Physician Online Reviews

My friend and practice advisor showed me two very negative anonymous reviews of my practice this week. Both were posted within a one-month winter period and were written about family members. They were not written by patients.

My staff and I tried diligently to identify the stated situations as they did not resonate with any of us.  Unfortunately, we were unsuccessful.  That frustrates each of us.

Combined, these reviews were aggressive and unflattering.  They mentioned my age, ego and seemingly lack of compassion.  I’d be lying if I said I wasn’t bothered by them.  I truly wish I could talk to those anonymous authors to learn their point of view and find out why they are so angry. I’d sincerely apologize to them if I did anything to cross a line.

At the end of the day, I like to look myself in the mirror and know that I have done the best I can for each of my patients. I am very passionate about my profession, care immensely about the well-being of each patient and believe in evidence-based medicine – not fads and or snake oil. I also hold true to my practice’s slogan – Access, Advocacy, Compassion and Prevention.

I spend a great deal of time in face to face meetings with my patients. I return all phone calls, call regarding all test and lab results and; usually I am aware when a patient is unhappy or dissatisfied.  If I am not aware, my office supervisor or staff know it and bring it to my attention so I can discuss the reason and clear the air or rectify the problem.

If quoting the medical literature to patients to explain a point of view, plus relying on years of experience, is being full of myself; I guess I am guilty.  If I do not respect the wishes of the family when the patient is fully competent to make decisions and is still the legal health care decision maker, than I am guilty as well.

When a patient chooses to leave my practice, I make it a point to send them an individual hand -written note.  I apologize for not meeting their needs and expectations and ask them to please let me know their grievances for the sake of improving the care and service and not repeating actions which a patient found to be negative. I ask “why” they left and if I did something that I should not have done, or did not do something that I should have done. After writing these notes, I have my office staff review them to make sure the tone and content are caring, inquisitive and appropriate.  Unfortunately, no one ever responds.

My friend, the practice advisor, felt it was important to identify these situations and try to further identify the author of each review.  He recommended, and I wholeheartedly agreed, it would be important to have a conversation with each of them to gain a better understanding of the situation, apologize and make any appropriate practice changes.

Since my staff and I are not able to put the pieces of these puzzles together, I am at a loss for identifying the authors.  Furthermore, these online sites do not typically allow a physician to confirm the author was, in fact, a patient and then respond to their review.

That’s a problem since 80% of patients who are seeking a new physician search online.  My advisor has shared with me countless examples of negative physician reviews where there was nothing to indicate the author had ever even been a patient of the practice.

A few years ago I experienced that myself on Angie’s List.  Fortunately, I was able to track down and contact the author and they admitted they and their spouse had never been my patients.  It was an error on their part which reflected poorly on me.  It took time and effort but we were eventually able to have the review removed.  That rarely happens.

If you are a patient who feels you have a gripe with your doctor, I urge you to call that physician or write that doctor and express your concerns and give them a chance to respond. Do that even if you wish to move on. It’s the only way a practice and doctor can improve.  We really do care.

And, if you are seeking a new physician, do not take online reviews at face value.  Gather as much information about the physician as possible and ask if you can have a short meeting with the doctor before making your choice.  That’s something that’s something I make available at my practice for anyone interested in concierge medicine.

I Work For T-Shirts

Every April my colleague and friend Joe Forstot calls to ask if I will do volunteer physicals for Boca Hoops and I always say “yes”.   Dr Forstot is a rheumatologist by trade, but to me he has been a senior resident and teacher when I was an intern, a mentor and now, the preceptor and teacher for my niece, a second year medical student. Most of all he is my good friend.   I am always intrigued by physicians who find a way to help others outside their normal professional role.  Dr Forstot is one of those individuals.

Twenty four years ago, his younger son, a wonderful basketball player and fan was cut from the school basketball roster on the final day of tryouts.  There were no alternatives. Boca Raton, Florida was a sleepy college town with one indoor basketball court inside the city’s oldest elementary school. The local universities and colleges still did not have an indoor facility and there were certainly few, if any, youth leagues.  Out of necessity, Dr Forstot and his friend Mike Doyle, a Broward County public school teacher, started Boca Hoops.

Everything about Boca Hoops was done correctly for all of the right reasons. Teams were formed by random selection after open tryouts were used to rank the childrens’ abilities. Teams were constructed for parity purposes.  Every child had to play the same amount of time in a rotation system for the first thirty minutes of a 32 minute running time game. Since there were not enough girls to start a girl’s league immediately, most teams were co-ed.  Sportsmanship, having fun and learning the game were the goals of the program.

To finance the costs, the organizers sought sponsors for teams and advertising banners. They came up with the idea of requiring a pre-participation physical exam and charging a fee for it. The fee from the physicals went to offset league expenses. Community physicians were asked to volunteer their time and perform the benchmarking physicals on participants.  In the first few years I was a sponsor of a team, a coach of a team and a volunteer physician.

The physicals were fairly basic discussing vaccinations and immunizations, age appropriate growth landmarks and some screening for cardiovascular diseases and congenital orthopedic problems. Inflation over the last 23 years has driven the cost of the physical from the original $5 to this year’s cost of $25.

From a physician’s viewpoint, we have moved from an elementary school cafeteria where we sat in little chairs and worked at little desks, to a high school teacher’s lounge where the chairs are kinder and gentler to our aching backs. The patients are still young and enthusiastic. The parents are still warm and appreciative. It’s a great opportunity to meet the young parents and children of the community and learn about what is going on in their schools and lives.

The league has grown over the last 23 years. It now encompasses almost a thousand players with separate boys and girls leagues.  There is a travelling competitive program for boys and girls plus three modestly priced summer instructional day camps. They play at indoor facilities at the local public and private schools as well as universities and city parks.  The shining jewel of the program is probably the High Five Division created for special needs children to learn the game and have a chance to play and have fun.

I have continued to sponsor a team each year since my children moved on to college and adult life. Many of the coaches in the pictures on the plaques I receive of my team either played for me as children or on opposing teams. Their children are now old enough to play in Boca Hoops.

I am running out of room on my office walls to hang all the team photos from my many years of sponsorship. The true prize of participation however is my Boca Hoops “Doc” T- shirt presented annually to each physician who volunteers. Over the years, the shirts have evolved from a plain blue t-shirt to a collared golf type shirt with a unique logo for Boca Hoops. The name “Doc” is printed on the front pocket.

I work for T shirts.

Physicians’ Seven Year Gap

This past weekend, while jogging through my community, I had the pleasure of bumping into a former colleague and his brother who were out for their daily five mile walk. Dr. G. had attended a local medical school, finished near the top of his class, and had gone on to do his internship and residency at the premier private hospital in Miami Beach, Florida. After completing his residency in internal medicine, and achieving Board Certification, he moved to Palm Beach County, Florida to practice.

He became the medical director of almost every skilled nursing home in the area.  No one wanted the job. The patients were elderly and in the last years of their life.

The bureaucratic rules meant he received hundreds of phone calls from the nursing staff at all hours of the day, every day. If a patient had indigestion and needed over the counter medication, they were required to page him. If a patient scraped themselves and needed a band aid and peroxide they were required to call him, all day and all night. The calls were so frequent most physicians would not cover his practice so that he could get a day off or take a few days vacation.  I met him for the first time while we were waiting to meet the Board of Directors of the local hospital on our first day of becoming staff members of the only hospital in the area at that time.

Over the years, my associate and I would take pity on the poor dedicated soul and agree to cover his practice so that he could take a break. It took at least two physicians to cover the practice and, frankly, by the second day the phone calls for minor ailments drove me crazy.

He practiced for 25 years then, due to some inherited money and good investments and savings, retired seven years ago. My only contact with him these days is meeting him and his brother on their walk. The conversation is always directed by him to the state of the practice of medicine. “How can you earn a living these days with all the cutbacks and regulations“, he would ask.  He would also inquire about health care reform and the sale of physician practices to the hospital and the health of colleagues he had practiced with.

On today’s walk he talked about a blog (website) he had discovered on line where physicians and patients discussed health care issues. He had read several articles about non physicians complaining about doctors earning money and charging a fee for the products and services they provide.  “What makes people think that doctors don’t have to earn a living to pay their bills as well as the next guy?”

Today’s walk was additionally special because it was the weekend of the NFL Divisional Playoff games. Dr. G. was a devout football fan. He bled Orange and Aqua for the Dolphins and Orange and Green for his Miami Hurricanes. As we walked he said,” I entered medical school in 1972 and completed my residency in 1979. It’s like there is this gap of seven years when I saw nothing and did nothing but study and learn medicine. I don’t remember who played in the Super Bowls let alone who won it. I don’t know who won the World Series.  I couldn’t tell you which movies won the Best Picture of the Year Award at the Oscars or who won the Tony for Best Musicals on Broadway?”

As we walked I thought about it too. Then I realized, that seven year period of time seemed as if someone had put a hold on my life as well. During that period, my friends from high school and college went on with their lives. They started businesses and other jobs. They married and started families. They travelled. They socialized.

I devoted seven years of my life to become the best doctor I could be. I studied and slept in-between 36 hour shifts on call with only seven or eight hours off at a time.  I had always considered my seven year gap a personal aberration but here was a colleague who experienced the same thing. I wondered about those physicians who had a ten or fifteen year post graduate experience before they got out in the world and re-joined the living. How did they survive?

Then Dr. G. said to me, “Imagine giving up seven or more years to learn and perfect your profession, helping others, and here we are in 2011 with patients complaining if you charge them a $25 co-pay or make a $2 profit by selling them a generic antibiotic they needed anyway”.

He has a valid point.  Our society doesn’t think twice about paying other professionals (I.e., attorneys, accountants, plumbers, electricians, etc.) a wage commensurate with their experience and expertise.  So, why then does our society, in general, have a negative perception of doctors earning a reasonable living commensurate with their education, experience and expertise?