Black Triangle

In the recent series of Strictly Come Dancing, the retired political correspondent John Sergeant performed spectacularly well. The judges had mistaken the show for a talent contest, rather than the test of popularity. Sergeant consistently hammered the better dancers in the contest in terms of the public vote, despite lacking any apparent dancing skills beyond dragging a bedazzled lady across the floor. However, John Sergeant’s dance skills were strictly irrelevant, the problem was the nature of the competition.

In much the same way, the government are now proposing a Strictly General Practice competition:

Patients in England will be able to comment on their GP’s performance on an NHS website, under government plans.
[...]
Mr Bradshaw told the Guardian: “I would never think of going on holiday without cross-referencing at least two guide books and using Trip Adviser.

“We need to do something similar for the modern generation in healthcare.

“I can already learn a lot from the comments of people, both positive and negative, about a type of treatment or a hospital. We need to extend the service to cover GPs.”

Oh dear. It appears that Ben Bradshaw has fallen for the fallacy that a Web 2.0 commenting system that people use to rate DVDs, computer games, or Hotels is automatically a good thing to assess professional skills. The customer is always right, or always knows what they prefer, may be useful in the purely commercial sector, but in a professional environment there are problems in its application.

The professional may make decisions in the best interests of their client, which the client may not consider to be in their best interests. For example, a patient may have an expectation of a prescription medicine to be given following a consultation with a GP, when the GP knows that the antibiotic may not be required (therefore carrying avoidable risks to the patient) or add to the burden of antibiotic resistance in the population.

A more important issue with such rating systems is that professionals have professional expertise that patients are unable to assess due to their own lack of knowledge. This may be seen as a paternalistic viewpoint by some, but people do go to the doctor for expertise they do not themselves hold. What are anecdotal comments from patients really going to tell you about a doctor’s diagnostic skills, or pharmacological knowledge?

In July of this year I wrote about a similar non-governmental attempt to rate general practitioners, and pointed out a comment about a particular GP. I repeat the comment again:

He was held in very high regard by the overwhelming majority of his patients. He was also respected by fellow professionals. His patients appear to have regarded him as the best doctor in Hyde. His register was full and there always seems to have been a waiting list. Patients liked him for a variety of reasons. Many would say that he ‘always had time’ for them. His surgeries overran but no one minded because they understood his wish to take whatever time was necessary for each patient. He never hurried them out. He always had time for a few words of a personal nature. Elderly patients and their families were particularly grateful for his willingness to visit at home.

That comment is about Harold Shipman, the most efficient serial killer in British history. Thankfully, he will be unable to benefit from the new government scheme, but I doubt he would have come off badly in such a scheme.

Janet Daley at The Daily Telegraph notes the BMA’s opposition to the scheme, and states that:

This is precisely the kind of comparison measure that tends to raise the standards of a public service in which there is no market mechanism to give consumers power of purchase.

No it isn’t. Any patient who uses such a scheme to judge their GP’s abilities would be making a grave mistake, akin to judging the abilities of the pilot on a plane by the sound of his voice when making turbulence announcements, or assuming John Sergeant was a good dance partner based on the public vote in Strictly Come Dancing.