Cross Talk on how we can all be armchair critics now
Websites that let patients rate their hospitals and even their doctors have started to spring up. Mike Cross wonders if this is a good thing.
So suddenly we're all critics. This year's healthcare informatics craze is using the web to promulgate our opinions as patients of the service we get from institutions and clinicians.
Websites such as Patient Opinion and Iwantgreatcare, not to mention the Department of Health's own web portal, NHS Choices, are beginning to amass a sizeable and searchable archive of patients' feedback on the NHS.
It's surely only a matter of time before we reach a tipping point where it becomes the norm for patients - or at least a literate subset of patients - to publish critiques on the web.
“Lots of people are getting very excited about this development. In some camps this excitement is manifesting itself as outright hostility.”
Reasons to be cheerful
Lots of people are getting very excited about this development. In some camps this excitement is manifesting itself as outright hostility.
Professional bodies are up in arms and a group of doctors has already got one of London’s top law firms keeping a sharp eye out for libels and other infringements of their rights.
So I’d better say right away that I'm an enthusiast. Information is nearly always a good thing, and the web offers a platform to voices that were previously unheeded, such as the voices of users of mental health services.
However, before we base too many personal decisions - let alone administrative and policy decisions - on the e-empowered voice of the consumer, we should consider a few challenges.
One is the sheer methodological difficulty of collecting and interpreting information from real live NHS users. Whole swathes of social science are devoted to finding robust ways of converting people's fears and desires into numerical data, and heaven knows they're controversial enough. Where do unstructured comments from a self-selecting group of patients fit in to the mix?
Tremble before the majesty of the law
Consider, too, the bias thrown into the system by the UK's legal regimes. Doctors can rest easy that they are unlikely to face a barrage of unwarranted personal criticism: it is actually dangerous to publish bad reviews on the web.
The whole weight of libel law is on the side of the individual defamed: the person making the allegation has to prove that what they said was true, or was fair comment based on truth. And as the law stands, an internet service provider can be held liable for damages if it doesn’t immediately take down material that is the source of any complaint.
Of course, a great deal of anonymous and defamatory tittle-tattle does appear on the web. But mostly it appears on blogs with tiny readerships, written by people who are not worth suing, perhaps because they have no money or they are outside the jurisdiction of UK courts.
A high-profile UK site publishing patients' reviews would have no such hole to hide in - the moment it published anything damaging, it would be a sitting duck for legal retaliation. The result will be a bias towards positive reviews – one good reason for taking information drawn from patient-comment sites with a pinch of salt.
“Should we apply the same standards of customer satisfaction to healthcare as we would to other consumer products?”
Citizens vs consumers
There's another reason; perhaps a more important one. Should we apply the same standards of customer satisfaction to healthcare as we would to other consumer products?
Even in the age of empowered patients, it is not necessarily a doctor's job to give them exactly what they want. The obvious example is prescribing antibiotics for common colds - patients will post glowing reviews, noting that they felt better the next day, but public health and the public purse will still suffer.
(This debate goes well beyond healthcare, of course. In his book Republic.com 2.0, Cass Sunstein of the University of Chicago makes a good argument for treating the decisions people make as citizens differently from those they make as consumers.)
As ever with healthcare informatics, this is a complex mix. My feeling is that the new flows of information generated from patient-review websites will prove valuable to healthcare, but not as valuable as some seem to predict.
Most of the value will emerge only after rigorous interpretation, and validation against other streams of data made available by the belated computerisation of medicine. We can enjoy reading comments like "the nurses were wonderful" - especially if they are “our” nurses - but we shouldn't necessarily give too much weight to them.
About the author: Michael Cross is a freelance journalist specialising in healthcare informatics and e-government. He is a member of the British Computer Society.