Althouse: Requiring patients to sign over copyrights to reviews of doctors so the doctors can make websites take down bad reviews.

May 25, 2011

Requiring patients to sign over copyrights to reviews of doctors so the doctors can make websites take down bad reviews.

If you've chosen a doctor based on all the good reviews in Yelp, and he won't treat you unless you sign a form that gives him ownership of whatever you might write about him, then you need to know how the Digital Millennium Copyright Act works, so you can see that the doctor has seized the power to remove his patients' bad reviews.

Or maybe doctors are just adopting this standard-form Medical Justice agreement and they're not really monitoring and censoring the on-line reviews... in which case they are unwittingly making savvy patients suspicious of what are genuinely good reviews.

(Via Matt Yglesias.)

45 comments:

edutcher said...: Can I have my lawyer post my malpractice suit instead of a review?; 5/25/11, 10:11 AM
Carol_Herman said...: Even at Amazon, I mostly disregard bad reviews! And, sometimes, I can see the reason a reviewer would take a public dump.

You need "Yelp" to find a good doctor?

There's a better way. You find yourself moving to a new community, let's say. And, you know in this new community you'll go looking for schools and churches. And, it's a good idea to see how far you need to go to reach a decent hospital.

Check it out. Go into the emergency room. Or even through the front door. Say you'd like to talk to a nurse on the cardiology unit.

The biggest secret kept in medicine is that the nurses know where the best doctors are! And, the question you ask them is: "Which one of the doctors here, do you, or your family members go to?

BINGO. You'll find the best.

The other of course is still the old-fashioned word of mouth. A friend who went to a surgeon. And, she'll even show you the results. So, you can make up your own mind.

Yelp? Might as well ask the horse's ass.; 5/25/11, 10:11 AM
chuck b. said...: This comment has been removed by the author.; 5/25/11, 10:12 AM
Carol_Herman said...: Hey, at the golf club, you can ask one of the successful attorneys whom he is not suing. Then, ask for a reference to whom he respects.

Lawyers, too, on occasion, have been known to need medical attention. It's not just lawsuits at the ying-yang.

Oh, also. Don't believe the crap you see on TV. Don't take "recommendations" on what house to buy, from a realtor. (They are in it for the commissions.)

And, don't trust strangers.; 5/25/11, 10:13 AM
Sprezzatura said...: Coming soon (thanks to the Patient Protection and Affordable Care Act, aka ACA, aka Obamacare) hospitals will be required to post how docs diagnosed folks, and how those folks did after treatment.

W/ this data it will be very easy for patients to find outlier docs. Both good and bad.

So, fussing w/ Yelp is not going to help them. But, getting an ACA repeal will. Less transparency is good for them. It's much better for them when the patient has little to no power, hence maintaing an unbridgeable knowledge gap is helpful. And, shockingly, the costs keep going north, in a market controlled by sellers.; 5/25/11, 10:28 AM
KCFleming said...: "Doctors and dentists are understandably worried about damage to their reputations from negative reviews, and medical privacy laws do make it tricky for them to respond when their work is unfairly maligned. "

But that aside,.....; 5/25/11, 10:31 AM
edutcher said...: Carol_Herman said...

Even at Amazon, I mostly disregard bad reviews! And, sometimes, I can see the reason a reviewer would take a public dump.

You need "Yelp" to find a good doctor?

On the reviews, you need to take the good and the bad both with a grain of salt.

Sometimes the size of Lot's wife.

You want to know who the good doctors are?

Ask the nurses. They're the ones who have to save the mistakes of the bad ones.

If they can.

And they have no problem telling you which ones are good and nice, mean and good, and which have actually gone through what they treat.; 5/25/11, 10:32 AM
KCFleming said...: "thanks to the Patient Protection and Affordable Care Act, aka ACA, aka Obamacare) hospitals will be required to post how docs diagnosed folks, and how those folks did after treatment."

Thanks to the same law, high risk and noncompliant patients are already getting shown the door.

Who wants to take the hit for an inevitable bad outcome?
Nobody, that's who.

So you're not exercising three times per week and your lipids didn't improve?
Goodbye.

Thanks, Barry!; 5/25/11, 10:34 AM
Sprezzatura said...: Pogo,

The data will allow patients to link illnesses and outcomes.

So, obviously the severity of the illness (e.g. high risk circumstances) will be accounted for. The results for folks w/ really bad chances of survival or recovery will only be compared to folks w/ the same difficulties. So, most docs, and most protocols will be average. But, some will be really good, these can be studied to see if it's possible to replicate the results. Some will be really bad, these should also be looked at.; 5/25/11, 10:47 AM
Scott M said...: If that's true and we're heading for the medical promised land, I'm curious why my mother-in-law (ER doc), my brother-in-law (eye surgeon) and my sister-in-law (pediatrician and fervent liberal) are all saying this is going to be bad for everyone involved.

We can wax hopeful or pessimistic based on what national figures tell us via the news media, or we can rely on those professionals we know and trust. I'm opting for the latter. While I don't pretend to understand all of the complexities, I very must trust three people I've known for decades and their opinion of how it's going to affect their craft directly.; 5/25/11, 10:53 AM
KCFleming said...: "So, obviously the severity of the illness (e.g. high risk circumstances) will be accounted for. "

Ha ha ha.
Good luck with that belief.; 5/25/11, 10:53 AM
Scott M said...: Please ignore that butchered last sentence...ugh.; 5/25/11, 10:54 AM
KCFleming said...: "Some will be really bad, these should also be looked at."

Hilarious.; 5/25/11, 10:54 AM
KCFleming said...: Just watch as major medical institutions move overseas.; 5/25/11, 10:57 AM
Sprezzatura said...: Scott and Pogo,

You folks may not trust in markets, but I do.

Give consumers data. Don't let the docs hide the truth.

And, what is the point of having medical institutions threaten to leave? Do they like the lower reimbursements that are typical in the rest of the world?

BTW, the reality is that US citizens (not docs) are leaving the country for more affordable medical care, because our docs charge more than the rest of the world's docs do. If our docs want to switch places w/ their poorly paid counterparts, I'd expect that some of the counterparts would be willing to take the pay raise, even if it means that they'd be held accountable for their work. Which is asking too much for some of our docs.

Shorter version: Pogo and Scott's relatives, don't let the door hit you.....; 5/25/11, 11:12 AM
KCFleming said...: "You folks may not trust in markets, but I do."

So you're destroying the market in order to save it?; 5/25/11, 11:14 AM
Scott M said...: You folks may not trust in markets, but I do.

You have absolutely no idea what you're talking about if you're hanging your hat on that statement. To make matters worse, nothing I've said, and nothing Pogo has said from what I've read, could possibly lead you to that conclusion.; 5/25/11, 11:17 AM
KCFleming said...: "I'd expect that some of the counterparts would be willing to take the pay raise"

In other words, the US, like Britain and Australia, will steal MDs from poor countries to meet the lack of native-born MDs, and deprive those poor countries of their best and brightest.

pbAndj, the a Neo-colonialist.; 5/25/11, 11:18 AM
PfMoen said...: sometimes there are "negative reviews" when the doc tries to get paid. nothing like bitching so you don't have to pay.; 5/25/11, 11:20 AM
Sprezzatura said...: Scott and Pogo,

You two like a free market where the seller has all of the power and knowledge, and the buyer is not given the tools required to evaluate the seller.

Congratulations.; 5/25/11, 11:21 AM
Scott M said...: You two like a free market where the seller has all of the power and knowledge, and the buyer is not given the tools required to evaluate the seller.

Again...provide proof that anything I've said backs up that statement specifically. This is your second attempt. Otherwise, stop claiming you have any idea what I think.; 5/25/11, 11:23 AM
edutcher said...: Pogo, the data will only be used to track which doctors support the Demos. As always, PB&J lies.

As you say, this is about destroying healthcare in the free market.

The goal is healthcare totally controlled by the death panels of Dr Berwick.

You want to see what ZeroCare will be like? Take a look at the horror stories coming out of Britain's NHS.

They voted in something similar in Canada and would love to get rid of it. Canadians coming to American hospitals always say the same thing, "Are you out of your minds? Why get rid of something that works? The last thing you want is something like what we have. We were hoodwinked - don't let them do it to you".

The Blonde has heard that speech more times than she can count - in some cases, from people who came all the way from Britain.

The laugh is people like PB&J always think the fix is in for them too, because they shilled for the Lefty masters. History tells us people like that are the first ones to the ovens.; 5/25/11, 11:26 AM
Sprezzatura said...: "In other words, the US, like Britain and Australia, will steal MDs from poor countries to meet the lack of native-born MDs, and deprive those poor countries of their best and brightest."

No.

It's a swap. You said that our docs wanted to go overseas, so they wouldn't be accountable for their work. I said, "good riddance." So, the poor countries will get you! Lucky them.

Scott,

You said that the Affordable Care Act, w/ it's data reporting (you referred to this as a promised land), was bad.; 5/25/11, 11:26 AM
KCFleming said...: "So, the poor countries will get you! Lucky them."

US physician émigrés will not be moving to poor countries, although I'm sure such a simple lie will help you sleep at night knowing the US will be -like the UK and OZ-) raiding the coffers of poor countries when they run out of local MDs.

You're a neo-colonialist, pbAndj.
Say it loud and proud!

"He steals from the poor and gives to the rich, stupid bitch."; 5/25/11, 11:33 AM
edutcher said...: pbAndj said...

"In other words, the US, like Britain and Australia, will steal MDs from poor countries to meet the lack of native-born MDs, and deprive those poor countries of their best and brightest."

No.

It's a swap. You said that our docs wanted to go overseas, so they wouldn't be accountable for their work. I said, "good riddance." So, the poor countries will get you! Lucky them.

He lies.

The reason Blighty and Oz import doctors is that they can't grow enough at home. The locals figure it isn't worth the hassle.

And more people are coming here for medical care than the other way around. Some people may buy their medicines in Canada, but that's it.

As I say, the Lefties can't win without lies.; 5/25/11, 11:40 AM
Bruce Hayden said...: "So, obviously the severity of the illness (e.g. high risk circumstances) will be accounted for. "

Ha ha ha.
Good luck with that belief.

Blogger ate my last, rather long, response. So, I will try again.

Again, I agree with Pogo.

Trying to take into account severity of illness is one of the harder things to do when evaluating physicians. There are a lot of problems there. For example, physician practices are rarely homogeneous. Rather, there are huge variations in practices. One doc may treat just the most serious patients, while the next one treats the least serious, and a third one treats the whole range. Or, then maybe a fourth one treats more serious than non-serious, but not as much as the first one. That sort of thing, but spread out over the entire physician population. Docs in the same practice group even vary a lot.

Add to this that the government, or, really anyone, isn't going to read all the charts, sit in the OR, etc. Rather, they are pretty much stuck with billing records and statistics on adverse consequences (and I have a friend who has lost a lot of patients, but never a malpractice suit - he ran an inner city ER).

It is a very complicated problem, and there are very few people in this country who really understand it (I work with some of them). Clearly not the 111th Congress, which passed ObamaCare, mostly listening to lawyers and lobbyists, and rarely to practicing physicians, and with few, if any real doctors on the winning side.

The reality is that this is just another place where the libs and other socialists will tell you that if we just put the smartest people in charge, they can figure it out, so trust them. Of course, they don't get the smartest people, and even if they did, it wouldn't work.; 5/25/11, 11:45 AM
Scott M said...: You said that the Affordable Care Act, w/ it's data reporting (you referred to this as a promised land), was bad.

Wrong. I said that the three doctors in my family, one of whom would probably out-lib you, says it's bad for doctors and patients.

Try again.; 5/25/11, 11:46 AM
Bruce Hayden said...: You two like a free market where the seller has all of the power and knowledge, and the buyer is not given the tools required to evaluate the seller.

No one is saying that data isn't good, but rather, at least I am saying that those who think that the problem of getting meaningful results from the data will be easy do not understand the problems involved, and are mostly operating on wishful thinking.; 5/25/11, 11:48 AM
themightypuck said...: The DMCA has always been broken and used for unscrupulous purposes. It needs to be fixed.; 5/25/11, 12:08 PM
Methadras said...: DMCA is one of the worst laws ever written. Period.; 5/25/11, 12:12 PM
Sprezzatura said...: ed,

Americans involved in medical tourism is real because they can save eighty percent by going overseas. Our docs and medical care costs too much, for the same results, see the link at 11:12.

Estimates of Americans involved in medical tourism seem to range from a quarter million to one million. That's a decent percentage of our population, though it's much smaller than the nearly fifty million uninsured folks who either go w/o care, or send the bill to the taxpayers when they end up in an emergency room.

Scott,

And, you clearly stated that you would go w/ whatever the docs said. Just like most patients, you'll go w/ whatever the docs say. You don't have any data to evaluate them, so you have no choice. And, that's how they like it.

Bruce,

You may know very knowledgeable folks, but you comment indicates that you're not one of them. There is already plenty of specificity in distinguishing illnesses and the care given. For example, Medicare billing requires very particular distinctions. So, there already is an detailed record that carefully characterizes what a doc is diagnosing, how the doc is treating that very particular diagnosis, and the outcome for the patient.

But, now this stuff isn't made public. That's changing w/ the Affordable Care act.; 5/25/11, 12:18 PM
Sprezzatura said...: ed,

Americans involved in medical tourism is real because they can save eighty percent by going overseas. Our docs and medical care costs too much, for the same results, see the link at 11:12.

Estimates of Americans involved in medical tourism seem to range from a quarter million to one million. That's a decent percentage of our population, though it's much smaller than the nearly fifty million uninsured folks who either go w/o care, or send the bill to the taxpayers when they end up in an emergency room.

Scott,

And, you clearly stated that you would go w/ whatever the docs said. Just like most patients, you'll go w/ whatever the docs say. You don't have any data to evaluate them, so you have no choice. And, that's how they like it.

Bruce,

You may know very knowledgeable folks, but you comment indicates that you're not one of them. There is already plenty of specificity in distinguishing illnesses and the care given. For example, Medicare billing requires very particular distinctions. So, there already is an detailed record that carefully characterizes what a doc is diagnosing, how the doc is treating that very particular diagnosis, and the outcome for the patient.

But, now this stuff isn't made public. That's changing w/ the Affordable Care act.; 5/25/11, 12:28 PM
Tristram said...: The funny thing about the release form / assigning of copyright: The doctor's office manager AND the doctor claimed it was to protect them against false comments by competetor's / disgruntled ex's / trolls.

However, they could not answer how people who did not sign the form (presumably, competitor's wouldn't have come in for a visit) could be prevented from posting / having the post removed by HIM signing the form.

Either the doc is not thinking clearly (a BIG negative in someone I am trusting my health, legal assistance, car, oh hell anything to) OR he is being dishonest about WHY he doing this (); 5/25/11, 12:31 PM
Phil 314 said...: Carol;
The biggest secret kept in medicine is that the nurses know where the best doctors are!

Not exactly. Nurses are as biased as the rest of us; they just base their bias's on different values. How would a nurse review a doc who gives her a hard time on the floor?

If a nurse highly values a cardiologist who knows his stuff and is excellent in the cath lab, will she give you the right recommendation if you're looking for a cardiologist who is circumspect regarding procedures and who's willing to discuss alternative options for treating your hyperlipidemia?

Finally how will a CCU nurse rate a family doc or general internist if neither group comes to the hospital anymore? Probably based on the occasional patient who ends up in the hospital as a result of a bad outcome. For example "Well the last patient we had in the CCU of Dr. X's, he had treated his chest pain with Motrin and completely missed the large MI".
Of course that nurse has a very limited understanding of what actually happened in Dr. X's office.; 5/25/11, 12:40 PM
Phil 314 said...: Its a brave new world out there for docs. For all the dangers there's no way they can avoid dealing with patient impressions of their care.; 5/25/11, 12:41 PM
Michael K said...: The biggest secret kept in medicine is that the nurses know where the best doctors are! And, the question you ask them is: "Which one of the doctors here, do you, or your family members go to?

Just as anesthesiologists know who the best surgeons are. In my early days in practice, I noticed that there was one awful surgeon who, nonetheless, was fairly busy. Then I noticed that his patients all came from internists who had never been closer to the OR than the doctors' dining room.

As far as the fools who think Obama and Pelosi are interested in quality, I spent years trying to get someone besides doctors interested in quality. When I retired, after a 14 hour back surgery, I spent a year at Dartmouth getting another degree and studying how to measure quality. I thought there might be a career there for someone who had done a lot of surgery but couldn't stand at an operating table anymore. I found the only, the ONLY people interested in quality are doctors, and some nurses (not the unions).

Medicare, Medicaid and insurance companies treat quality measurement the way vampires regard garlic. At one point, when I was on the UC, Irvine faculty, there was a big grant opportunity to study the effect of managed care on the poor and elderly. We had the methodology. All we needed was the data. Orange County had just hired a former chief of Medicaid in DC to run a new county program. The data from the fee-for-service program still existed and could be used as a control to compare the effect of managed care, like an HMO.

All we needed was permission to use the data. The grant was in the half million dollar range. They would NOT give us permission to use the data. Nobody wants to know about quality because EVERYONE assumes it will cost more. Done right, it doesn't but you will never convince Obama, or Berwick, of that fact.

Fools think that the government has your interests in mind.; 5/25/11, 12:42 PM
Michelle Dulak Thomson said...: pbAndj,

Estimates of Americans involved in medical tourism seem to range from a quarter million to one million. That's a decent percentage of our population, though it's much smaller than the nearly fifty million uninsured folks who either go w/o care, or send the bill to the taxpayers when they end up in an emergency room.

This is really OT, but can we please, please retire this notion that you are either insured, going without medical attention altogether, or else freeloading at the local hospital's ER? It is possible to purchase medical services with cash. People do.

And it is not "the taxpayers" who foot the bill for indigent ER care, exactly; it's the hospital. This isn't (yet) Canada or the UK. Hospitals have a legal duty to provide care to anyone in serious danger, but they aren't arms of the state.; 5/25/11, 1:30 PM
MeTooThenMail said...: I had a pseudonymous person write a "review" of his experience with me as a patient.

Based solely what was written, it was clear to me and my staff that this person did not, could not, have ever seen me as my patient.

I thought about posting some type of response but quickly thought the better of it - I also thought about contacting our in-house legal department as the comments were abusive, inflammatory and certainly libelous - here too, I was advised to let it go.

And yes, with the tracking of arbitrary outcomes as defined by the federal government - high risk, non-compliant, recalcitrant, and otherwise undesirable patients will have a very hard time indeed finding doctors.

With all due respect to pb&j and his/her medical tourism - my advice - please, by all means, "save 80%" on your health care needs and leave the country to get your medical care.

As an alternative, a good friend of mine had a "lap-chole" at world class tertiary med-center-university hospital - her bill was somewhere north of $20,000 - her out of pocket expense - $400 or so.

Good luck with that travel medicine stuff.

Really, go.

And tell everyone you know, and their families, and their friends and families to go.

And keep going.

Really.

And yes, doctors are already beginning to change their scope of practice and the older (experienced) ones are heading for early retirement as fast as possible.

And no, there aren't enough US grads or J-1 visa docs to make up the shortage.

Really, good luck with that.; 5/25/11, 1:56 PM
DaveW said...: I'm suspicious that any doctor that wanted to do this is exactly the type of doctor you shouldn't want anyway. Are some doctors so low on business that they need to worry about these reviews? I find that hard to credit.

Everyone has to put up with being evaluated. Sometimes evaluations aren't fair. Tough. My sense is that most people smart enough to read reviews when selecting a doctor are probably smart enough to evaluate the reviews as a whole.

Much like reading product reviews on Amazon, which if you read them carefully you'll see the complaints are often about something you don't care about or some specific one time failure.

I picked my doctor (internist) by reading online reviews and I'm very happy with him.; 5/25/11, 3:44 PM
Tibore said...: I'm actually going to go off topic because I don't give a damn about the Medical Justice agreement form. That'll work itself out in one way or another, and I'll decide whether I like the result of that then, not before that.

To me, the real juice in the story is on the concept of online reviews of medical professionals itself. The article opened "I needed a new dentist, and Yelp says Dr. Cirka is one of the best in the Philadelphia area...". But yet, when I read the Yelp reviews, what I saw were endless statements concentrating on the minutiae and practically nothing about how well he meets whatever the dental standard of care is. I saw statements like:

"Everyone is overly helpful in this office - to the extent in which it feels as if something sinister is going on. They walk around with these cult-smiles..."

... and not a damn thing about how competent this dentist is. And that's a far bigger problem than any manufactured sturm-und-drang about DMCA applicability or any notion of coerced contractual agreements that is being brought up: There's an unspoken presumption that the reviews themselves are worth protecting.

No. They're. Not.

Conceptually, independent reviews of doctors' offices experiences are worth reading in this fashion. But that's not the tone or gist of the opening of the article; the notion that the author determined that a dentist was "one of the best" merely by reading superficial online reviews is.

So what's the problem? Well, patients of pseudo-doctors, like homeopaths and the like, tend to report sky-high satisfaction with their care. That does not mean that the care itself is any good. It only means that someone passed judgements on superficial aspects of their care and didn't rate the core issues. When a treatment or a professional giving treatment is incompetent yet friendly, they will get very good ratings despite the fact that their ability to actually deliver proper medical care is insufficient. I cite homeopaths for a reason; there's no actual caregiving in homeopathy; it's a pseudoscience, it doesn't work. Yet, it gets rave reviews, unjustifiably.
(continued...); 5/25/11, 3:46 PM
Tibore said...: (... continuation)
Likewise, when extended to legit health care, the same problems remain. Does a caregiver get rave reviews because that person is eminently competent and delivers the best care possible? Or do they get raked over the coals for issues irrelevant to the delivery of the care to begin with? The dentist in the arstechica story is getting hammered for that form and for other reasons, but how many of those reviews adequately judge the man's competence?

If this were merely about office experiences, I wouldn't be so strident. But again, the notion was judging whether a medical professional is "good". That infers judgement of competence. Yet, trusting in the judgement of anonymous online posters and conflating of minor, irrelevant details with the skill of the caregiver in the all-encompassing judgement "good" is a fatally flawed conceit. Why defend the notion of patient reviews when no effort is made to determine what constitues a good review? I.e. one that actually distinguishes between core and peripheral issues, and one that gives good information that allows you to make truly informed opinions. The author of the article is defending judgement via gossip. And for determining medical caregivers, that's an utterly, damnably stupid thing to defend.

Review sites tend to be axe-grind forums. Or Hallelujah ones. Very little actual, average data on average experiences. This is what that article is defending. Not honest evaluation sites, but superficial gossip ones. So the question is, why is there no criticism of the review site, or the notion of wild-west, anything goes reviews? Why not make the distinction "This isn't the best way to actually do it, but the notion of patient reviews is a good one if executed better"? Why worry about the MedJustice form? The real issue is not what preconditions the doctor (or in the article's case, the dentist) sets on you before he accepts you as a patient. It's this notion that free-form evaluations with no standards is worth defending. That needs to be fixed before I worry about what one individual professional sets as conditions of a relationship. If I don't like conditions, I'll go elsewhere. But you can't walk away from a bad review, nor can you undo the immense distortion of perception that occurs when issues as complex as medical care are judged in such hideously superficial ways. Again: Homeopaths get judged highly. But would you trust one over a cranky oncologist who gets low ratings because people don't like his body odor or office staff? I just care what his competence and levels of knowlege are.; 5/25/11, 3:50 PM
Bruce Hayden said...: You may know very knowledgeable folks, but you comment indicates that you're not one of them. There is already plenty of specificity in distinguishing illnesses and the care given. For example, Medicare billing requires very particular distinctions. So, there already is an detailed record that carefully characterizes what a doc is diagnosing, how the doc is treating that very particular diagnosis, and the outcome for the patient.

Sure, and guess what? Medicare billing fraud is rampant, and basing most analysis on those absolutely precise diagnosis codes and the like is statistically unstable. One doc may look good one year, and horrible the next. That is where I am coming from - having read a large number of articles on the statistical problems that result from analysis based on those supposedly totally accurate and explanatory codes.

Let me suggest that you may be falling into a statistical fallacy similar to the idea that if you just use enough decimal places, you will get accurate results. And, I am pretty sure that the proponents for all the statistical provisions in ObamaCare definitely did so. What I am talking about is the idea that 3.141592656 +/- .5 is really any more accurate than 3.14 +/- .5. And, esp. when aggregated over billions of claim items.

So, let's take an example. Let's say that a doc gets one rate if he uses 1-9 stitches, and a higher one if he uses 10-19 stitches. Sure, he probably won't use 10 when 1 will do, but may use 10 when 8 would work. Some other doc won't. Ditto for diagnosis. Maybe there is a diagnosis break above and below a certain size for a tumor. Fine, if the image is absolutely clear, and you can make instrumented calculations. But what happens if there is a bit of a fuzzy line between? A shadow?

Sure, Medicare may come in and second guess him. But he was just being a little more cautious when he put those extra two stitches in, and has finer hands than most. And, it still looks like a 2 inch tumor to him, even if it only looks like a 1.9 inch one to the reviewing Medicare doc (who, BTW, isn't practicing, likely hasn't really done so, and is only board certified in bureaucratic operations). Assuming that they hired a doctor in the first place, and this review isn't being done by a civil servant clerk.

And then you have the aggregation problem.

In any case, the supposed precision of the data is a mirage. It isn't nearly as precise as you seem to believe, and even if it were, it cannot be aggregated with any great consistency, accuracy, and stability without a lot of work and experience by skilled statisticians. And, right now, even for them, it almost seems like more art than science.; 5/25/11, 4:00 PM
Tibore said...: One last point, and then I'll give it a rest: I don't have a problem with the notion of reviewing a medial professional. I have a problem with the notion that
1. Any review is legitimate,
2. Any are allowed to stand, and
3. Online anonymous reviews somehow have the intrinsic value that allows them to be a legitimate method for judging a medical caregiver.

Not all reviews are legitimate or even worth the bytes the consume. For examples, look at the Yelp page provided by the Arstechnica author. I've seen fashion reviews have more useful data. Two, I see no method for the removal of inaccurate reviews at that Yelp site, and I've yet to see any review site include such a function. I understand that there will always be areas of disagreement, but if a patient is noncompliant and a believer of alt-pseudoscience in place of medicine, and judges an evidence-based medical practitioner who recommends evidence based treatments on their alt-med basis, there is no distinction drawn between that and a legitimate review that compares such a professional against the established standard of care. And if such a judgement is an outright lie (i.e. "chemotherapy never works!"), how does that get removed? Can anyone tell me what the procedure is for undoing deliberate disinformation posted as a review? That leads into my last point: The notion of reviews unshackled by association with the professional being reviewed is a valuable one worth defending. The notion that an any-and-all, free-form, use-any-criteria-you-want forum being adequate information is not. It is openly damaging. Yet no distinction is being made between the chaff and the wheat. I'm all for freedom of what's posted online. But if the rant is against measures a medical professional will take against unfair, inaccurate reviews, that rant had better procede with the acknowledgment that freedom also includes responsibility. And using a free-form, superficially judgemental site like Yelp as an example is headed in the opposite direction from responsible.

So my point is: Don't think I'm arguing against review sites. I'm arguing against the notion that they're intrinsically worth defending. They're not, not without the concurrent responsibilities of accuracy and context. Leave those out, and they're only worth defending in a First Amendment fashion (i.e. against government censorship). Not in an anti-consent form one.; 5/25/11, 4:08 PM
Tibore said...: Whoops. Did a couple of my continuation comments get eaten? Or are they merely being held as supposed spam?

Man, Google Blogger just irritates me sometimes. There wasn't a single link in any of my posts, and all 3 were all on-topic. Yet, two disappear. Blech... I'm just hoping that they're in abeyance for approval.; 5/25/11, 4:11 PM
Sprezzatura said...: Bruce,

I certainly agree that docs screw up their diagnoses.

This is why we need more data, not less. W/o the comparative data you can't look for outliers, which can help identify fraud and piss poor or overpriced medical care.

Sometimes docs make errors. Other times the screw-ups are intentional doc fraud, including situations where that fraud is fairly easy to hide when each circumstance is only observed by itself, e.g. your stitches/tumor hypos. But, looking at the big picture with all of the data makes it possible to see anomalies.

It's big business for hospitals to hire folks to review all doc coding so that everything is correct, this ensures that the hospital isn't billing fraud. Beyond ensuring accuracy, these programs tend to result in a huge net increase of dough for the hospitals because docs w/o oversight miss a lot of possible billable revenue. Getting the data right is often a money maker for hospital admin.

Regarding the complexity of sorting and usefully evaluating data: so what? When thing are hard it doesn't mean they shouldn't/can't be done. I don't think it'll take Wall Street style payouts to convince some quant-type folks to give it a try. After all, there are plenty of smart folks. Some of those who don't end up at Goldman et. al. are still very capable folks.; 5/25/11, 4:52 PM