December 5, 2016

More on 5-star doctors

This Sunrise story was triggered by my piece for the The Huffington Post Australia.


Rate-my-doctor: the next step in patient power?

I use AirBnB to book apartments, AirTasker to get furniture assembled, and Uber to get across town. So why not use an app to find the best doctor?
Whitecoat is the latest in a run of disruptive technologies allowing consumers to make decisions based on reviews. It was created by health insurance giant NIB (more on that in a moment).
For many afflicted with illness, this is wonderful news. I know. I was once a cancer patient. When choosing a doctor I was wracked by uncertainty. One surgeon had a pretty straightforward treatment plan on offer, the second more complicated. When facing a real possibility of death, which way to go?
Yet what I needed at that point wasn't the best doctor. I needed the best doctor for me. And -- as much as I wish it did -- a star-rating system such as Whitecoat doesn't help with that decision. The "rate-my-doctor" platforms oversimplify the doctor-patient relationship. Here's why.
The relationship between a doctor and patient is an intimate one, full of nuance and complexity. Modern patients are increasingly independent and informed, but remain vulnerable and scared. I was scared the first time I met my cancer surgeon and I've been scared every time since.
Each cancer check-up for me is a mix of anxiety, sadness, gratitude, joy, waiting... and needles. I couldn't possibly reduce such a rollercoaster of experiences -- not to mention emotions -- to a 5-star rating. My treatment team and I are just so much more than that.
And now, as a medical student training to become a doctor myself, I am also seeing another side: how difficult it is to diagnose, care, and manage complex conditions. A doctor has a hard job compounded by an enormous, bureaucratic system around them. Lots of decisions are out of their control, making measuring their performance a bewildering business.
As a patient-turned-doctor I want more power for patients. But the unique nature of the doctor-patient relationship needs a unique approach.
And I'm not convinced that this can be a space carved out by insurers. That NIB, Bupa and HBF are behind Whitecoat makes me wary. It's like Hilton starting AirBnB, or Cabcharge starting Uber.
To truly upset an established, often stale system (which you could argue much of modern medical care is) outsiders must come in -- or consumers desperate for change. Not companies with existing power, who gain by continuing to optimise profits and focus on established networks.
Neither doctors, nor patients, can be reduced to a simple rating, as if they are a restaurant or a new film. The doctor-patient relationship isn't like finding a handy-person or the best latte. It's often a life-changing relationship based on intimacy, fear, compassion and trust.
There is a role for the 2.0 web and disruptive, patient-centred technology. But "rate-my-doctor" and reducing all the care, attention, and complexity of the medical process to a few gold stars in the process, is surely not the right path.

Originally published by The Huffington Post Australia here.

July 31, 2016

Guilt of all kinds

As I've written in my post Three Years, one of the hardest aspects of surviving cancer, for me, is leaving behind the people that don't.

So when Cancer Council NSW approached me to speak in a webinar on survivors' guilt I didn't hesitate. Survivors' guilt in people living with cancer is being increasingly recognised by doctors and researchers and it's an important issue.

A couple of days before the webinar, The Huffington Post interviewed me and made this:

How A Cancer-Free Diagnosis Can Trigger Survivors' Guilt