‘Stay Far, Far Away’ and Other Things Gleaned from Yelp Health Reviews
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Surprise, charlatans who promise that they'll make everything ok by poking you with needles/adjusting your spine get better reviews than the honest doctor who says "Quit smoking or you'll get emphysema".
http://well.blogs.nytimes.com/2012/09/11/acupuncture-provide... http://archinte.jamanetwork.com/article.aspx?articleid=13575...
THAT SAID anybody who claims they can adjust your chi or cure cancer is a charlatan and deserves prison time.
That always led me to believe it must be having some sort of a provable positive effect on the patients.
By contrast, an acupuncturist that charges a fraction and pretends to cure them is more effective.
"Well, there's probably nothing wrong, but there are some test we can run to be sure."
The patient agrees to the tests because it gives them peace of mind and they mostly don't pay for them, their insurance does.
The doctor orders the test because if they don't and there is some sort of rare problem that was actually present, they can be sued for malpractice. GPs in the US generally aren't making any money from these tests, but they do have a strong incentive to avoid a malpractice lawsuit as those are costly and time consuming.
But yes, this is part of why US healthcare is so expensive.
There is basis for the claim that sticking needles in people can help with some ailments. There is no basis for the claim that meridians are a thing and in any way relevant to those effects.
Most times I've never had any relief after going to a doctors office. Muscle and back problems are like moving teeth with braces, you need to keep working on it or the muscles (or teeth) will go back to the original position.
* did I have a long wait time?
* was the office staff polite and helpful?
* was my physician/NP/PA polite and helpful?
* were there billing problems after the appointment?
These things do matter, but there are more important factors in play that patients are not in a position to judge:
* were standards of care followed by the provider?
* were unnecessary tests ordered or unnecessary drugs proscribed?
* were necessary tests skipped or necessary drugs not proscribed?
* if they had access to my medical history, did the provider bother to review it before seeing me
* etc, etc.
Quality of care can absolutely be evaluated, and that's happening more and more, it's just that patient satisfaction is only one small part of the whole picture.
The things which actually matter like total cost and effectiveness of treatment, etc. Are hard for a single person to judge -teams would have to study and compare data, rather than feelings.
So what we can end up getting, if this how doctors get reviewed, is them acting more as feel good doctors, than actual physicians giving you hard advice.
I don't care how good a chef at a restaurant is, if it takes me 2 hours to order and wait for food, the silverware is dirty, and the surroundings are miserable, I'm never coming back.
Already in this story you see the effect of massage therapists being statistically advantaged over internal medicine doctors. That's obviously silly, but the same effect happens within the medical profession, between different doctors.
/endrant
But the next tier after that will be a raft of professionals who are not necessarily effective, but still apt at customer service. Elevating them is a loss for consumers.
The question you then want to ask is, is it harder to be good at customer service, or harder to be good at internal medicine? I think customer service is easier, and thus worry that the second tier will be the largest of the tiers.
An easy response to this is to say that doctors will learn to get better at customer service. Maybe. But the effect I'm talking about also happens if we stipulate that none of these professionals really change at all, and instead the market just changes the way we sort them. I think that is likelier than the scenario where doctors who are not simultaneously good at medicine and managing an office suddenly figure out customer service.
In conclusion, it is a nice idea to think of the doctors as "business people" but the reality is there are fewer and fewer who are. Most are now employees in a large corporate system.
(also +1 to the sibling comments)
On the other hand, the woman who gave her dentist a low score should also be considered. Was the treatment her dentist recommended really unnecessary? My dentist has told me that I should look into getting my wisdom teeth removed, since they might become a problem later. Is this necessary? Right now it isn't. Tomorrow my gums could become inflamed and I would be unable to chew and will need immediate surgery. At what point is that surgery necessary?
However, a good dentist should have given her enough explanation so she can make the choice herself.
In the end, I don't really want to end up in a situation where doctors optimise for good review scores on Yelp at the expense of providing good care.
It's a thorny issue.
Then went to see another one, she zoomed on another tooth and said that one "needed urgent root canal" while previous dentist had something else "urgent" in a completely different tooth.
With my original dentist I never had any fillings.
As soon as the next dentist came in she recommended 2 fillings and then a later 3rd. Of these filings, one didn't even require anaesthetic for her to drill and complete the filling.
After this dentist left, the next had a policy of, if it isn't causing you pain, filling it is unnecessary (because you often have to drill a tooth slightly to fill it, damaging the tooth worse).
That dentist eventually moved on, and two of those earlier fillings fell out within a month of each other (really not a good time having to carefully eat around these teeth, one on each side of my mouth), and the new dentist gave me two root canals because the roots in the affected teeth had apparently died (potentially my fault, for delaying an appointment due to the timing being several weeks before I was to leave uni). Several months after these root canals had been completed, I had an abscess on one of these teeth, but it passed after a weekend of paracetamol(?). One of these root canal'd teeth then further broke, and the dentist recommended having a crown placed on the tooth, I did enquire about simply having the tooth removed because it had become so much hassle, but the dentist was really against it.
Due to my situation of being at university, and having to travel several hours down the country for each dental appointment, and the need for 4+ appointments to have 2 crowns I opted to visit a dentist local to my university. They ended up recommending removing both the root canal'd teeth (one specifically because the tooth had broken below the gum-line, so it should not be crowned/filled) and they also applied dental sealant to an unrelated tooth. This dentist also stated, if you have an abscess on a root canal'd tooth, that it has become infected, and that infection is unlikely to ever go away, it will simply come back when your immune system is weak (at the initial abscess I had been doing a 48 hr all-nighter for a large assignment deadline), so it's best to have these teeth removed.
tldr; Dentists in my own anecdotal experience can have vastly different opinions of best practise.
I'm also UK based, so dental treatment is relatively inexpensive, due to the NHS funding a large part of it.
Then your imagination is limited. It's more a function of the entire medical experience. Sick people are grouchy. Busy places with waiting rooms make people grouchier. Few doctors provide immediate relief, which means their patients often leave just as grouchy. And upset customers are drastically more likely to leave reviews than satisfied customers. It's just the nature of the business.
People (including doctors with regards to themselves) are terrible at judging health outcomes that don't involve a transition from "I'm going to die" to "now I will live" - the biggest predictor of patient opinion of the quality of their medical care in a hospital, for example, was always how nice the room was.
Conversely, many practices will do everything they can to maximize physician utilization, including scheduling lots of back-to-back appointments. Inevitably, if a doctor is actually doing a good job, some visits will uncover more complex health issues than planned and require more than the 15 or 30 minute allotted to address. This means that appointments start to back up, people start having long wait times to see their doctor, and patient dissatisfaction ensues. Again, this isn't a problem with individual doctors or practices-- although it may seem that way to patients--it's systemic.
People who have bad experiences tend to look for an outlet, and there aren't many ways to "punish" your doctor. The good experiences are never thought about again...
That being said, both my current doctor and dentist were chosen partially on the basis of Yelp reviews. It's been a huge help, far nicer and far better service than I've ever had previously.
A couple of my family members have put their medical and dental offices through the Scheduling Institute[1]'s on-site consulting. The day starts with an institute trainer picking up the phone book, and calling several competing practices in the area to try and make an appointment.
Invariably, the receptionists are brisk, and often outright hostile. They get long hold times, and very poor customer service. And that of course doesn't end once the patient actually makes it to the practice.
There are reasons behind this (overworked providers and office staff, a limited marketplace, poor customer service training), but the result is even if the actual provider gives great care, the overall patient experience can be pretty shitty.
The other challenge I've experienced with my wife's medical practice (which puts an emphasis on customer service) is that patients don't really think about reviewing their doctor on yelp for a "good" experience. We do patient satisfaction surveys, and while the vast majority of patient's who respond to the surveys are very happy with their care, very few will leave a Yelp review about it.
We do just about everything we can without outright asking for Yelp reviews (check-in offers, prominently linking to Yelp from our site etc.), and still only 0.2% of her patients have left a review on Yelp, and only about 25% of those reviews have made it through Yelp's filtering process to actually post.
The other contributing factor is that older people use healthcare more than younger people, and older people aren't as likely to use Yelp. When I have a positive experience at a local business, I'll leave them a review on Yelp as a way of saying "thank you." If my wife could trade every jar of jam, or tray of cookies she got from a grateful patient for a positive Yelp review, she'd have hundreds of 5* reviews and I'd probably be a few lbs thinner.
Health and Medical reviews in general are skewed a bit toward 5 stars. The average rating for Health business in general (3.87) is on par with that of other categories.
And what are those resources?
I'm actually looking for a new PCP in NYC and there are hundreds or thousands of options. It feels like my best course of action is to just pick one at random.