My nephew fractured a small body part last week. When he called, he told me that no orthopedic surgeon was available in his locality. When I asked how he knew, he said he had searched for orthopedic surgeons in his locality on Google and called the numbers listed and each one of the doctors had left for the day on that Saturday at 8 PM. I finally called an orthopedic surgeon friend who saw the X-ray on WhatsApp, reassured me that it wasn’t a major issue, advised a tape and a sling and agreed to see him the next day on Sunday in the morning.
I do not understand this concept of searching for doctors on Google. How do you really know how good or not the doctor is? From the person’s mugshot or photograph? From reviews? A typical Google review will say something like “The doctor was so nice. She took great care of me and was smiling and we didn’t have to wait…”. A bad review will read, “Despite an appointment time of 3 PM, we had to wait till 4.30 PM and no one paid attention to us”, or “The receptionist was not smiling”, or “The doctor was not willing to give a discount and is overpriced”, etc.
These reviews do not address the fundamental issue of how good or not the doctor is. Social niceties are not a barometer of the doctor’s expertise and experience. Doctors are not salons where you can see the result of your haircut and makeover and instantly give a review of how good or bad the end-result is, nor is a doctor or hospital a restaurant, where the quality and presentation of the food are issues you can immediately comment upon. Unfortunately, if a doctor uses Google to list their business, to make it easy for a patient to find the address and get to them, there is no way the doctor or hospital can opt out from being reviewed by people.
A few years ago, I asked an audience of non-medical people a question. If you had to decide between a great surgeon with amazing results, but who was rude with poor bedside manners, versus a surgeon with average results, but with terrific bedside manners, who would you choose? 90% of the audience chose the first, I assume because the surgery and the results are more important than how good the surgeon’s bedside manner is. While empathy is important in patient care, it is not necessarily the most important part of the treatment and management.
Online aggregator platforms, many of which heavily advertised on television and in print last year, spending their PE or VC money like water, which now just seems to have just evaporated, are equally pointless and useless. Their premise is/was that they can make it easy for patients and people who have medical problems to connect with doctors across the country to get answers to their questions at a reasonable price.
A typical search for “nephrologist” for example, a few months ago, on one of these platforms showed up a list of 700 plus nephrologists with varying years of experience from 8 to 34 years and consultation fees that ranged from Rs. 299 to more than Rs. 1500, with no correlation between the years in practice and the fees charged.
How do you choose an online doctor? What parameters do you use? Price? How do you know whether the doctor charging Rs. 1500 is better than the one charging Rs. 299? Years of experience? Some experience does matter…so a doctor with 10 years of experience is likely to understand your problems better than one with just 2 years under the belt. But beyond 10 years, someone with 20 or 30 or 40 years of experience is not necessarily better. Expertise and experience are not the same and the two do not always go hand in hand. So then, do you use ratings? Ratings, even on these aggregator sites, just like Google reviews are based on non-medical factors such as politeness and adherence to time and perhaps whether the doctor gave you the diagnosis and treatment you wanted. So how do these ratings, good or bad, help you decide how good or not the doctor is?
You can’t choose doctors like you order food on Swiggy or Zomato or the way you buy books or other items on Amazon, because you have no way of knowing how good or not the doctor truly is. And there is no return policy available.
Some doctors are very active on Twitter, Instagram and Facebook. How do you choose a good doctor based on their social media presence? Number of followers? Interesting posts and the number of likes per post? The number of forwards? How do any of these reflect on that doctor’s capabilities and more importantly the eventual results and outcomes?
So, how do you rate results and outcomes, which is perhaps the most important parameter when choosing a doctor? How do you as a non-doctor know how good a diagnostic centre is, or how skilled a specific surgeon is, or how better that particular physician’s results are as compared to the others? How do Google reviews that are mainly about waiting times and smiling faces or online platforms that focus on pricing and discounts or the number of followers on a social media platform, help anyone determine how good that centre or physician or surgeon is when it comes to results?
Many hospitals in the West, publicize their results. In some countries, these are available on national databases. These allow us to compare the success rates of single procedures like a coronary bypass surgery, or cholecystectomy (gall bladder removal) or hernia surgery based on the number of people who recover without complications and other similar parameters. These tabulations however can also be flawed, because a hospital that accepts the sickest of sick patients may have outcomes that are worse than those that accept only healthier patients, even though the doctors at the first hospital may be more skilled and have better overall outcomes, if the same sets of patients were properly compared. Even the “Top Doctors” lists published by newspapers and magazines, are based on reputation, rather than outcomes. More importantly, it does not mean that those who don’t make the lists are not good.
So how do you know? The other day, a friend of a friend came to see me and expressed pride over how thorough she was with her research before choosing a doctor. I asked her how she researched doctors. She proudly said, “Google reviews” and then went on to give me me “gyan” (knowledge) about how we should improve our reviews (it was I think a 3.5 aggregate at the time). I asked her why she had come to us despite our “not-so-great” reviews and she said, “because my friend highly recommended you”.
And that is how, though not a perfect method by any standards, it still works. Your best bet is still to depend on trusted family physicians, if you are lucky enough to have one, other trusted doctors, doctor friends, friends and family who can help or the brand of a hospital or diagnostic centre, assuming that the same treatment or quality of testing is available in every setup of that brand.
And then you have to place your trust in that doctor or hospital or both and cross your fingers and hope for the best, because there is never any guarantee that your disease and treatment will necessarily have the outcome desired…all you can hope is to improve the statistical probability of a good outcome by using recommendations and word of mouth rather than futile and useless Google search or reviews or non-transparent online aggregators or social media platforms that are mainly just popularity contests.
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