Yes
Sir Muir Gray
Director of the NHS’s National Knowledge Service and adviser to NHS Choices

The 20th century was the century of the clinician and the 21st century is the century of the patient. How patients experience care is very important to them and they should be at the centre of improving it.

Many patients would like a better experience than they receive at the moment. GPs are not equally good at understanding how patients want to be treated. Their communication skills determine to a large extent how the patient perceives their care.

Feedback has always existed in different forms, but the internet changes everything. We are in the middle of a revolution driven by citizens, technology and knowledge. Patient feedback is the best means of helping doctors to know how they can improve and enabling patients to make empowered choices. We are seeing a different relationship between users and practitioners in the age of the internet, and feedback is a part of that.

Feedback websites are going to happen anyway. It is inevitable that, if such sites are not managed properly, people could leave malicious comments. This is an important concern. We should look at how we can make the best use of websites for clinicians and patients, encouraging people to use a structured system and making sure malicious comments are identified and removed. I don’t believe reviews need to fall at the extremes. We know that people like getting positive feedback. I was instrumental in setting up Iwantgreatcare.org, a website for patients to review their doctors, and it works well. One doctor I know advises his patients to leave feedback and the majority of comments are positive.

Our technology wizards have built in checks so that if you have a vendetta against a doctor, we will spot it as soon as you send in two malicious e-mails from the same address or computer. Doctors will be able to follow up consultations that are commented on and justify their decisions, saying, for example: “We didn’t give you antibiotics and here is the evidence why.”

I believe that we have underestimated the ability of patients to understand and judge the quality of their care. Many decisions require medical knowledge, but you don’t need to understand the physiology of the gall bladder to understand the benefits and risks of having it removed.

Less experienced GPs could benefit from the service and I believe there is an even greater need for feedback in hospital care. Hospital doctors get little training in communication. This could help them to pinpoint their strengths and weaknesses.

When we set up NHS Choices, an information service for patients, we decided that we should give the public access to all the good-quality material available. If we don’t, they will find rubbish on the internet.

I believe that patients have responsibilities as well as rights. They have a right to great care, but it is also their responsibility to help to make the health service better.

No
Dr Nigel Watson
Sits on the General Practitioners’ Committee of the British Medical Association

There are 300 million NHS consultations with GPs every year and the number of complaints is very low. For the vast majority of patients, the level of satisfaction is high. GPs value patients’ feedback. We need to be responsive, not only to patients’ medical needs but to be able handle them in a sympathetic and receptive way.

The problem many of us have with such user review websites is that the large majority of patients who are happy and content aren’t going to go on there and sing your praises.

My practice has 13,000 patients and offers more than 800 appointments a week. You need only one or two disgruntled patients to post derogatory comments to damage your reputation and that of your practice. It could be a patient who wants antibiotics because they are convinced it will make their cough go away – you explain that it is a viral infection and antibiotics won’t help, but still they may not leave satisfied. I recently saw a drug addict who came in demanding methadone and diazepam. When I refused, he went away very dissatisfied and probably would not have scored me highly on any website. Patients can judge some aspects of what we do, but I think it would be unfair to have a website where they can make potentially libellous comments.

As a practising GP, the most important thing for me is not that patients like me but that they trust me.

GPs are skilled at managing risk. Not everyone comes through the door with a clear story. Their myriad symptoms may be difficult to unravel. You cannot send everyone with unexplained symptoms to hospital. Sometimes a few weeks down the line the diagnosis becomes clear and patients say: “Why wasn’t it picked up before?” But medicine is not an exact science. Does this make the GP a bad doctor?

Harold Shipman was a murderer who also happened to be a GP. He was well liked and would have passed all the government checks.

Some patients are obsessed with what is on the web – cyberneurosis. There is some quite good information out there – NHS Direct, for example – but some of the information is cranky and not helpful.

As Lord Darzi of Denham said in his review of the NHS, we need to involve patients and put them at the centre of what we do. But if we look at the way doctors practise now compared with 20 years ago we are much more patient-centred. It is a much more open relationship. In our practice, we conduct surveys regularly and meet to look at how we can improve based on the results. The majority of patients are satisfied. Some are even getting survey fatigue.

Of course, there are a few practices that aren’t so good and that’s part of the Government’s plan to measure and improve. Our quality of care is going to be measured to make sure the standard of medicine we provide is safe. Patient-centred practices will be able to prove it.

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