[stuki]

Reputation systems, reviews and properly skeptical consumers, are what to aim for, in determining who is good and who is not. Whether for restaurants or doctors. Not frightfully pricey lawyers and other coercive, after-the-fact institutions. And, in the most egregious of cases, say McDonald's spiked granny's coffee with a hand grenade, the criminal courts get involved as a last ditch anyway.

Reliance on civil courts may sound attractive to the naive, but the lawyers and institutions involved, are just as single mindedly focused on their own personal gains, financial and in prestige, as either party to the original dispute. It's not that they are necessarily systemically partial to one side or the other, but rather that they are partial to making the fight as acrimonious and expensive as possible. As that is, after all, their "side."

[karmajunkie]

The problem with that theory is that many doctors require patients to sign documents that prohibit online reviews, and many "bad reviews" from patients are somewhat frivolous. So reputation management is largely worthless in the medical field.

Additionally, in Texas for example, tort reform has done nothing to limit costs of healthcare (though it has made malpractice insurance much cheaper, which makes life nice for doctors and their insurers.)

[stuki]

And what kind of reputation, do you think an Amazon seller who makes potential customers sign "no review" contracts, will get?

There's nothing magical about the medical field, that makes approaches developed elsewhere somewhat irrelevant there. It's just another fee for service arrangement. Although many Doctors do like to fancy themselves as special snowflakes.

[jemfinch]

> There's nothing magical about the medical field, that makes approaches developed elsewhere somewhat irrelevant there.

There absolutely is something different about medicine: consumers' participation in the medical market is involuntary. We don't see doctors because we want to see doctors, we see doctors because if we don't, we will be maimed or killed by disease or dysfunction.

By the time people are seeking a doctor, they're often not in any position to evaluate the market--if a real market for medicine even exists where they live--and weigh the reputations or contractual demands of several doctors before choosing one. They're in pain, they're suffering, and they need a doctor now. That's very different than buying a watch on Amazon.

[stuki]

Outside of emergency rooms and acute care, people have quite a bit of choice as to when to see a doctor, and whom to see. It is conceptually little different than auto repair in that sense. Making the world artificially black and white only serves to obscure nuances. Some times you really could use some help right now, most of the time not. The efficient way to deal with the former, is to plan ahead and make arrangements. For the latter, YAGNY may well be the efficient approach.

Heck, even someone rendering services as conceptually involuntary as a will executor, can have a reputation fr being good or bad. Despite you not necessarily having much choice on the matter when the headline service is being rendered.

[arrrg]

And in many cases everything goes well. The system is not completely dysfunctional and I don’t think anyone was claiming that.

This is mostly about exceptional cases.

[SilasX]

You could say the same thing about many goods. For example, "I'm purchasing food, not because I really want it, but because I need it to exist. Therefore, no one should be able to use review systems to decide which food to buy. [or make a profit, or be run by private corporations, or whatever other remedy is merited because of the human need for food]."

[rictic]

That's some elegant rhetoric and ideology but it doesn't address the reality of the situation.

The evidence that I see says that this has been a practice for at least five years, and according to the Boston Globe[2] one reason for this is that doctors feel like the conversation is one-sided, as they are legally forbidden from saying much about their patients.

1] http://boingboing.net/2009/03/05/doctors-force-patien.html 2] http://www.bostonglobe.com/lifestyle/health-wellness/2013/03...

[rayiner]

Mandatory no-fault insurance would be better than reputation systems for medical care. I think people hand-wave around whether reputation systems work for low-probability but catastrophic avoidable error.

Also, the whole "greedy lawyer" trope is a wonderful bit of social engineering. Companies figure out how to save or make money while creating risk for consumers and bystanders, and its the lawyers that are greedy. Ford saves billions making a less safe car, and its the plaintiffs' lawyers that are greedy because they make money seeking compensation for the people that get hurt by that decision.

[thenmar]

Here are the two main problems with this comment:

-"lawyers are greedy" trope isn't really true, most lawyers would prefer to settle than go to trial (trial is more profitable for the lawyer) because it's a satisfying win for themselves and their client, most lawyers weigh ethical considerations heavily

-"reputation systems" can be gamed, are difficult to interpret, are vulnerable to selection bias, and exclude people who are too poor to own smartphones and computers

[dinkumthinkum]

Reviews are for people that don't know statistics. Mostly what you get are unhelpful bimodal distributions, hardly a way to redress serious grievances. I think your discount of civil court is either naive itself or just o early cynical to the same effect.

[stuki]

Reviews weighted by trust, seem to do quite well in most places where they are employed. From Amazon and Ebay sellers to Uber drivers to College rankings. Even yelp rankings, which are extremely unspecific, seems to provide users with waay better than random ability to pick the good from the bad. Even when it comes to doctors, as a matter of fact.

I would honestly be very, very surprised if they didn't end up working substantially better for medical doctors than for most other service providers. As, at least in my experience, very few people who decide to though the effort of becoming a doctor, do so with the express intent of scamming their way to riches, the way many Ebay and Amazon sellers do.

I am sure that in some selected cases, an aggressive tort system could be construed to have provided a better outcome, but at what systemic cost? Massive over treatment of every conceivable low probability condition, to stave off grounds for lawsuits. Doctors scared of going with their hunches, and instead of doing what they feel is the best for the patient, doing what they expect will be easiest to defend if the outcome should be less than ideal.....

Doesn't forcefully injecting an expensive and completely unconcerned outside party, into an arrangement between two parties that are outcome concerned, strike you as an inefficient use of resources? Why not, instead, try to find ways to make the two concerned parties understand each other better?