Posted by: Dr. Thunder
So, I'm back from my outback junket.
I'm back practising medicine in a hospital that has actual equipment and specialist staff. It's nice not having to say to any more patients "You need to see a neurologist. There's one visiting from the city in 6 months time. I'll see if there's s space on his list, if there isn't, of you can't make that appointment, he'll be back about 8 months after that", or "Yes, your child needs to se an Ear, nose and throat specialist. There isn't one here. And none visit either. I'll just have to refer you to a general surgeon. He'll probably know something about tonsils".
As I've had no real regular internet access for the last few months, I've been catching up on the world of medical blogging this week. There seems to be one recurring theme coming from the UK. That is http://www.iwantgreatcare.org/. This has managed to annoy the medical fraternity in Great Britain like nothing since the government told them they would be making thousands of junior doctors unemployed "But patient care won't suffer".
So, I had to investigate further. Iwantgreatcare is the brainchild of Dr. Neil Bacon. He's a doctor who set up the excellent website http://www.doctors.net.uk/
Spurred on by the success of that particular endeavour he has now embarked on this new project, which aims to let patients judge their doctors online. So, you go to http://www.iwantgreatcare.org/, find your doctor's name, and give your opinion of him/her. Simple and quick to do, and increasing transparency and accountability. This is what Neil Bacon says anyhow. Obviously, the patient isn't identified. there is no way to verify if they are a patient and there is no right to reply for the doctor.
I have grave concerns about this. It sounds condescending and paternalistic, but patients aren't always the best judge of a doctor's performance. This week a particularly aggressive mum demanded I give her toddler antibiotics for a snotty nose. I refused. I tried to reason with her, but she went home in a huff. I believe I did the right thing. If Iwantgreatcare had a section dedicated to "Irish doctors in Australia", she would no doubt have told the world that I was a crappy doctor who doesn't even know how to treat a runny nose.
Similarly, the lady who went potty at me in the emergency department 3 weeks ago would likely be another customer of Dr Bacon's. Her child had a mild viral rash. The emergency department doctor tried to send her home with reassurance, but she wouldn't go anywhere without seeing a paediatrician. I was called about this very well child while I was stabilising a newborn that I had just resuscitated in the neonatal unit. I said I was going to be a while. I was. It took me about 2 hours before I got to see this rash. The child's mum went crazy. She said she was going to write a letter to the hospital. She may have done, I don't know. I told her that, as the only paediatrician in the hospital, I had to prioritise. A very sick newborn takes priority over a well toddler in the play area with a rash. Two hours was the best I could do. It wasn't good enough, apparently.
She would love Iwantgreatcare. So would many of my patients' parents.
I have an excellent rapport with most of the familes I interact with in work. I don't imagine, though, that they'd go home and look up a website to tell the world that I'm amazing. But those who have a gripe will. Just like the patient on that same website who says his doctor "put his wanger in my ear"!!! Or the doctor who was described as being "like David Brent".
But it's only a hair brained scheme, and it will likely die out soon as no-one in their right mind will regard something like this as being the way forward in assessing doctors. Surely anyone with half a brain will realise that allowing anonymous comments by anyone on the web about any random doctor, without any verification process whatsoever, is not sensible?
Apparently, senior members so the General Medical Council (The body that regulates medical standards in the UK) and the government support this idea, and are giving this website their backing.
I despair, I really do. We can give patients what they want, or we can use our judgment. I know what i'd rather my doctor did.
May I remind any doctors in the UK who despair at being reapeatedly humped from all sides by a crappy union, an ineffective regulatory body and a shamefully spin-driven government, that it's 27 degrees here, and it's mid winter :D
I look forward to seeing more of you guys out here soon. I'd also be very interested in comments about how we should regulate doctors' standards in a sensible way. Maybe you think http://www.iwantgreatcare.org/ IS the sensible way.
Share your thoughts below.
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