Rothenfluh Fabia, Schulz Peter J
Institute of Communication and Health, Department of Communication Sciences, Università della Svizzera italiana, Lugano, Switzerland.
J Med Internet Res. 2017 May 1;19(5):e127. doi: 10.2196/jmir.6875.
Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance.
To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects.
In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method.
In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes of care were also judged to be very important, but both parties agreed that they would not be evaluable by health care consumers.
Health care consumers in Switzerland show a high appraisal of the importance of physician-approved criteria for assessing health care performance and a moderate self-perception of how capable they are of assessing the quality and performance of a physician. This study supports that health care consumers are differentiating between aspects they perceive they would be able to evaluate after a visit to a physician (such as attributes of structure and the interpersonal skills of a doctor), and others that lay beyond their ability to make an accurate judgment about (such as technical skills of a physician and outcome of care).
医生评级网站为医疗保健消费者提供了匿名评价医生的机会。然而，医生的专业培训和经验在医疗问题上造成了医生与患者之间巨大的知识差距。这引发了关于医疗保健消费者对医生表现评价的相关性和重要性的伦理问题。
为确定医生评级网站应提供的评价方面，本研究调查了与识别优秀医生相关的医生及其执业的各个方面，以及医疗保健消费者是否有能力评价这些方面。
第一步，对来自4个专业领域的医生进行了德尔菲研究，测试各种指标以识别优秀医生。这些指标理论上源自多纳贝迪安，他将医疗保健质量分为结构、过程和结果支柱。第二步，基于德尔菲研究中制定的指标，对瑞士的医疗保健消费者（N = 211）进行了横断面调查。参与者被要求对这些指标在识别优秀医生方面的重要性进行评分，以及他们在首次就诊后是否会觉得有能力评价这些方面。根据医生和医疗保健消费者判断的评价和重要性，将所有指标排列成一个4×4的网格。应用霍尔斯特方法计算医生和医疗保健消费者之间的一致性。
在大多数方面，医生和医疗保健消费者在识别优秀医生时哪些护理方面重要或不重要以及患者是否能够评价这些方面上达成了一致，一致性水平为74.3%。双方一致认为，基础设施、工作人员、组织和人际技能对于优秀医生都很重要，并且医疗保健消费者可以对其进行评价。医生的技术技能和护理结果也被认为非常重要，但双方都同意医疗保健消费者无法对其进行评价。
瑞士的医疗保健消费者高度认可医生认可的评估医疗保健表现标准的重要性，并且对自己评估医生质量和表现的能力有适度的自我认知。本研究支持医疗保健消费者正在区分他们认为在就诊后能够评价的方面（例如结构属性和医生的人际技能）和超出他们准确判断能力的其他方面（例如医生的技术技能和护理结果）。
