Tom Lee on why online doctor reviews are good medicine

Thomas H. Lee, M.D. is the Chief Medical Officer at Press Ganey and a Professor of Medicine at Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.


Everyone realizes that healthcare has to reorganize. It has to become different. It has to organize around meeting the needs of patients as efficiently as possible. One of the healthiest things I see organizations doing around the country is bringing patients onto committees, onto groups within the care delivery system. And when patients are actually at the table, it doesn't even matter who the patients are, it doesn't even matter if they say anything, just their very presence reminds our clinical colleagues of what it is we're supposed to be doing.

I think people are changing the way they actually try to get our colleagues to work together. University of Utah is a national, and really I would say, international leader in understanding how transparency can not just shape what consumers read about us, patients read about us, but actually change the way that clinicians look at themselves and work together.

You know, the arc of history is clear. It is toward transparency and it's impossible to make an argument against transparency. When I was working at Partner's I was always pretty careful about pushing transparency because I felt like it was the right thing. But if your colleagues don't come along, then it's obviously, it can be a very destructive thing to be pushing things before people are ready.

I certainly know what I'm afraid of, what my colleagues are afraid of. They're afraid that patients won't understand the complexity of the data. They are concerned that the data won't be robust enough, they won't have risk adjustment and they're afraid maybe they actually are worse than average or just average.

Everyone in healthcare is for transparency for everyone else. They just get very nervous when it's applied to them. But then as organizations like University of Utah has gone out there, put data out there, they find that the things that they really worry about, they don't really happen. And many good things happen that they didn't encourage. It's kind of like having kids. I've always said having children, all the bad things are true, all the good things are true. But the bad things aren't that bad and the good things are better than you imagine possible.

I believe the same thing is true about transparency but is even weighted more to the good. But it's not just transparency about patient experience. There's transparency about cost, when prices, that I think the arc of history is toward that as well. And then there's transparency about what we do. Giving patients full access to the notes that physicians write. Several organizations have led the way with that, the OpenNotes project, Geisinger, Group Health, [inaudible 00:02:53]. Now others are going that way.

Of course my colleagues are nervous, I would be nervous. At the same time, does anyone doubt that that isn't where we're going? And organizations that can move faster and learn how to do these things well, it's a big strategic advantage, it's the smart thing to do.

I haven't seen any organizations I would characterize as happy or feeling like they've got everything nailed and everything is going beautifully according to plan. It is a time of turmoil and transition and everyone is under stress. Now that said, I think that there are fantastic things happening all over the place. The progress that's underway scientifically is breathtaking and I think it feels to me the way it must've felt just before antibiotics became available and became widespread. And so that Fleming discovered penicillin, World War II came along, they were able to mass-produce it and the world changed. I think we're on the verge of the same kind of thing scientifically and for cancers and genetic diseases.

I think when they look back on our times, they will have limited interest and sympathy for our budgetary issues and the financial crunch. But they will look at the progress and they'll look at the reorganization of care that occurred and they'll say, "It was a great era."