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Angie's List, as it once was, hasn't existed for years. It's now basically just an advertising service for contractors.
Yeah, it's called Angi. I've used it twice and both times got services at a reasonable price. If I had bad service, I could have rated the contractor which would have made it less likely for them to get future work. And it also saved me from having to call 50 places for my $200 job that no one would have wanted.
I know this is an internet forum and it's cool to be jaded. But, I don't know, this corporation provided value to me 🤷. I wish there was an Angi for health services.
Their is. Sort of - and they fucking suck.
The industry has essentially landed on patient reviews as the mechanism to do this and you can find all kinds of websites that track this, and certain forms of reimbursement may be partially contingent on patient satisfaction metrics.
The first layer of problems is the usual review issue - most people don't bother to leave a review if they had average care, a small fraction of people who receive great care leave a review, and a lot of people who are mad leave angry reviews, this creates a lack of realistic balance in the reported experience.
The other piece is that what makes for good care isn't usually legible to patients. NPs like to brag about studies where they have higher levels of patient satisfaction and it's often tied to not appropriately saying no to patients or things like unnecessary testing and treatment. People don't like being told "no" or "I don't know" doctors are better at doing that but it pretty uniformly pisses people off. The classic example is telling a patient no when they ask for antibiotics for a viral infection. This is good healthcare but obviously decreases patient satisfaction, and that's not bringing up things like angry patients seeking drugs of abuse and review bombing, or psychiatric patients who are angry because they have poor insight and received good care.
Outside of outpatient clinic medicine things get even trickier. The best hospitalist in the hospital is spending his time not in the room with you running down to pathology and radiology, calling insurance companies or social workers for dispo, teaching students, etc. The worst is sitting in his office playing Sudoko. Both only spend five minutes with you a day, you'll have no way to tell if they are good or not unless you have an avoided near miss or something like that.
I was hospitalized a little while back at my own hospital and was the victim of a pretty severe and unacceptable/easily avoidable medical error. I don't think a non-doctor would have even noticed.
Some other examples - anesthesia.....you'll wake up either way, the horribly wrong outcomes aren't generally the doctor's fault. With good gas you'll have an easier emergence, or if you know exactly what to look for on your anesthesia record you could see you were getting good care. How many people get enough surgeries or have the training to read those tea leaves?
For surgery... a lot of aspects of outcomes are patient and not surgeon dependent (like overall health status, engagement with PT), you don't know if your insides are an avoidable mess afterwards or not. The good surgeon might make your next surgery much much easier but you are unlikely to ever know. Patients will also often jump at the chance to get surgery not realizing when NO surgery is the better outcome. You might be a better doctor for saying no...and get worse reviews.
Exceedingly hard to manage this.
There have been attempts to look at more formal outcomes and this rapidly runs into pretty severe juking stats and perverse incentives.
A classic example is transplant surgeons forcibly keeping patients "alive" to get them to die outside of various thresholds (since that gets reported).
Surgeons will sometimes refuse to operate on risky cases because of the morbidity and mortality outcomes. Some of the best surgeons have the worst outcomes because they'll swing on cases that others won't. Some of the worst surgeons too - they'll swing on cases that they shouldn't.
It's a mess.
I do get asked "how do I find a good doctor then." I don't have good advice for this. In my specialty and my area? I already know who is shit and who isn't and hoard that knowledge like gold. Some related specialties? My specialty further away than I don't know them personally? Sometimes I can guess, but mostly I just have to know someone in that specialty in that region who has the wisdom to be able to determine which of their colleagues are ass.
That is not generalizable.
I agree, patient reviews are clearly a bad indicator. The ideal would be some kind of anonymous ranking of doctors by other doctors, but it’s hard to imagine a feasible system for it.
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Would you mind saying more about the error in question? If not, I totally understand but you've nevertheless piqued my curiosity.
I've bitched about this enough IRL that I will refrain due to opsec.
A good example is NPO status though. Your surgeon says don't eat or drink anything. You are thirsty and hungry. Your nurse has mercy. Surgeons are very conservative with NPO, nurses want to be nice. Patients aren't going to know when "psst have some ice chips" is a good idea and when it isn't.
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