back to article Doctors sick of anonymous-coward NHS feedback commentards

A leading GP has declared that the general public are too rude about doctors on the internet in a complaint that may amuse those of us more familiar with the culture of "Internet feedback". In an interview with eHealthInsider, Dr Chaand Nagpaul, of the British Medical Association's GP Committee said that patient comments about …

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Anonymous Coward

Worrying...

If the Drs are gullable at falling for troll bait, then how many of them believe everything else they read on the internet.

Anon for comedy purposes.

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Re: Worrying

The worrying thing is that some people hold doctors in such high esteem that they consider them infallible. It's this sort of belief that let Harold Shipman get away with his slightly less than impeccable behaviour for so long.

The only thing more worrying is that most doctors also appear to have an even greater belief in their own infallibiilty.

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IT COULD ALSO BE A...

CLEVER by some practices to discredit legitimate complaints by branding them trolls as a whole.

What if a doctor took a dislike to you as a patient because you cost him too much in time and treatments. A way of making you go to another practice is by the doctor being unhelpful and rude and uninterested.

The patient would not complain under his name for fear of being branded difficult to the new practice.

Practices like low maintainance patients so before you brand every complainant a troll just remember that they may be the one with a legitimate grievance.

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Anonymous Coward

I don't think you have any idea how much unreasonable shit doctors have to put up with. An anonymous forum is inevitably going to attract those same people. The world is not full of people with legitimate complaints against medical professionals. It is however full of people who get unhappy when the doctor won't prescribe them morphine, or doesn't take their hypochondria seriously, or forces them to wait 3 days for a non-urgent appointment. Remember this before you assume that there is a genuine complaint behind what looks like an anonymous troll. If it talks like a duck, and quacks like a duck, it's probably a duck. If people's legitimate complaints get overlooked because they look trollish, tough shit. That's their problem, not the doctors'.

(Posting AC because I love the irony.)

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Anonymous Coward

"The worrying thing is that some people hold doctors in such high esteem that they consider them infallible. It's this sort of belief that let Harold Shipman get away with his slightly less than impeccable behaviour for so long.

Went to my GP with a persistent cough and generally feeling unwell. Told me it was a virus and to come back in a few days if I don't get better. 2 days later, feeling much worse. Back I go to see the Dr. Listens to my chest and prescribes some antibiotics. 3 days later, feeling even worse (could barely get upstairs without becoming breathless), go back to see Dr again. Told I hadn't given antibiotics a chance to work. Said that I'd given them 3 days and was actually feeling much worse. Told to go away.

Next day, feeling absolutely hideous, the worst I'd ever felt in my entire life, I drag myself to A&E. Got admitted with severe Pneumonia. A&E Dr asks why I left it so long.

Your life in their hands, eh?

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@ AC

"If people's legitimate complaints get overlooked because they look trollish, tough shit. That's their problem, not the doctors'."

Wow. Just...wow. Spoken like the true arsehole doctor these sort of forums are meant to expose.

Unreasonable shit? I suspect most of that shit flows downhill from the processes put in place by the NHS board, rather than the small minority of unreasonable requests from patients, who are - by the vast majority - genuinely seeking medication attention.

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Joke

doctors also appear to have an even greater belief in their own infallibiilty.

Q: What's the difference between God and a doctor.

A: God knows he's not a doctor

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Anonymous Coward

i post ac too,

You sir are a plonker who sees no further than the end of your nose, and judging by your reply must have an interest in the medical profession.

Now that is ironic

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Devil

The squeaky wheel...

The squeaky wheel is likely to be the one with the problem. The bulk of your customers that are more or less satisfied are simply not going to bother. Any self-selected forum is going to bias towards the more motivated respondents. Of course this is going to include those that are the most p*ssed off.

I agree with the idea that some doctors can't handle honest feedback and want to somehow silence or mute the complaints by discrediting them all.

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Anonymous Coward

@AC 12:36

Any time I have had sufficient cause to believe the doctor was giving an unrealistic and broad-brush treatment I wasted no time in seeking a second opinion. The prime example was when I was prescribed anti-biotics in ever increasing doses to deal with glandular fever. It was apparent to me very quickly that they weren't appropriate and when also given the "not enough time to act" bs I went elsewhere. Whilst this is in no way as severe as what you had it highlights the basic premise that "it's your body and your responsibility" - if you don't trust what you've been told then seek further opinion. Always.

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Flame

fired for hitting nail on head?

The practice manager in Chelsea probably hit the nail on the head by "dismiss[ing] your comments as unhelpful and unsubstantiated". Firing him/her was unjustified.

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@Larry

Isn't it absolutely hilarious when someone loses their job and potentially wrecks their career when you make an anon troll post:? I tell you, my sides are absolutely splitting when he goes home to his family and tells them he's unemployed because someone on the internet put him in an impossible situation.

There is a time and place for trolling. A forum dedicated to medical needs where a comment could save someone's life is not it.

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Unhappy

@Larry F54 "fired for hitting the nail on the head?" I agree entirely.

If someone wants to post as an AC and say what the fuck they like then they have no basis for any complaint about the kind of reply they get. Posting as an AC where you have perfectly acceptable reasons for wishing to remain anonymous is fine. I see any number of postings here that are, in and of themselves, perfectly acceptable expressions the the AC's opinion - whether I agree with him/her or not. However, the moment an AC posts abuse then we are in another situation. I think that it was a flaming disgrace that a reply that was blunt but not actually abusive led to her cowardly employer firing her.

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"put him in an impossible situation."

Difficult to ignore commentards maybe but hardly impossible. I'd say blame lies roughly 50% with his superior for firing him for something so minor 25% with him for overreacting and 25% with the guy who posted the original comment. For all we know though it might have been a valid complaint, some people have weird perceptions of health issues or like to join the dots themselves and arrive at odd conclusions.

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Firing unjustified?

Hard to know from such a small amount of information surely?

From the Guardian article:

"Replying to another patient, who said they had switched to a competing practice because of the poor standards of service, the employee added: "This is wonderful news. We are all delighted you have been able to find a new GP.""

I'd say that there was a distinct possibility that the practice employee wasn't exactly toeing the corporate line.

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"...unemployed because someone on the internet put him in an impossible situation."

I don't know about that. Does that mean that everyone who lost their temper was justified in doing so because someone put them in an impossible situation? It is no longer required for you to act professionally because someone upset you?

Obviously this article does not say what he responded to, but he did it representing his employers, and in public. In addition he did it somewhere that gives the impression that the whole purpose of the forum (to generally improve standards) is not followed up on.

Perhaps he could've done what the rest of us do from time to time to ease tension? go to the workshop and carry out a secure "erase" of a HDD using a hammer.

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percent responsible?

Why don't you thrown in a few percent for the ISP too ... by your logic they facilitated the whole exchange and surely have some degree of responsibility too

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lost temper?

<i>Does that mean that everyone who lost their temper was justified in doing so because someone put them in an impossible situation? It is no longer required for you to act professionally because someone upset you?</i>

Nothing indicates the person who was fired lost his/her temper or acted unprofessionally. He dismissed a troll's comments as unhelpful. That can be done in a perfectly professional, calm way.

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I can see the Dr's point..

My surgery gets a slamming in its comments and yet I have only ever found them helpful and polite.

Sure it's hit and miss about when you can get an appointment but what surgery isn't?

That said they shouldn't rise to it and the fact they do normally means they are worried about something...

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Presumably you said this is your comment about the surgery then :)

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FAIL

Of course the majority are complaints!

I work in support, and I don't think I've ever had a call/email along the lines of "I just wanted to say that your stuff is brilliant and I love it."

I have had a few callbacks to say "The thing you suggested worked, thankyou".

However, almost all my calls are "This thing doesn't work". When I fix it I usually get a "Thanks very much, bye!", and that's all I want.

No matter what 'spontaneous' contact method you use, most people simply are much less motivated to go out of their way to say "That was great" compared to "That was terrible". It's human nature!

You see it everywhere when comments on any service aren't directly solicited - you'll only get much in the way of positive comments if you ask people immediately afterwards, even and that runs the risk of annoying them.

Most satisfied customers usually think "That was good, I'll go there again.". And that's all I want.

- As to that practice manager who was fired? That was the correct decision.

My employer has a forum, and quite often someone will post a nasty comment on there. If it isn't spam, then it stays and somebody will try to give a useful reply. Being rude back doesn't help anyone.

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Vic
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> I don't think I've ever had a call/email along the lines of "I just wanted

> to say that your stuff is brilliant and I love it."

I put in a big order to CPC a while back. On delivery, it was short one small item (which I didn't need urgently anyway).

I called them and asked if they would put one in the post sometime. It turned up the next day by courier.

So I called Customer Service & asked to speak to a manager. I got a very resigned tone when she picked up the call. I told her the story, the name of the woman who had helped me, and how happy I was with the service.

And she had no idea what to do with my call. I suspect I might have been the first ever occurrence of praise :-)

Vic.

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re: Presumably you said this is your comment about the surgery then :)

I did indeed yes...

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Only human

... and of course all doctors are fine, upstanding, conscientious and talented.

The main reason for people "hiding" behind an anonymous posting is to avoid the possibility of retribution - or even of a practice deciding they don't want whingeing patients on their books. You can just imagine a situation, moments before the doctor says "cough, please" when they decide to raise the topic of your last, critical, posting of their bedside manner.

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Surgery actions

It's not like surgeries haven't thrown people off their books for spurious reasons is it? I've heard of several stories where surgeries have thrown people out for making what seems like perfectly reasonable requests. I've also heard of surgeries doing the same with people whose medical needs are 'too high'. Given the above (maybe from a very small number), are they really surprised when people to refuse to put a name to the comment?

Some surgeries have already shown patients what retribution looks like, so maybe they don't want to experience it a second time?

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Expectations

The thing is that I see it as about expectations. Imagine a ficticious website that allowed you to feedback you experiences at your local Sainsbury's. Imagine a poster said "Oh wow, I went into Sainsbury's today to buy some bread, and they had some; what's more they let me buy it!"

Possibly the people who posted on Choices saying "My doctor was wonderful, listened to me, and was very helpful" had much lower expectations (either through previous experience or guessed from general opinion of doctors). This in itself says almost as much as the posters who said "I went to the doctor, they were awful, and I wish I hadn't gone".

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Item on the R5 business program last night was talking about "reputation management". One of the contributers said that businesses always had to treat negative comments more seriously than positive ones since the rule when he started 20-30 years ago was that a happy customer told 2 or 3 people about theie good experience while an unhappy customer told around 10 - but the change was now via the internet an unhappy customer now tells thousands.

As for saying "My doctor was wonderful, listened to me, and was very helpful" - that's what I said a few years ago to someone I know who's a GP when I was impressed that having gone in to get a prescription of hay fever treatement the doctor I'd seen had had a short chat with me about my general health, what exercise I did and then checked my blook pressure ... however this positive illusion was quickly dispersed when the GP I knew explained "that's just because he would have needed to do that to meet a target for the practice bonus"

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Stop

and?

"that's just because he would have needed to do that to meet a target for the practice bonus"

Doesn't mean it's not a good thing to do - I see no reason at all why your positive illusion should be dispersed because you have a cynical GP friend.

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Anonymous Coward

Problem should be acknowledged

This isn't just a problem of trolling. With anonymity, people tend to be harsh or unbalanced in commenting in a way they wouldn't dream of doing in any other context. I think there has to be some way to measure a person's reputation online - otherwise everyone's feedback is reduced to junk.

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Anonymous Coward

what a load of drivel. do you even know what the hell are you talking about?

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Anonymous Coward

Nice one!

@AC: "what a load of drivel. do you even know what the hell are you talking about?"

I see what you did there.. ;)

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Holmes

No shit, Sherlock

" that anonymity allowed the commenters to say things that they wouldn't if they were named"

YES, D. Nagpaul, hence the term ANONYMOUS.

Surely this guy knows about Commonwealth standard defamation laws - that you can be sued for defamation even if what you are saying is the truth - the plaintiff only needs to prove the comment 'harmed their character in the view of an average person'. The Law makes no distinction about true or false comments.

Billy Bragg said it best - 'This isn't a court of justice, son, this is a court of law'

oh an Dr. Nagpaul? this is TEH INTARWEBS, not your living room.

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How wrong can you be

It is a complete defence to a charge of defamation to show that the defamatory information is substantially true.

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it's the british way

Anyone who has ever looked at the BBC's website (especially when they had the old have your say area) can see there are a lot of angry people using the internet to rip on anyone in hope (I assume) to make themselves feel better.

Anyone with a serious concern with their surgery should bring it up then and there and I suspect in most cases it'll be taken care of.

Instead they act like nothing is wrong, probably say thank you numerous times, and then when they get home rage on the NHS site.

The doctor shouldn't have lost his job. He was completely right in his response.

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The trouble is that this isn't always the case. For instance recently I was hit in the face with a stick playing hockey and needed to see the dentist. Being a weekend I phoned the counties emergency helpline they said sorry we're too busy phone back tomorrow - when I did at 8am they said sorry again and confided that they actually only had 2 appointment slots for the whole county!

When I phoned up my practise to get an appointment with them on the Monday the best they could do was a week away and when I complained that I thought this was a bit long for what I considered urgent the best they could say was sorry.

Complaints of this sort I'm sure are not uncommon (ever felt you're being hurried at the GPs? that's because they have 7.5 minutes per consultation) and sometimes complaining to a wider audience seems like the best way to escalate it or at least blow of steam.

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Anonymous Coward

As I understand it

The best way to get better treatment from your doctor its to go to a walk in centre. When the doctor learns you've consulted someone else they'll be all over themselves to protect their quotas.

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is it illegal to bribe a doctor? I don't mean a full suitcase of cash just a few notes or chocolates or something. try the suitcase if that doesn't work.

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Joke

Perhaps the Doctor in question

Should have posted his reply anonymously........

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Coat

@AC 1030 06/02

Since you choose to hide behind the title of 'anonymous', I have little alternative than to dismiss your comments as unhelpful and unsubstantiated.

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Holmes

All rather predictable

The cast majority of patients probably have a satisfactory and unremarkable trip to their local GP. These people are unlikely to be motivated to go online and leave a comment.

Those who are disgruntled, annoyed or dissatisfied will have plenty of motivation to go and air their grievances.

Eventually you end up with a forum full of complaints and everyone looks bad.

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The majority of patients rarely need to see their doctor and might not find out if the practice is good or bad till it's too late. Think it took nearly 10 years before I met my longest serving GP. 4+ years on I've tried but still not managed too see a doctor from my current surgery - thank god for locums and a pox on 0845 booking systems and 25min call queues.

If the choice is no comments or inevitably biased comment, I'll risk mentally filtering for bias over pure chance.

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What the NHS Choices forum really needs....

... is more Sarah Bee. If people think that responses to trolling have been abusive already, they ain't seen nothin' until they've seen the (ex-) moderatrix in action.

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Anonymous Coward

How long until...

GP's start hiring some offshorian outfit to spam the forum with rave reviews?

---

And you lot blaming some anon troll at a keyboard for someone losing their job scare me. Step up and be responsible for yourself* and your* reactions, rather than pointing vaguely into the abyss and blaming some faceless non-persons nasty ASCII for your* consequent behavior. Sheesh.

*'your', because if you're gonna excuse someone else's behavior on those grounds, I'm pretty sure you'd extend yourself the same dumbarse excuse.

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Anonymous Coward

Within my family, I can think of several instances when things have been awkward with NHS services. Some problems, such as emergency dentistry access, are specific instances of a general failure. Others, I wonder if the "back-office" management is adequate. And I really can't take seriously the idea that GPs are automatically the right people to be in charge.

Part of the problem is that the internet generation can get at good data sources that, twenty years ago, even the Doctors struggled to access.

And there are huge quantities of rubbish.

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The doctors comment seems perfectly valid to me. An anonymous comment on a public forum could easily just be some idiot shouting their mouth off.

I don't really see the point of such a forum in the first place. Still, I suppose there is only so much you can spend of healthcare so the NHS have to find something to spend the rest of their money on. And it gives them an excuse to get rid of some of the huge surplus of GPs so its a win-win.

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Anonymous Coward

Welcome to the jungle^Wintarwebz

So, what is this commenting thing for, those GPs believe? For a big happy family? "Slegs vir gemiddelde?" Really now, if you want feedback you shouldn't skew the results beforehand by insisting they should be from "average patients" only. It's the outliers you're most interested in because it tells you something about the weaknesses of the medical system.

That there's querulous and trolls and simulants and whatnots, well, those you see in Real Life general practice too. I'm actually quite surprised that GPs have trouble with this. Something about starry-eyed self-delusions and inexplicably not matching reality.

A bit of moderation can be quite a good thing, just as it can make the "forum" useless, or indeed worse, of course.

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Well ACs call my GP practice hell on Earth

And they're not wrong either! The NHS is in desperate need of reform, both at an organisational and a cultural level. I just don't think Con part of the Condemolition, with their ideological blinkers, are the government to do this (in fact, I think they'll make things far worse, leading to more cowards complaining anonymously).

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FAIL

key thing in any forum / rating system is to identify trends

If all the posts say Dr Smith was rude & abusive you have reason to suspect they probably were - investigate.

If all posts say I can never get an appointment the phone is always busy only way I can get an appointment is to queue first thing in the morning - investigate they are probably right.

My surgery is among 3-4 who used to have that complaint some improvements have been made and they get fewer now.

If they all say is the surgery needs a repaint then relax and schedule a decorator, you are obviously doing an ok job.

Comments are about trends, you interpret them and then decide if there is an issue.

Look at eBay you look at someone with a high positive rating then at their complaints, if they are minor and well dealt with then you buy from them. If they all say X was wrong then you make an informed decision.

If you have one person with an apparently serious gripe you ask them to give more details privately or complain officially. You don't tell them to go away.

If a member of staff had behaved that way towards a customer in the practice they would have faced disciplinary action, why should it be any less serious when they type it?

If they don't want to hear bad things, don't do bad things - if you do people will tell you and you can fix it. Point of a comment system surely?

By the way we want BOFH!!!!!!!!

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Anonymous Coward

Or...

"...A leading GP has declared that the general public are too rude on the internet "

There, fixed it, etc. etc.

I find it really rather sickening that normal people who would never be rude to someone in real life will say some of the most unpleasant, obnoxious things to people on the internet and hide behind their anonymity or pseudonym in order to do so.

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