Patients rating doctors: dangerous imposition or quality driver?

As the NHS tries to move on from the Francis Report, there’s a danger it becomes focused on implementing the 290 recommendations. I can see every trust drafting action plans and enormous spreadsheets! A danger is that we miss the need for rebalancing the relationship between patients and the professionals.
As a Medical Director and Responsible Officer I recently was appraised in order to be revalidated. As part of this most doctors are required to present patient feedback. I used the forms on the GMC website for 30 patients attending my clinic. To be honest I didn't find it that helpful.
The questionnaire is too long and the unblinded small sample size raises issues in my mind regarding statistical validity. It is a cumbersome paper-based exercise that would be expensive and unwieldy if it were done by every doctor in the trust.
I did feel there must be a better way. A bit of research led me to I Want Great Care. I registered for the site with a degree of scepticism. I got my own personal URL ( and a batch of professional cards for me to distribute to patients.
I must confess it was an anxious leap of faith to start asking patients to take cards home and rate me anonymously. I have read lots of stories about the pitfalls of unmediated review sites, e.g. TripAdvisor.
I have been giving them to every patient I have seen in clinic for three months. To start with nothing happened. A couple of weeks later I received my first review & it wasn't that flattering: I wondered if I was doing the right thing.
However I persevered and further reviews started to come in. Fortunately some were much more positive and it is always nice to hear good things. Most patients after all do trust, respect and value their doctor, in contrast to many other professions. In addition I have received constructive comments that I have tried to learn from.
Without this sort of feedback I might never know how I am perceived by patients. The response rate is still not high but I feel that it is an incredibly powerful rebalancing of the doctor-patient relationship for the patient to know that I have invited them to feedback. It does involve trusting the patient but it is important to remember that the patient is trusting me to operate on them!
Not all patients have internet access and this could affect some specialities disproportionately, although age is not always a barrier to "silver surfers" using the internet. One fabulous Suffolk patient when asked if he had Internet access responded: "No, but I do have running water".
I am convinced a system such as this can play a major role in changing the culture of medicine towards transparency and putting the patient in charge. It also plays a major role in providing patient feedback for doctors to support their revalidation. A number of clinicians whom I spoke to were highly positive.
It could also be of considerable benefit trainees. If a candidate at a consultant interview presented evidence of high volumes of positive patient feedback this could be a significant factor in the success of their application.
Every doctor on the GMC list of registered medical practitioners is already on the site. I asked IWGC to make a connection on their site between West Suffolk and the doctors for whom I am Responsible Officer.
I was well aware that some doctors would have reservations about this. Anonymous malicious internet comments could be posted. The site does have in place systems to detect (and if necessary delete) inappropriate ratings by patients (and even doctors).
My initial instinct was to consult widely but if there were a vocal minority who objected they could have an effective veto.
This process has caused considerable discussion. A significant number of doctors were incredibly enthusiastic and routinely give out IWGC cards to their patients
Others are uncomfortable with the idea of patients having an easy opportunity anonymously to rate a doctor. A small number of doctors were openly hostile.
I told doctors I would not force them to use the system but that they did need to obtain patient feedback somehow for their revalidation and this was a simple way to achieve it. If they chose not to use the system they would need to seek alternative means via a validated methodology.
Some doctors demanded that their names be removed. I am happy that if they are not yet ready to use this system then there is no point in seeking confrontation and they are no longer linked to West Suffolk on the IWGC website. A patient would still be able to find a registered doctor in the same way as already existed prior to the connection being made by West Suffolk.
I met Neil Bacon of I Want Great Care to discuss their service and possible enhancements. I would love to see a "West Suffolk" front page making it easier for patients to rate both the hospital and their doctor. A number of tweaks are still needed to make the system more patient and doctor-friendly.
One beneficial side effect of IWGC is that patients are also invited to give feedback on the hospital and the department. The numbers of responses received by West Suffolk have soared. There is also potential to use the system to collect the data required for the "Friends and Family" test.
Overall I believe that systems for patients to rate doctors and hospitals are potentially very powerful tools. IWGC is not the only option. Others include NHS Choices or Patient Opinion.
There is still a feeling of fear in allowing unmediated anonymous comments and I fully understand the reservations of some of my colleagues.
I do not claim that we have cracked it at West Suffolk but I do believe that we have made considerable progress in demonstrating to our patients that their experiences of their care matter to us and that we genuinely want to know where we need to improve. The routine collection of feedback from patients has the potential to be a powerful stimulus to improve the quality of care that patients experience.
I would emphasise that I have no relationship with IWGC
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© 2013 Dermot O'Riordan
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