0/10, do not recommend
What does it mean when *I'm* the thing getting reviewed?
I was Googling myself on a beautiful morning last summer, as one does, sifting through the listings for reassurance that I was relevant in a cold and existential universe. And there, amongst the familiar search hits – my primary care physician bio page, my writing – I found a very angry review.
One star, the reviewer gave me. “Rude, ignorant, and uneducated – do NOT recommend,” they wrote. It was one of the first hits that came up when searching my name online, associated with a Google business listing for my primary care practice. (For the record, my employer set up the business listing, not me, but it has my photo on it and is titled “Mara Gordon, MD.”)
Receiving criticism is part of my job, but this one particularly stung. It was clear it was from someone who felt wronged by me. But there was also something striking about the way it was phrased. It didn’t feel like a review of my practice or the hospital I work for.
It felt like a review of my existence.
I scanned other reviews written by the author, Caribbean vacations and Mexican restaurants, and then, quite easily, I found her full name. It took me a minute to recognize it.
It wasn’t one of my patients. It was written by another doctor.
I immediately realized what had happened. A few weeks before, I had seen a new patient who came to me after being prescribed chronic opioids after a major injury. The patient had, many years ago, had an addiction to heroin, which made her prescription for opioids particularly high risk. But I didn’t want to abruptly cut her off, since that carries its own risks, so I asked her to see a doctor who specializes in pain management. I hoped we could find a long-term solution that didn’t involve opioids.
The patient tried to go see the pain doctor, but she hadn’t adhered to the rules of the practice, forgetting to bring valid identification. So the pain doctor sent her back to me. “Your primary care doctor can just prescribe your opioids,” the patient said the specialist told her.
I had been, as we say in medicine, thrown under the bus. And I was mad about it.
I called the other doctor to talk about it, but was put on hold and then transferred to voice mail. “This made me feel really disrespected,” I said into the void of her answering service.
It was, by far, not my finest moment. Primary care doctors can be prickly about being seen as a catch-all solution for all of the challenges too unsavory or frustrating for our specialist colleagues, and I had lost my temper. I should have waited to have a live conversation with the doctor, cooled off and taken time to think about why she might have sent the patient back to me.
But did I deserve to have this moment follow me on the Internet, forever, in the form of that awful review?
An everlasting digital footprint is not a new concept, and many smart people are justly concerned about it. What struck me about this snafu was that I hadn’t consented to have a Google business page put up in my name.
Where does Dr. Gordon. the business, start – and Dr. Gordon, the human whose feelings were hurt, end?
Most doctors I know are not thrilled about how easily and frequently we are reviewed. Our patients are sent surveys after every appointment, rating us on everything from how friendly the front desk staff are to whether or not the doctor took their concerns seriously. (I looked up Press Ganey, the company that administers the most common doctor surveys, and was disturbed by this dystopian description of their work: Press Ganey improves the overall Human Experience. Phew… That’s a tall order, guys!)
These surveys are not methodologically sound nor do we receive enough responses for the results to be statistically significant. There are all sorts of possible sources of bias. I don’t order the full-body MRI my patient thinks she needs? “Dr. Gordon didn’t take my problems seriously.” I don’t prescribe opioids or antibiotics? “Dr. Gordon didn’t treat me appropriately.”
Yet there are real consequences to negative Press Ganey survey results – one of the most compassionate and brilliant doctors I know was sent to “be nice to patients bootcamp” because she had received negative reviews for running late. For a field that prides itself on rigor and the scientific method, it’s surprising to me we still give so much weight to an assessment methodology that wouldn’t get published in any medical journal.
The stakes get even higher when it’s publicly searchable, like on a Google business listing. One frustrated reviewer, and it’s online forever, haunting us.
Now, of course you’re thinking: Mara, there’s such a power imbalance between doctor and patient. Who am I to complain about my patients complaining?
There are so many real examples of doctors who don’t listen, doctors who dismiss their patients’ concerns, doctors who are racist and sexist and transphobic and judgmental…. Aren’t these reviews one small way patients can get some power back?
Maybe. But to me, it’s one of many examples of the increasing corporatization of health care. Physicians are businesses, with business listings on Google. Patients are customers. It’s all so transactional.
The constant reviews make me feel like my patients are customers to win over with whatever makes them happy in the short term, not humans to support in a long-term partnership in pursuit of wellness.
After I figured out who was responsible for that scathing Google review, I did what any responsible, professional adult would do: I wrote a nasty review of her.
JUST KIDDING. Seriously, I didn’t. I put on my big girl pants, and called her. I apologized for my frustrated message. I told her I saw the review, that it upset me, and I asked her if she would take it down. And she did. We moved on.
There’s a lesson here, one I often think about in the context of my patients reviewing me, too. Now, when I meet new patients, I tell them I want their feedback. I tell them I want to know what I can do better.
Certainly, I can’t fix everything about their experience in health care. Some people still won’t feel comfortable telling me what they really think, or will worry it will compromise their quality of care. Some will just be so annoyed I’m running late that they will have to take it out in survey form. (I’m sorry guys – you know the appointments are only 15 minutes long, right?!)
But by inviting them to communicate with me human-to-human, I hope I might just make the whole thing a little less dehumanizing.
Have you ever felt compelled to review your doctor? Doctors, what’s the craziest review you’ve ever received?
Isn't it a bit inappropriate for a fellow physician to be reviewing you? She's not your patient. Am I missing something?