Grade Whore

Hi my name is Dr. Laura Katz and I have been a doctor for 24 years. I signed up to care for people 24 hours a day, 7 days a week, regardless of how much I get paid. I signed up for a lifelong commitment to the health of others, sometimes at the sacrifice of my own health and my family life. I signed up to compassionately listen, problem solve, give 110% and guide people every day into better futures for themselves and their infants. I did not sign up to be a grade whore!

OK. That was a strong word, but it is fitting nonetheless. So, what the heck am I talking about? No worries. I am about to explain. We now live in a society in which patients do not seem to be thought of as patients anymore. They are thought of as clients or consumers, which changes the whole flavor and mentality of the doctor patient relationship. ( I personally am kind of stuck on the patients as patients idea. However, I am behind the times to say the least.) I think that this kind of thinking is potentially very harmful. The kind of thinking involved that classifies patients as consumers or clients lets loose a whole wave of entitlement behavior on the part of the patient. The old adage ” The customer/client is always right” has really run amuck here. Patients now think that they should be able to go to their doctor’s office and demand what they want for their medical care or demand what pills they should have prescribed , just like they can demand what hair cut they want or what good they want at a restaurant. If they don’t get what they want, they have complete free reign to go on Google, Health grades, Vitals and attempt to destroy that doctor’s reputation with little to no recourse available on the part of the physician. Sure, we can go to Google and attempt to reply or prove why the stated comments are skewed or not factual, but the chances of that review coming down are slim to none in my experience. What’s worse, said patient who is posting the bad review does not have to really be accountable for it or even prove that they have ever actually been to that doctor’s office! What?! How is that ok? How did this review process get so out of hand? I am all for having input in your medical care and having patients advocate for themselves and insist on quality, but these rampant reviews when things do not go their way? No. I think that is wrong. Reviewing the wrong doctor? This could actually ruin someone’s career. I have had some reviews in the past that were awful and caused anguish and concern, only to find out after extensive research that that person had never actually seen me! I am sure that they are still out there somewhere and they still haunt me. I never want anyone to be hurt or wronged by me, but I cannot help rectify a problem with someone that I have never met. Still, these reviews are treated as gospel by those patients who carefully comb through online resources when selecting a doctor. They may not stop to question whether they could actually be true or not. They will just keep looking. I have to admit, as a patient, I look for reviews as well when selecting a physician, but if I can speak to someone directly who has seen the physician, that holds a lot more weight in my decision-making process. I am much more a fan of fact, not potential fiction.

We are all obsessed with reviews even at a hospital-wide level. We have things like HCAHPS and Press Ganey reviews that survey patients in a whole hospital environment. Hospitals then turn around and use these reviews to grade themselves and physicians and somehow use them as a judgement of worth. Now I will admit that these reviews at least require some documentation that a patient actually received care at that institution, but there are still too many factors not under the physician’s control that they are being lumped together and used to judge them. Patient’s will return a poorly rated survey if they didn’t like their hospital food or if they did not like their nurse for example. These are things that the doctor does not have any control over. There are some patients that you can bend over backwards and sideways for and they still will not be satisfied. Are you supposed to go against your medical judgement to do something that a patient wants in the hope of a better survey score? This is not supposed to be some sort of contest in which the 5 out of 5 score is the only objective. Did you know that places like John’s Hopkins have done studies regarding this kind of patient/consumer driven care and that outcomes tended to be worse when patients dictated their own care and doctors complied for fear of a bad review? Think about that.

This kind of culture sends us doctors scurrying and begging for positive reviews from our patients in the office as well on a daily basis because now we are worried what could be out there on all the public sites and how many of them could potentially apply to us. I have to admit, I have stopped looking at those reviews because they really mess with my head at times and actually get in the way of me providing quality care to my patients. I understand the concept of healthy feedback and its potential utilization in betterment of myself and my practice, but that does not seem to be the intent of the review process as we know it today. It feels like I am begging for a good grade or asking patient’s to sign some invisible report card when it really does not matter. I will give them 110% whether they leave me a review or not. Now having said that, we do conduct in-house reviews every day. Every single patient is given an option to review our practice and myself every single day. Every single patient decides whether or not they want their review to be shared. Now these reviews I look at carefully, each and every one. I take these to heart because I know that these are the patients that I am actively taking care of. We have been very lucky in that this review process has been very informative and that patients have been very thoughtful in their reviews. This has allowed our practice to take all appropriate action when necessary. I do believe in the review process, but it has to be done the right way to be constructive and true to it’s original intent.

I think that our culture of the patient as the consumer has also led to a huge breakdown in the respect that patient’s show to their physicians. No, I am not yearning for patriarchal 1950s medicine when gruff physicians dictated to their patients and patients followed without question. But, there is a part of me that thinks it is worse to have patients running amuck and dictating their own care. The customer/patient is not always right in these situations. Sometimes patients want things that are actually dangerous for them and would put both of us in danger. I actually have the medical degree and the training. Please let me use it and guide you. I like patients to be on their own team. I like to make decisions together. I like them to advocate for themselves, but not yell at me when I don’t do what they want even if it would be bad for them. I think we need to compromise somewhere in the middle. Have a fantastic day everyone!

Dr. Katz

What happened to my sweet girl?

I think it is safe to say that most every mom is asking this question when her daughter hits the teenage years. I find myself asking that like all the time. I can remember the sweet, fearless, loving, carefree, friendly to everyone child who lit up every room that she entered. She was pure sunshine, almost never cried and almost never stopped chattering away telling me about every moment of every day. She was brilliant and not afraid to show off. She was full of infinite talent and every day was a new adventure. I couldn’t wait to see what she would do next. I wanted her to stay little forever. I was sure that our bond would last forever! I felt so connected to her that sometimes I felt like I could actually read her mind. Ok I realize that this all sounds like a huge wad of rose-colored glasses baloney, but I definitely wore them with pride. Every mom does at one point or another.

Boy how times have changed! Guess what I am doing right now? My little ray of sunshine has me watching Annabelle Comes Home because she loves horror movies and sometimes they are the only thing that can brighten her ever dark or at least mysterious mood. ( I have to admit that I am not exactly under duress because I love them too) But seriously, we have gone from My Little Pony to Annabelle? Overnight? Just kidding. It is not really over night. I realize that if I don’t sit and watch it with her, the end result may be that she just disappears up into her room until it is time to go to bed and then I will be left all by myself. At least this is some kind of bond right? It’s not the tons of cuddles and snuggles that I might prefer, but it is something. Sometimes you take what you can get.

I can tell ya that the chatterbox I once knew has also gone the way of the dodo. Most days there are sullen stares and monosyllabic utterings at best, complete with a complimentary sullen look or two. It’s not that she it outright mean or unkind, just enigmatic and reluctant to communicate without pulling so many teeth that you are afraid you will run out…lol Every now and then she throws me a bone and we have an extended conversation and I get a glimpse into her beautiful head and what she is thinking, but these moments are too few and far between for me. I soak them up like a sponge while trying not to seem too eager.

The fearlessness has disappeared, which makes me sad. I miss the little girl that could just charge up to anyone and make friends within minutes. Now she hesitates, overthinks, and sometimes misses out on some really great opportunities and friendships. I don’t completely understand why. She labels herself as having social anxiety as an explanation. She worries about looking like she is trying to suck up to people and that somehow she will get interpreted as being disingenuous in some way. She seems to need a lot of convincing that people will think she is worth knowing in some situations. I find myself wondering how this happened? I realize that it is part of the normal course of growing up to tailor behavior dependent on the situation and that people would not always find it appropriate for a teenager to just go running up to people whenever she wants. Ok, sure, but how did it get so far? How did I miss this progression from social adjustment of age-appropriate behavior to outright anxiety? It wasn’t for lack of asking her how she was doing or trying to “check-in” with her on a regular basis. Did something happen to her? Did someone hurt her? Is today’s teen social culture so stressful that it turns happy-go-lucky kids into anxious adults? I can imagine that that would be true. Look how open and exposed they are all the time with social media. These kids don’t keep anything to themselves and in turn leave themselves open for all kinds of judgement, rumor and scrutiny. They put more pressure on themselves than we adults ever could. Now there doesn’t seem to be any limits to bullying or anything else. If you want to ruin someone’s life nowadays, you don’t even have to be near them. You can just cyberbully them online. What is happening?

She has a boyfriend now too. He seems great and they have things in common. She loves him. They are both respectful and good kids. I like him. He seems to make her happy and annoyed at the same time. It is a strange combination, but I can understand it because that is how I feel about my husband sometimes…lol For all the good parts to their relationship, the reality is that it creates another level of separation between us. He is probably her number one choice to spend time with now. Now I have to wonder what they are up to. Are they being safe? Are they getting themselves in over their heads? I am no dummy. I know what teenagers are up to these days. I see them every day at the office. I have to realize that my main job now is not to necessarily know what she is up to every minute of every day, but to keep the lines of communication open, hope that she has been listening to the advice that I have taught her, not make it any easier for her to get herself into trouble and above all, hope that she will come to me if she does. That is NOT easy.

Ok in my rational moments, I actually realize that my girl is still my girl. She is still talented, beautiful, intelligent, and wise beyond her years. She still loves us. She is just changing and trying to figure out her new mood-labile hormones, growing up, how to fit into the world in a different way and how to balance her relationship with her boyfriend and her relationship with us. That is a lot of change over a pretty short period of time if you think about it. All these things are just as hard for her as they are for us. There will be no easy path through this. I just have to keep reminding myself of that and try to be patient. Have a fantastic day everyone!

Dr. Katz