Yelp May Not Help

Concomitant with the metamorphosis of the practice of medicine into the business of healthcare delivery, patients have been transformed into customers. Healthcare providers compete not only on the basis of outcomes, best practices, centers of excellence, advanced technology and cost, but also on customer service. In fact, reimbursement is not influenced by all these criteria. Patients-- I mean, customers have the right for all medical personnel to address them with respect and courtesy, to be professional in dress and demeanor, to have their privacy protected and to be treated in a clean, accessible and comfortable environment. Most hospitals and clinics hire professional questionnaire solicitation to confidentially poll and quantitate how individuals and institutions meet these goals of customer satisfaction. This data is used for quality improvement and professional reward or chiding. The information remains outside public purview. The quibbling over terminology is trivial, but a more significant fear is that overemphasis on patient satisfaction has a hidden moral paradox. In the internet age, patients come armed with preconceived notions of appropriate care gleaned from unvetted information and physicians are perversely influenced to pander to their demands to get another Michelin star rather than firmly providing guidance for a more difficult, but perhaps safer and effective care plan. In total, however, I cannot say that there is a positive correlation between customer satisfaction and patient outcome.

            In contradistinction, in this age of sharing, tweeting, liking, crowd sourcing and rating, physicians may be harmed by non-confidential, anecdotal, and unprofessional assessments made by patients posted on sites such as Yelp or Bing. We live in a time when people go online to find a gastroenterologist for a colonoscopy as if it were no different than hiring an electrician on Angie’s List. How many stars does your allergist have? The great conservative Edmund Burke could have had a more enlightened view of caveat emptor, but his statement was spot on, “In ascending order of treachery come lies, damn lies and statistical lies.” The unsolicited ratings on social media are gleaned from a skewed population of a physician’s practice and are no way accurately representative of how Dr. XX or XY provides medical care. Most social media ties are younger, healthier and less medically experienced than the Medicare population that has benefited in longevity and wellbeing from the long-time attentions of their physicians.

           Online ratings are representative only of those who choose to post, not the multitude that, cannot do it, do not see any value in sharing, or do not have the vanity of etching their name and opinion in Yahoo-land. Many patients voice concern directly with their healthcare provider rather than tattling online. Is there help from Yelp, or does Yelp not help and in fact, besmirch the undeserving? As if medical practice was not cluttered enough with unremunerated busy-work, now we all need a new consultant: the social media spin doctor.


By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton

Making Money With Your Business, Profit and Cash Flow, Five Sustainable Companies That Make a Lot of MoneyFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 10

It is time to make money! You have been through a couple of rounds of market testing now you feel like you are on to something. The next step is to run the numbers to make sure that the business is sustainable. There are two sides to making money, profitability and cash flow.

Why Competition Is Good For Entrepreneurs and How Blockbuster’s $50 Million Mistake Helped Reed Hastings and Netflix Destroy a $6 Billion Empire Find Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Epis

When battling for resources or investment, early-stage entrepreneurs may believe that competition is a bad thing. On the surface, they are correct. There are a limited number of angel investors willing to provide a finite amount of venture capital to founders.

Upscaling and Scaling Business Ideas into Reality – Jeff Bezos takes Amazon from Online Bookstore to Global DominanceFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 4

Congratulations, your market testing worked and you were able to find customers, or at least one customer. Your beta test was successful and you are confident that you are ready for more. What do you do when you start getting customers or users? I recommend you do some scaling or upscaling.

What Kind of Business Should You Start? – How Mark Zuckerberg Pivoted From Rating Hotness to FacebookFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 1

When it comes to brainstorming startup ideas, new entrepreneurs and even seasoned ones scratch their heads in confusion. Living in the information age, you can scan the current market and see countless new business ideas. With so many options out there, how do you know which one is right for you?

Why Would a Doctor Abandon a Steady Paycheck to Become an Entrepreneur?

As physicians, we are expected to be compliant with rules, restrictions, and regulations. We are expected to be risk averse. We are expected to be “providers,” but not necessarily innovators or leaders. As the healthcare system becomes increasingly consolidated into large overcrowded clinics, we are required to perform to the standards set by bureaucrats and clinic managers. These rules are often at odds with the best interests of patients and with our sanity.

The Alienation Of America’s Best Doctors

The best and the brightest simply don’t want to become doctors anymore. Physicians are burning out. They are leaving the profession. They are going bankrupt. They are selling their private practices to big hospitals. They are retiring early. We are facing a growing doctor shortage.

Better to Live and Die in the U.S.A.

The United States healthcare system is often berated for how it treats patients near the end of life. They are purportedly attached to tubes and machines and subjected to unnecessary invasive procedures that cause inordinate pain with no potential benefit, there is underutilization of more compassionate hospice services. This “travesty” is expensive, as the care of dying seniors consumes over 25% of Medicare expenditures. We hear this story so often; it is almost taken as gospel-- but is it actually true? Is it more expensive and invasive to die in America than in other developed countries?

Gun Ownership and Doctors?

According to the Pew Research Center, there are approximately 32,000 gun-related deaths annually in the United States; 19,000 are suicide, 11,000 are homicide, and the rest are accidents, police shootings or of unknown causation. Moreover, there are more than 78,000 nonfatal gun wounds each year. Given the disproportionate number of victims that are less than 40 years of age, the morbidity and mortality of gun violence is significant. Physicians are involved with many types of public health issues, but few are as controversial or divisive as gun safety. Is it really an issue that falls within the medical domain?

O Tempora, O Mores: Affordable Care Act - Big Dream or Big Let Down?

I confess I was a strong proponent of the Affordable Care Act. My reasoning was subtler than the hallowed pantheons of its staunch supporters and the apocalyptic predictions of its detractors. Forty years after graduating medical school I concluded, after many stutter steps, the American healthcare delivery system was economically unsustainable and the citizenry was neither living longer, nor better, despite medical expenditures that dwarf any other developed nation. My career also allowed me to personally interact with cardiac surgeons from all continents and see that their clinical results and research efforts were laudatory by any standards.
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