April 24, 2017

We rate everything now. Google, Facebook, TripAdvisor are a few of the many internet based platforms where people can rate their experiences. While well intentioned ratings can be useful in many cases like TripAdvisor, there are also places where it is a mess. Hospitals and physician practices are a few such places.

I have been reading a lot about the scourge of the narcotic epidemic in America. It is destroying the lives of many men and women while upending families in the process. It is quite personal for pediatricians as it directly affects many newborns that are born addicted in our hospitals. It is beyond sad to witness a withdrawing newborn! I bring this up because I think that to some extent physicians are partly to blame for this epidemic. We have given in to the societal pressure to satisfy patients often giving out drugs that have unfortunate side effects.

Hospitals and corporate owned clinics have turned to ratings systems for their employees over the past few decades following the national trend that has been pushed by the federal government. The original idea was that this would have meaningful repercussions on health care quality. As always, intentions and outcome are often different.

Hypothetically, let us say you are Dr. X in the emergency room seeing patient Y. Patient Y has back pain and after reviewing his chart, you notice a drug seeking pattern that is worrisome. To prescribe more narcotics for this person is violating your hippocratic oath to do no harm as this chronic drug use will only hurt this patient more over time as every study has proven. You also think about the possibility that patient Y may sell his drugs to a young pregnant girl who is addicted as well. She then delivers an addicted baby who needs narcotics for a month to detox. What a mess!

If you do not oblige this common patient, you will rack up poor ratings and get a call from your friendly non clinical administrator. What to do? With the narcotic, antibiotic and antacid use data in full view, clearly, too many people are choosing to follow the wrong path.

In our office we have similar pressures from parents to prescribe drugs like antibiotics. We refuse to use narcotics because there are better ways to handle most pain issues than a masking and addicting drug. The FDA has finally banned codeine (narcotic) for use in kids adding to a growing list of drugs used to help symptoms but has more downside then upside.

We have chosen to not have a rating system based on the data and that we feel that it is our duty to always do the right thing without fear of influence. Our goal is every child's wellness with the best path with or without medicine as dictated by the clinical scenario. This should be the goal of every clinic in the country.

In our opinion, patients should have a grievance mechanism in place. We have an office manager that handles any concerns and my partners and I will try to personally contact any parent regarding these concerns to help rectify the situation or improve where it is shown to be possible. Ultimately, the most important mechanism in place for a consumer is choice. If they are not happy, moving to another provider is the best solution. However, providing unnecessary care or worse care that hurts the child but pleases the parent in the long run is against our ethos and every physicians hippocratic oath. The satisfaction game is a slippery slope toward unintended consequences and we are not willing to gamble with children's health.

Knowing that over using antibiotics, narcotics and antacids will lead to more disease in children has driven us to draw a line in the sand that makes ratings and peer influencing mechanisms of no benefit despite the trend to do this more often.

Dr. M

Stanford Study
Review Article
The Atlantic Article
FDA Warning