Jeremy Laurance: To fairly rate doctors we need to go beyond their bedside manner

Medical life

I happened across one of the those "best second opinion" medical websites the other day – the Trip Advisors for the health community that rate doctors according to the opinions of patients treated by them. I clicked on a surgeon I knew and a column of remarks from patients verging on the adulatory appeared. "Trustworthy", "careful", "professional", "brilliant". I know him as a consummate professional; decent, charming, empathetic. He has only one drawback – he is not very good at surgery. I know this from his colleagues who tell me that as a result he has moved into teaching – at which he excels – and reduced his clinical work. There is no suggestion that he is incompetent or dangerous, merely that he is at the lower end of the surgical skill scale. Somebody has to be, after all.

What struck me was the divergence between what I happen to know about this particular surgeon and what anyone reading the website would know. Patients' opinions are an essential part of rating doctors – but they inevitably rely on the visible attributes, the bedside manner, which can be publicly assessed. To get a richer picture we need deeper knowledge – and despite years of effort we still don't have it. The only specialty to have shown real commitment to greater transparency is cardiac surgery, where monitoring of death rates was introduced in 1998. Two weeks ago the first survey of deaths following bowel cancer surgery was published, showing a seven-fold variation between NHS trusts. That is the kind of deeper, richer information patients need, but it has taken 13 years since the cardiac surgeons first provided it. How long must we wait before the rest follow suit?