How Does Your Doctor Rate?

One of the good things about the internet is the way it offers consumers a chance to interact and compare notes on a given subject. When we book our physicians for medical conferences, it is handy to have guest reviews of given hotels in places we're unfamiliar, to get a sense of the quality of service.

Reading the reviews, you can sometimes figure that a person is nursing a personal grudge or just had a bad time, or on the opposite end possibly working for the hotel in some capacity. Still, most of the reviews I've come across are pretty straight forward and helpful.

But what about applying that same consumer test to doctors? Recently, I visited the site RateMD.com, where patients can name doctors and offer their opinion as to the quality of their work. Based on a five-point scale, the categories available are Staff (poor service/good service), Punctuality (not on time/on time), Helpfulness (very unhelpful/very helpful), Knowledge (unknowledgeable/knowledgable).

There is also a space to note what insurance company was used, the amount paid, and a section for comments. The latter categories of Helpfulness and Knowledge are tabulated to give an overall score which is manifested by a either a smiley face or a frown.

The site is very user-friendly, and interesting, but as a medical professional, I will admit to a certain amount of trepidation. It's one thing for an average person to criticize the quality of, say, a hotel room, or restaurant meal, but to decide on whether or not a doctor is knowledgeable about their specialty is a completely different can of worms. Often, the patient is only looking at their narrow range of problems, and it's possible that they have misunderstood or misinterpreted something.

While it seems very easy for a doctor to be penalized, it also seems possible for the opposite to also happen. Incompetent doctors who get lucky or have a good bedside manner could get a rave review by someone who doesn't have the proper information necessary to make a good value judgment. Just listen to some of the negative and positive comments I came across:

• "The doctor is a kind, helpful, and compassionate physician. He calls you in and leads you back to the examining room himself."


• "Only had a consult with this doctor, but left feeling like I was putting him out. He didn't listen at all and had his own agenda. If someone has had good work done by him, consider yourself lucky. I definitely got the feeling he is an LA doc in it for the big money. I am not new to this and have had wonderful, ethical, skilled doctors before. He is not one of them!"

There is nothing wrong with making the practice of medicine more accessible to the average layperson, and I'm not condemning this site completely. I just wonder if doctors shouldn't be held to a higher standard than one that offers a smiley face as a seal of approval. As usual, I am curious what you think? Have any of your staff doctors been rated? Do you think it's a good thing?

You've Got E-mail



As many of you know, I am a big advocate of using modern technology to ease the burden of office work. One of the common tools at our disposal, but which I've been hesitant to use, is e-mail. The physicians at my practice felt it would create a problem, if they were available online, and they had visions of overloaded servers as patients asked them endless questions that should be handled on a direct, face-to-face basis.



Still, I've read that patient satsifaction increased greatly when email was made available, so I continually broached the topic at meetings. A month ago, I got the go-ahead to give it a limted trial basis.



The first thing I did was skip the free stuff like Yahoo! and Hotmail. Keeping medical records private is of paramount importance, so I subscribed the office to a secure, encrypted site which charged us a set-up fee, and then a nominal monthly fee thereafter.



The next thing I did was select patients with chronic issues thar required regular check-ups and maintenance. For a fee of $25 per year, I told them they could have unlimited e-mail access. They could use it to make appointments, ask general questions, request prescription refills, and even see part of their medical records. They could also use e-mail to replace any regular phone consultations they were making with their doctor.



I emphasized to them that anything requiring actually contact, such as a change in condition or a check-up, had to be done in person. Insurance companies are notoriously difficult regarding e-visits, so thus far we've avoided any situation where a copay might be involved. It is a direction we may be headed in, but right now we are restricting e-mails to routine things.



There were a few misunderstandings at first. One patient started to describe a rash he had gotten on his backside, and the doctor had to tell him to come into the office, but overall this test run has been very successful. There hasn't been a flood of unnecessary e-mails--in fact, most of the patients became more careful through the act of putting their thoughts into words. The best part was every single patient who participated loved the process, and the satisfaction rate has made it clear that this is the direction we will be heading in for the foreseeable future.



Of course, I wonder if anyone else has taken this plunge. Do any of you use e-mail in your practice? If so, how is it working? If not, what are your concerns? As always, I'd love to hear from you!

From the Mailbag



Occasionally, I get emails from some of you, and while I often answer them in private, sometimes they address something that I think would be beneficial to share here in the blog. Recently, I wrote about our office policy regarding no-shows, and a clinic manager named Sheri sent me the following email:



"I have been recently informed by DMAP that we are restricted from charging their clients a fee for missing their appointments. Do you charge DMAP patients along with everyone else? Actually, the majority of missed appointments are from the DMAP clientele. I would like to hear how others are working this out."



I would say Division of Medical Assistance Program patients are an exception to the general rule, and we have an unwritten policy not to charge them for no-shows. I'm not surprised that it's official policy--although perhaps this differs from state-to-state? However, I should also note that we don't have a large DMAP clientele, so it isn't really an issue. Perhaps other readers could offer Sheri their own experiences?



The next email comes from someone also named Ann:



"I have a question about compensation for my doctors. If a practice offers certain benefits to the partners and one partner does not want the benefit is it customary to compensate them for that benefit monetarily?"



This is an excellent question. I have never had to deal with it personally, but we have it covered in our policy manual. For us, the short answer is "yes," we will compensate a partner in lieu of benefits, if they so wish. The distinction is that we have no set rules for this, as the other partners prefer the discretion of negotiating on a case by case basis. Also, this policy does not transfer to office staff.



As with the previous question, I would appreciate those who have had direct experience with this situation to please comment. I am sure there is more to this than meets the eye, and I'm anxious to know how it has played out in the real world. Why would a partner turn down benefits? How was the compensation calculated? If compensation was denied, did that create problems?



On a final note, I'd like to address the comments regarding my obesity post. I loved the point made that if overweight people can affect thin people, why can't the opposite be true? How many fat people were reformed by their association with fit people? My own parents are a perfect example of this phenomena. Every night, after dinner, my mother drags my father out for a walk around the neighborhood. She even bought him special walking tennis shoes!



Mind you, I'm not trying to discount the value of the study I noted previously regarding the social impact overweight people have on those around them. I just think it's important to avoid stigmatizing people, and working toward productive, healthy solutions.



Thanks for reading! I hope those of you who can help with today's questions will take a moment and offer a comment. I would love to hear from you!

Obesity Is Not My Friend



A recent article in the New England Journal of Medicine suggests that obesity is a social problem, and that people often gain weight when those around them are fat, as it becomes something of a cultural norm.



Being somewhat heavy myself, I took this article to heart. My husband is a large man and when we got married, I was of an average size. Of course, having children has affected my body, but I do see the way I've gained weight through the years by living with someone who is not careful about how they eat.



We've tried to diet off and on, but the truth is our busy lifestyles are conducive to bad habits. Fast food happens more often than I'd like to admit, and I will confess to making dinners that serve more as comfort than nutrition. It's no secret that food can be a form of stress relief.



Most of our friends are a bit overweight, and the study seems to imply that a good way to change things is to do so as a collective. I wonder if that wouldn't be smart, since the will of the individual can be stronger when it's part of a greater good. Still, there is the risk of alienating dear friends who may be in denial of their problem, or who may not share your zeal.



Regardless, I think the study is an important new way to look at obesity, which is an epidemic in this country. Did any of you read the article? What is your opinion? As always, I'd love to hear your thoughts on the matter.

Cruel to Be Kind

One of the things I hate is when we're forced to charge for patient no-shows. There was no firm policy regarding this when I started working at my current practice, and after a spate of cancellations early in my tenure, I finally put my foot down.

We established a rule that notice must be given within 24 hours of the visit. Also, everyone would be charged a nominal fee regardless of coverage. Signs were posted prominently in the waiting area. When out receptionist called patients with friendly reminders, she also mentioned the policy.

As a general rule, we've always allowed for the rare, solid excuses (when they are offered), and every patient is allowed one time to abuse the policy. After that, however, we do charge them a no-show fee after more than one missed appointment, and even though it seems harsh, I feel it's a worthwhile policy. It reminds them that while we are in the business of healthcare, we are a business, and there is a financial impact for their failure to arrive as scheduled.

What about your office? Do you have a policy regarding no-shows? Do you charge patients for missed appointments? As usual, I'm interested to hear your perspective.

It's Nothing Personal



At the last office where I worked, the staff was smaller, and there were only two doctors. One of the doctors was younger and fairly new, so much of the practice revolved around the older, more established one, and he was a handful.



We had a professional bookkeeper, but they often were unable to decipher the main doctor's credit card statements to determine which expenses were personal and which were professional. It was eye-opening to sift through the various charges--sometimes we learned more than we wanted to know--but it was also fairly time-consuming.



One year the IRS came knocking, and it wasn't pretty. Several of the expenses we listed under business got re-categorized to personal. The bookkeeper lost their job, and I was put on notice.



Afterward, the new bookkeeper we hired did a very simple thing to correct our muddle. They opened a credit card account for the practice, and forbid the doctors to use their personal cards for anything business-related. Having an account strictly for business purposes made everything clear and understandable.



It's important, especially in a smaller practice, to not let the doctors mix business with pleasure. Keeping clearly defined records are your best protection in the case of a potential audit.



Of course, I'd be very interested to learn of your experiences regarding this type of thing. Please feel free to leave a comment.