tightly controlled environment that aims to deliver a system to help patients find great care, and for doctors to simply, safely and easily get the full benefits of real-time feedback from those they look after.

>> 3. The American website he refers to is a promotional website for making appointments with clinicians, not reviews.

zocdoc.com is based on reviews to guide patients in choosing a doctor.
This is the bed-rock of their service and has proved very popular with both patients and doctors.
After reading reviews patients can then book an appointment online.
Not surprisingly, the doctors that get the most appointment requests are those with the largest number of positive reviews.

>>It seems to work like PrivateHealthcare website in the UK whereby clinicians pay to be listed. I tried looking for some well-know shoulder surgeons and they were not there.

As you suggest, not everybody wants to use the system – it is used by early adopters, and those are the ones who are seeing the benefit in terms of increased clinical practice.
Of course, it is only two years old, so one would not expect all doctors to be there.

>>4. There are many other established websites that do what he is trying to do already.

There is no other site giving UK doctors the ability to harness patient experience feedback on them as individuals – either for revalidation or to drive increased practice.
No other service has the safeguards and securities that I have outlined above, nor terms and conditions giving such broad protection to doctors.

>> The most established is http://www.ratemds.com/ and even that has very few review. What is does have is a worldwide database and a well controlled system for dealing with unfair postings which is very easily explained (similar to Tripadvisor.com)

Ratemds.com is an American site that has been sued many times by US doctors. Largely because it does not give any of the protections outlined above.
The IWGC system for dealing with reviews has been proven in daily usage over three years and there are full FAQs for doctors at http://www.iWantGreatCare.org

The comments from your colleague have focused on concerns and negative fears, but fail to consider the proven benefits of IWGC to doctors already using the system across the country. These include clinicians in Newcastle, Birmingham, Walsall, Brighton, Oxford, London, Bristol and numerous other hospitals – both private and NHS. Here are just a few examples of what actually happens when doctors make open, transparent feedback part of their clinical practice and quality monitoring systems:
Chris Bulstrode
Cathryn Edwards
Sebastian Yuen

And a quote from a consultant who has been using iWantGreatCare since 2009:
“As an NHS paediatrician working in a busy district hospital iWantGreatCare has become a valued tool to support and improve my focus on the experience of my patients and their families.
Despite the initial concerns of some colleagues, iWantGreatCare has been increasingly adopted across our department and has become one of the easiest and most effective ways I have found to establish a culture that positions patient experience as a fundamental measure of the quality of the service we provide.”

Consultant Paediatric Nephrologist, Walsall Hospitals NHS Trust

Fully appreciate that this will not be for everyone and no doctor is ever forced to use the service – but at the same time it is important that the facts under consideration are clear and accurate, such that those who do see the benefits of such an innovative approach can decide for themselves based on the evidence.

Interestingly, when doctors who have the most concerns actually trial the system (and they are able to opt-out at anytime) – it is they that often become the biggest supporters once they experience the reality.

I would of course be more than happy to come and discuss this personally with your group, to answer questions and address concerns.

Thank you again to yourself and colleagues for considering such an innovative way to support your practice.

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