Whether you agree with the Trump administration assertions about “fake news” or not, the term has gained legs and has at least put the American public on notice that you can’t trust everything that you read in the media or on the internet.
Fake News Definition
As the term “fake news” has become more commonplace, it remains loosely defined, often being used as a blanket pejorative against information that counters the interests of those using the term. This article from the Daily Caller describing how journalists are declaring war on fake news without knowing how to define it conjures ideas of the old Keystone Cops movies.
I’m going define “fake news” as information that is reported as fact but is without foundation, is demonstrably false, or is presented in a manner that is intended to deceive the reader. To differentiate “fake news” from opinion pieces, we sometimes need to look at the actual or apparent intent of the report, since arguments may be intended to sway opinion, but shouldn’t necessarily be considered “fake news” if they are well-reasoned and supported by evidence.
In some instances my definition may fall short, but then again, “fake news” may be one of those terms that is difficult to define but that “everyone knows it when they see it.” Compare that “recognition” definition with concepts such as “justice”, “due process,” and “pornography” which even courts have had some difficulty consistently defining.
The internet realm of “fake news” includes such things as “clickbait” and sponsored posts. While I would initially fall for links to posts with phrases such as “this will make your jaw drop” or “you wouldn’t believe”, seldom was I incredulous or left with my mouth agape. Yet the clicks that those links created benefited the publisher by improving site stats and advertising revenue. Similarly, sponsored posts may seem like they’re intended solely for the information and benefit of the readers, but may also be created for compensation at the request of another interested party. These types of “fake news” are more difficult to detect, but the federal government was so concerned about the issue that the Federal Trade Commission created rules requiring disclosure of any sponsorship in posts endorsing a product.
Applying Fake News to Healthcare Reports
The event that prompted this post and bumped others that I was working on was the news story about former prominent Texas neurosurgeon Christopher Duntsch. I wrote about the story several years ago over at EPMonthly.com. My prior post was, in turn, prompted by an excellent article in the Texas Observer by Saul Elbein. The gist of Saul Elbein’s article was that Dr. Duntsch had multiple egregious medical misadventures while operating on patients and that those misadventures caused multiple serious patient injuries and one patient death. Dr. Duntsch would bounce from hospital to hospital after he started feeling heat from his malpractice, so it took some of the hospitals a while to figure out the problems. However, the Texas Medical Board was reportedly notified of these misadventures on multiple occasions by multiple physicians from multiple different hospitals, but Dr. Duntsch reportedly kept maiming patients in surgery while the Board “investigated” for more than a year before suspending his license. See Order of Temporary Suspension from the Texas Medical Board here (.pdf file).
The recent articles on Dr. Duntsch provide some closure. He was tried criminally for his botched surgeries – an extremely difficult allegation to prove. However, after only four hours of deliberation, a jury convicted Dr. Duntsch of the first degree felony of “harming an elderly person” with regard to the care of one of his patients. Dr. Duntsch now faces life in prison. See more information on the trial in the articles from KHOU.com, CBSDFW.com, and Dmagazine.com.
By now, you’re probably wondering what all of this has to do with fake news.
I have a lot of problems with how Dr. Duntsch was allowed to keep practicing medicine. The system failed most of the patients he injured. One aspect of the system failure was a physician rating site. As Dr. Duntsch went about maiming patients, Healthgrades.com rated Dr. Duntsch as a 4.3 out of 5 on its site, stating that he was “above national average” in his specialty. Of course Healthgrades.com has since removed its rating on Dr. Duntsch, but I happened to get a screen grab of the site when all of the negative information about Dr. Duntsch was first being published (also see the full screengrab of this deleted page here).
A physician who was just convicted of a first degree felony related to his medical practice was rated by Healthgrades as “above national average”? How could this happen?
One problem with physician rating sites is that consumers think that the ratings mean one thing when the sites know that the ratings mean something completely different. Patients who visit these sites are often searching for a quality physician. Sites know that there is no way to measure “quality” medical care. Instead, the sites take metrics that can be measured and use those metrics as a surrogate for physician quality. When a physician gets a “Patient Satisfaction” score of 4.3 out of 5 on a site like Healthgrades.com, the public is led to believe that the physician is of excellent quality. In reality, the ratings represent something quite different.
For example, on Healthgrades.com, Dr. Duntsch was rated on how clean his office was, how easy it was to get appointments, how friendly his STAFF was, and how long patients had to wait to be seen during their appointment. See full size .jpg of one of Dr. Duntsch’s deleted Healthgrades.com pages here. The surveys say nothing about the quality of care Dr. Duntsch provided. In fact, one neurosurgeon called to fix some of Dr. Duntch’s mistakes reportedly wrote to the Texas Medical board that “The [Medical Board] must stop this sociopath Duntsch immediately or he will continue [to] maim and kill innocent patients“. At the time this letter was written, Healthgrades.com was telling these same “innocent patients” that this same Dr. Duntsch was “above national average.” When the truth about Dr. Duntsch’s practice became known, Healthgrades.com deleted Dr. Duntsch’s data and pretended that it never led patients astray.
Rating Healthcare “Quality” is a Multi Billion Dollar Business
Healthgrades.com was sold to Vestar Capital Partners which is a private equity firm, so company financials are difficult to ascertain, but Vestar’s Portfolio page notes that it has invested more than $6 billion in companies valued at more than $40 billion, so there isn’t much doubt that Vestar is profiting from the Healthgrades.com web site.
The problems inherent in Healthgrades.com physician ratings also apply to other rating sites such as Press Ganey, although on a much larger scale. Press Ganey was purchased by private equity firm EQT for $2.35 BILLION last year. By the way, did anyone notice that the WSJ article linked above stated that Press Ganey was “majority owned by private-equity firm Vestar Capital Partners” prior to its sale? As in … before being sold last year, medical rating company Press Ganey was controlled by the same private equity firm that currently owns medical rating company Healthgrades.com. Let that sink in for a minute.
Anyone who has read this blog knows that while I think patient feedback is invaluable, I think that assigning a numerical score to satisfaction data and then comparing those scores using unreliable techniques amounts to fraud.
Wait! Did WhiteCoat just engage in fake news?
No. That’s my opinion. Here’s the data I used to form that opinion: The data behind the scoring systems are proven unreliable, the integrity of the data is suspect because there is no control for who is completing the surveys or what motives those people have for doing so, and studies have shown that satisfaction scoring encourages medical practices that are injurious to patients. I won’t link all the studies here, but I’ve got a whole web page dedicated to exposing much of the fraud and misinformation behind patient satisfaction scoring.
In case there is a question, I actually do quite well on my patient satisfaction scores, so this isn’t an issue of sour grapes for me.
My issue is that companies like Healthgrades and Press Ganey KNOW that their data is statistically invalid, but they keep preying on uneducated hospital CEOs and less savvy consumers – creating an impression that the data means something it does not. Those companies rake in billions of dollars perpetuating these schemes.
This corporate dishonesty demoralizes the medical profession, adversely affects patient’s medical care, and it rakes in billions of dollars in profits for certain venture capital firms.
Both get 1 of 5 stars.