HEALTH CARE/Joan Retsinas

Yelping for a Doctor

Galen and Hippocrates. We know they were famous; historians sing their praises. But what did their patients think of them? Did these fathers of medicine make their patients wait? Were they empathic? We don’t know. Without sophisticated satisfaction surveys, the unempowered patients of antiquity couldn’t vent pleasure, or dismay. Luckily for us moderns, this is the age of Yelp. We Yelp Uber, restaurants, hotels, hairdressers, lawyers, plumbers. Thanks to Internet-sharing, everybody is a customer, avidly evaluating “services” ad nauseam. Nothing is sacrosanct: students, whose arrogance trumps their ignorance, now routinely evaluate professors. (What grade would Plato have given Socrates –Irrelevant?).

So why not Yelp doctors? Over coffee, patients have always swapped tales, decrying some physicians, praising others. Although the managed care networks have restricted choices, many of us switch physicians almost as cavalierly as we switch coffees. Did this pediatrician stress breast-feeding too much? Not enough? Was this primary care doctor too reluctant to prescribe antibiotics? Too eager to prescribe them? How long did this physician make patients wait?

The physician’s political philosophies are fair game for yelpers. Did the physician say anything that sounded conservative? Liberal? What does s/he think about guns? Abortion? Global warming? Patients want physicians on their wave lengths. We also want, from physicians as well as from anybody peddling a service, an alchemy of empathy, compassion, humor. The age of yelp has spawned the cult of congeniality, where everybody selling anything, from surgeries to tacos, strives to be pleasant, to garner good reviews.

We know what we want; and the internet has expanded a zillion-fold those coffee-conversations. Today everybody is a shopper; everybody shares ad nauseam.

Yelping doctors is becoming de rigueur. Patients do it; would-be patients look to those reviews. We link patient “satisfaction” to “quality” care because, after all, we patients are consumers, and we consumers know what we want. Hospitals have boarded the “Yelp” bandwagon. They look to surveys to validate their “quality.” Press Ganey, a company from South Bend, Ind., has carved a niche at developing these surveys. To encourage hospitals to take these surveys seriously, the Affordable Care Act will dock hospitals that score low. So, when faced with “low-scoring” physicians (i.e., ones that patients don’t like), hospital administrators try to make those physicians likeable, at least enough to raise their scores. The code for upping patient satisfaction: “reputation management.” For doctors, the dilemma is real. They were not trained to woo patients. Marketers have rushed in, promising to bolster physicians’ wooing skills, making “bedside manner” a required course. Eye contact. Hand shakes. Maybe a joke or two as an opener. Empathy uber alles: the new motto. Plus short waiting times: nobody wants to wait, even with stacks of up-to-date magazines.

Beyond empathy, the key to pleasing patients is to please them – to say “yes” often, to say “no” rarely. Not-so-hidden clues to popularity: Agree to the tests patients want, the drugs they want, the hospitalizations they seek. Don’t remind them that they should lose weight, lock up their guns to keep them from children, wear seat belts, exercise, find an AA meeting, and/or stop smoking. A physician (William Sonnenberg, “Patient Satisfaction Is Overrated,” Medscape, March 6, 2014) notes that patients pleased with their physicians are 12% more likely to be hospitalized, 26% more likely to die.

Yet what do we truly need in a physician? Diagnostic skill, surgical skill, expertise, experience, thoughtfulness, common sense. We should want to know about outcomes, malpractice claims, hospital evaluations, board certifications. A-grade healthcare does not equate with A-grade customer service. We need to hear “no.” We need to hear prescriptions for lifestyle changes. The enthusiasm-to-Yelp may give us charming physicians who “listen” to us – not necessarily the best physicians.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, August 15, 2015

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