Five reasons why rating your doctor is wrong

Five reasons why rating your doctor is wrong

Feedback in whatever form is key to learn. However, rating systems are not designed to provide feedback to healthcare providers. Instead, they are just a form of advertising. And while rating systems may seem to be objective and reliable, they most certainly are not.

The big problem is that ratings nudge patients into potentially the wrong directions based on ill-founded and flawed data. Governments, general medical councils and any other regulatory body should nip emerging rating systems in the bud.

And here’s why.

1. Rating data are not reliable

In order to assess the reliability of data, you should be able to interpret the quantitative results based on qualitative insights. You’d have to know who rated the doctor and what exactly justifies that rating. Someone could hold a grudge to the doctor being rated, another one may see competitive advantage in giving a bad rating to the doctor, etc.

You simply cannot assess the quality of the data gathered through rating systems. And as such, one can hardly conclude that rating systems data would be reliable, objective and/or verifiable. Hence, one cannot make any statement about the amount of truth a rating holds. Numbers never tell the full story.[1]

2. Rating data are one-dimensional

First of all, whether you would give a high or low rating to a doctor could be the result of a multitude of dimensions, not just one as ratings may suggest.

One patient may give a good rating to a doctor because of the doctor makes the patient feel very comfortable. Another patient may not care about the empathic skills of a doctor, as long as he demonstrated great competence. And another patient encountered a doctor who refused to just prescribe what the patient wanted for which he gave the physician a poor rating. And so on.

Second, people who see the rating data should be able to assess from what dimension they should look at the data. If you don’t care about an empathic doctor, but just want to see results, it doesn’t help you at all to find positive ratings for doctors, who get positive ratings because of their empathy but who may not be the most competent.

3. Ratings may turn into an objective

According to Goodhart’s law, “any observed statistical regularity will tend to collapse once pressure is placed upon it for control purposes.” Or put in other words by Marilyn Strathern: “whenever a measure becomes a target, it ceases to be a good measure.”

To prevent a measure from becoming a target, it is key to not attach any consequence, good or bad, to the measure. As soon as you would attach consequences, the measure will most probably become a target.

And should rating data turn into an objective, this may lead to very adverse effects. Healthcare providers who are rated on how they perform, may be indulged to only take the cases with a high success rate in terms of patient satisfaction, curing the patient, etc. And this may even occur unintentionally. Successful healthcare providers will take the successful cases, and in turn the successful cases will come to the successful healthcare providers, and vice versa. This will create a virtuous cycle for the healthcare providers who are perceived successful, and a vicious cycle for the unsuccessful healthcare providers.

4. Rating systems may reduce intrinsic motivation

In general, there are three kinds of motivation, three reasons why people do what they do. The first is biological: we eat, drink, have sex because we are biologically driven to it. The second is extrinsic: we do something because we are rewarded or punished for doing it. The third is intrinsic: we take pleasure solely from performing the task itself or we are driven by inner beliefs or perceptions.

Rating systems are a clear trigger of extrinsic motivation. Over the last couple of decades research has shown that extrinsic motivators may lead to adverse effects, and more importantly it may harm our intrinsic motivation.

I for one would really want that healthcare providers are more occupied by the health and lives of their patients, instead of how many likes they get, how well they are rated, how much status they have acquired, etc.

5. Rating systems may lead to a rat race

Only healthcare providers that have a good rating will be sought by patients. Healthcare providers who have a bad rating obviously won’t be sought by patients. But also healthcare providers without a rating will not be favourable, let alone healthcare providers who are not present on those platforms.

The same happened to companies by the way. Would you trust a company who does not have a website? I’m guessing you won’t. Healthcare providers nowadays also have to be present online.

This danger may be remote, but should be regarded as an actual threat. Of course, the more fierce the competition between healthcare providers, the higher the threat this may lead to a rat race which will be very difficult to undo.


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