Monday, 21 July 2008


Comment is free. Well, almost free, now that web space is so cheap. It's certainly cheap when you shamelessly rip off a collegue's postings over the last month just to add a wee point of your own (apologies Jobbing Doctor!). Anyways, there're exciting new initiatives such as this one, although it's incomplete and is generated by a failed doctor.

As doctors we learnt anatomy through dissecting dead people. We spent time as clinicians around dead people, what with learning pathology in weekly post mortem examinations. We learnt about life and death, how to keep folk on the right side of the fence. We read old textbooks, thus learnt the thoughts and ideas of people long dead. Doctors mastery over death. Sweet justice, p'raps, that in a similarly necromantic vein patients can now claim dominion over doctors, when their doctor dies, through being able to comment without challenge on said doctor. Well, the doctor may be challenging it, but as I'm not that adept at necromancy, and speaking with the dead being something the NHS isn't yet investing in, it's essentially comment without redress.

It's this comment without being able to give your side that piques me.

I'm all for patient comment and feedback. My out-patient clinic is a leisurely affair so I'm often sitting in the reception or waiting room and capture what folk are chatting over. I meet with patient representatives twice a month and carer representatives once a month. My Royal College was paid a handsome sum of money to undertake 360 degree appraisal. I listed 30 odd staff I work with, including cleaners, secretaries, nurses, Consultants, anaesthetists, social workers, home care staff, support workers, occupational therapists, CBT practitioners, all sorts. Then I listed 30 consecutive patients I saw. That list went off, I had no say in what happened next. Folk were chosen and sent lengthy questionnaires about me, answers were mailed in sealed envelopes back to the Royal College who collated the information, told me how I came over in loads of domains (ask me about my Emotional Intelligence and I can now tell you!) and critically collated and summarised what my patients think of me. They also gave me a CD with the details. They also compared my results with national averages so I could see how I measured up. At my annual appraisal with the Medical Director in another hospital we went through all these pages, with staff and patient comment being scrutinised and impacting upon my formal annual appraisal (and thus can have impact on my pay).

This is a robust system of feedback, that's pooled and although information from patients is anonymous (so to this day I've no idea who was asked to comment let alone how folk rated me or who said what) to my mind it's fair. I'd no choice in which patient to select so there's no bias. I'd no notion who was contacted. They had no pressure to say anything good or bad, nobody was looking over their shoulder and everything was collated by a reputable third party. Well, the Royal College of Psychiatrists, which is still vaguely reputable, even if they're changing at a pace measurable in geological epochs, but ho hum that's another issue. From 360 degree appraisal, I find patient feedback is invited and is specific (with a structed questionnaire) and so is fair. I'm happy. If this yielded results which were less than favourable I couldn't challenge them with whoever made them but I could try and offer an account in my formal appraisal for why I felt patients had such an experience. I don't know who's said what, I can't challenge them directly but I've got a voice in it all. This seems sensible and just. I'm happy.

If we want patient feedback, let's use comment and complaint systems that are already in place, but also use mechanisms such as 360 degree appraisal.

Using scrurrilous websites that lack credibility, honesty, authenticity or explanation/just redress is A Bad Thing since it's harmful to doctors and isn't helpful for patients. Let's hope the lawyers can effect change, here.


Disillusioned said...

Good post.

The same can be said about the "rate my teacher" type sites.

Nothing new....

But still not good.

(Though I did try to post a very favourable review of my own GP - and couldn't. The site seemed caught in an endless loop. I tried to alert the site creators to this. Their feedback is caught in an endless loop of computer generated responses, so I didn't get very far with that either.)

Dr Andrew Brown said...

Perhaps the site is designed only to accept negative comments?

But it seems self-evident to me that such a site is more likely to receive negative than positive comments. Unlike the 360 degree appraisal which you describe, people who make comments will be self-selected and hence more likely to be motivated by agitated discontent than calm satisfaction.

I'm sure Fred Shipman would have rated highly prior to his less orthodox treatments becoming known.

Calavera said...

I thought it was an absolutely abhorrent site. There's absolutely no way to verify the integrity behind the feedback - I could easily go on there and find a consultant or an arsey SpR I may have seen on rotations once and then run my mouth off about them through this rather nebulous site behind a cloak of anonymity. Absolutely awful.

...although, have you checked out It's the parody to iwantgreatcare and it is HILARIOUS! I couldn't stop laughing!

cbtish said...

"If we want patient feedback..." LOL! You should read this great post about how doctors sometimes fail their patients.

Oh, hang on a minute...that great post is your own previous post here. The point is that failures of that kind are commonplace, and that the sanitised systems of feedback that are already in place are not effective in changing those doctors' attitudes and behaviours.

And one of the attitudes that needs to change is: "If we want patient feedback..." It's the feedback you don't want that will create change. It's true, of course, that iwantgreatcare in its present form is not going to create that change either. It is, however, the writing on the wall...

The Shrink said...

cbtish, I'd make the distinction between patient feedback undertaken in a systematic and credible fashion, in contrast to poor clinical care.

In that post I was highlighting roles. PCT commissions services, service providers undertake that clinical activity they're tasked to do. Patients can fall between services when the system lets them down. Individuals are part of that system, so individuals have choices and responsibilities but work within a health/social welfare community and can't orchestrate change unilaterally.

It's this issue of duties that I was posting on. Only medics working in that system, or managers commissioning/operating it, have the insight and appreciation of what's not working well for patients.

I see that as a systemic failure and thus different to individual patient feedback on a doctor's specific performance.

Blurring the 2 is unhelpful. "Dr X is a heartless swine, he didn't give me a third course of infertility treatment. He doesn't understand my/my husband's need for a child. He's mean and didn't listen."
"Dr Y is uncaring. She didn't understand that my back pain is stopping me driving to work or playing with the grandchildren because she didn't refer me for a spinal cord stimulator to cure it. So she's ruined my life and I can't work now."
"Dr Z is rude. He said to me that although I have insulin dependent diabetes I must take my insulin and must take it every day. I know diabetics who just have diet or diet and tablets but Dr Z didn't listen and wouldn't give me pills. The needles are really saw and I hate taking them to restaurants as I look like a drug user. Dr Z has ruined my social life and didn't give me choice and treated me unfairly compared to other diabetics."

None of these would be justified comments about individual doctors, all could be challenged. They're about systems (how many infertility cycles the NHS funds in that area, how the PCT assesses and funds £20000 SCS) or clinical decisions (an insulin dependent diabetic who stops insulin will only go one way). Yet patient naturally will shoot the messenger. "That doctor said . . ."

Without explanation, that's meaningless. Patient feedback should not be meaningless. 360 degree appraisal can make it meaningful.

Cockroach Catcher said...

What about 360 on the Prime Minister and the Health Secretary and others. Also, hospital managers and perhaps revalidation too on them too.

The Cockroach Catcher