Monday, February 23, 2009

Should Zagat Review Physicians?

Wellpoint, which provides medical coverage to more than 35 million Americans, has teamed with Zagat, which is known for its restaurant ratings, to provide patient ratings of their doctors to Wellpoint members.

Doctors aren't happy. Here are comments from a recent New York Times article on the Wellpoint/Zagat collaboration:
“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.”

Dr. Angelo S. Carrabba, an obstetrician in Rocky Hill, Conn., complained that Anthem Blue Cross and Blue Shield, a WellPoint company, was “treating medical care provided by dedicated and caring physicians as if we were preparing a meal.”

Dr. Ronald C. Thurston, a psychiatrist in Ventura, Calif., questioned the validity of the Zagat feature. “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.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said he was skeptical about open forums evaluating doctors.

"There is no correlation between a doctor being an inept danger to the patient and his popularity," Professor Caplan said. Reviewing doctors is “a recipe for disaster," he said.
It's not surprising that doctors don't like the prospect of public ratings by their patients, especially by a company whose slogan is "Eat, Drink, Stay, Play." But I think it's a good idea.

Zagat has earned its good reputation in the consumer rating sector. My wife and I have used the restaurant guides for years. We understand that the guide represents a compilation of subjective reactions, not divine truth. Over time we've found that the subjective perspectives it presents are reasonable predictors of how we're likely to react. I'd be surprised if most of the folks reading this blog haven't sought out opinions about doctors from people they respect. Zagat ratings could contribute to that same process.

This is the rationale presented by Eric Fennel, WellPoint's Vice President of consumer innovation (see here):
"We've been doing patient satisfaction surveys for a long time. What we recognized was that we needed to create a vehicle that would engage people in this conversation and do more than just solicit their opinions. Most decision-making tools in the industry today are centered on providing clinical quality or cost information to members. When people have to make a decision they tend to turn, first and foremost, to friends and family for help and guidance and then look to other information that might be available."
In thinking about an innovation like the Wellpoint/Zagat collaboration we should assess risks and benefits as we do elsewhere in medicine. There is no doubt that, as Arthur Caplan says, "There is no correlation between a doctor being an inept danger to the patient and his popularity." But his conclusion -that reviewing doctors is “a recipe for disaster," doesn't follow. We assess whether a doctor is an "inept danger" by whatever process (does he wash his hands before examining his patients?) and outcome (do his patients recover from surgery well?) measures that are available to us. What gets called "technical quality" is the baseline criterion for making a referral. But the subjective factors that the Wellpoint/Zagat system is setting out to summarize can help patients choose among qualified physicians.

But in many areas of medicine "subjective" factors - including plain old likeability - contribute to the therapeutic potential of the doctor-patient interaction and should therefore be considered "technical" factors as well. And painful as it can be, receiving the kind of feedback the Zagat process is intended to provide can potentially help us become better "human technicians."


eric said...

Well said! We are a service industry. Of my summer jobs, busboy prepared me best for doctoring.
I wonder how the Zagat rating process compares with the Press-Ganey process. Is there a validity gold standard?

Jim Sabin said...

Hi Eric -

Although it's true that in economic terms health care is an "industry," I find that except when I'm talking to economists or policy wonks I prefer to use the word "profession." I agree that we are a "service profession." I'd be interested in knowing which learnings from your busboy experience have been most useful for medical practice!

The Zagat process is too new to evaluate. Your suggestion of comparing different rating tools is a good one.

As always, thanks for the comments!