One of the difficult things about having a career in medicine is that reputation is paramount. It is quite precious and is easily shattered. There are not many industries where interpersonal interaction is more important. From interactions between a provider and his patients, nurses, ancillary staff, and other providers, the professional reputation of a doctor is made. Sometimes it is fair, sometimes it is not. It’s an industry where subjective opinions of others dictates the volume and quality of referrals a doctor can get.

Whether the technical or intellectual skill of a physician is good or bad often does not matter. If the nurses on a floor like you, they will undoubtedly tell their friends and help develop your reputation in that institution. Similarly, the way you treat patients will directly affect what they say about you to their families and colleagues.  In this day and age of online reviews of doctors, you can never be sure whether what you say or do will show up online.

In this era of managed care where providers cannot spend much time with patients, it is even more important for physicians to develop good rapport with patients. Unfortunately, the system is set up so that a provider cannot make ends meet unless he sees patients at least every fifteen minutes. If you have ever visited a doctor, you know that fifteen minutes is barely enough time to go over one complaint, let alone multiple things that will likely affect you as you age. Thus in order for physician’s to stay financially solvent, they must limit the time they spend with their patients. As you can imagine a doctor’s reputation declines from this type of behavior. Thus it is the rare physician who is able to make his patient feel that he has spent adequate time with the patient when the reality is that he has not.

There have been many efforts to rate doctors objectively. Those have all been failures. There are no good metrics by which to compare physicians. Those measure that have been used have been formulated by insurance companies aimed at cutting costs.

One could argue that managed care kills a provider’s reputation. Perhaps it has already killed a provider’s reputation so much that doctor’s are going to work for Kaiser or other managed care organizations where reputation does not matter. In those organizations a patient does not have much choice and thus the doctor’s reputation is not at stake. He will have patients to see no matter what.