The government is currently funding a new website for NHS Choices and it is expected to include the option for the general public to give ratings and comments based on the performance of their doctor. The idea being that it will give public services the same transparency and incentive system as Ebay and Amazon.

There are so many problems with this proposal it’s hard to know where to start.

Confidentiality is a big problem. If a patient gives a negative comment that the doctor disagrees with, they cannot adequately defend their actions publicly because of the patients right to privacy.

Who is going to regulate the system to ensure a bored teenager isn’t spamming the system, destroying a professionals reputation in the process. Surely, if that were to occur  a doctor would have a legitimate case for libel, costing the taxpayer yet more money in legal fees.

The profession is already heavily regulated. Doctors have many exams to pass and the GMC is bringing in new systems every year to ensure doctors’ skills remain up to date.

The patient needs to know that the doctor is doing what they think is best for their health, not pandering to their every demand to get good feedback. GPs have a hard enough time already getting patients to leave the consulting room without antibiotics for their cold, imagine how much worse that would be if the doctor would be punished for not meeting the patients unscientific demand.

Who are the patients that will use these systems? On ebay I’m sent a reminder by e-mail to give feedback. Under the governments proposals the public have to go to the website unprompted. If I have no issue with my GP I’m not likely to go to any real effort to publicly declare that fact. If I have a problem on the other hand, I’m very likely to shout my complaint from the rooftops.

While some patients will have legitimate issues, surely this isn’t the forum to air them. Perhaps a more reasonable system would be a private web feedback site. That way if I have an issue with my doctor I can give feedback to the practice directly and the doctor can respond to me personally. It is more likely to improve the doctor patient relationship than the alternative.

The BMJ has an interesting article and editorial on the issue this month. Dr. Rant also gave an intresting take on the issue last week.