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09/15/2014

Google Maps and Moral Authority

At a recent conference held for the leadership of state veterinary medical associations, I had the opportunity to listen to the sobering economic statistics that veterinary medicine faces. These are not, by the way, altogether new or shocking (I’ve listened to them and read them well before the average new graduate entered the profession with the 2.7:1 debt to income ratio of the Class of 2014), and my profession always seems to endure. When care for the equine-based transportation infrastructure was supplanted by Fords and Chryslers a century ago, veterinarians began a focus on pets that now dominates the profession. So we contend today in practice with few patients named “Trigger” and more named “Toonces,” a paradigm shift of the first order, and, increasingly, with our medical expertise supplanted by the opinions of “Dr. Google.” It is a reminder that, whatever the intensity of the human-animal bond, much of our profession is supported exclusively by the discretionary income of others. We’re not unique among professions who consider the practice of their craft a fragile thing indeed. The palpable angst of the many physicians who blog in this site, those who face challenges in the human medical profession far more revolutionary than evolutionary, sometimes seem to blunt the big professional worries faced in my field.

But common to all of us is a sensed need to practice defensively. No one wants to offer low-hanging fruit to the trial lawyers, or to spend depressing amounts of time dealing with liability cases. We all document things assiduously. When the dust settles in a case, I may ultimately look like an idiot, but it sure better not be because of a failure to accurately chronicle what I was saying or thinking.

But now, according to a bright veterinarian who is a marketing guru and speaker (and, curiously, about whom I say all those things without sarcasm and with notable reverence), we have new fears. In a competitive marketplace for services, we need to stand out; we need to offer something that others do not. Any medical professional knows that already seems to be stamped on our DNA—we got to medical or dental or veterinary or whatever school because we were driven to be the best, to stand out, and we have the emotional scars and empty Prilosec bottles to prove it. It’s what makes us all, not just DVMs, think, as American Veterinary Medical Association (AVMA) Executive Vice President Ron Dehaven recently stated, that “ninety-nine percent of veterinarians think they communicate better than their peers.” We crave excellence in what we do, and how we communicate it, and have reasonable expectations that the work we do and the hours we sacrifice will make us just a bit different than our peers. We will offer that optimal “experience” that the gurus say we must.

So often the way we stand out has nothing to do with our medical or surgical competence, but has everything to do with how we are perceived in the public. Dr. Google, and his cousin, Professor Yelp, and what seem like a host of other sites can give us star ratings that appear whenever someone in the public just seeks our phone number online and is automatically shown a “Google Map” of our location, complete with our reviews. These can build up our professional egos, or crush our spirits. Chillingly, statistics say that 69 percent of the population would place as much stock in an online review of a medical professional as they would from the personal recommendation of a friend. We have become, as Tristam Englehardt, Jr., has commented, a society of “moral strangers.” The online opinions of a disgruntled former employee or the supportive golfing buddy of a doctor, neither of whom has to particularly identify as such, are granted the same authority for help in making significant and important and often difficult medical choices as a trusted friend. How awful.

I’ve written of the consequences of online bullying of a veterinary colleague before, bullying that seemed to have contributed to her suicide. Medical professionals have long had to worry about what happens if the outcome of a case is not optimal. Now they (we) must monitor the Internet as sentinels waiting for the poor rating from a client or patient we may have inadvertently offended, from any number of rating sites. I say this as someone whose practice has great online reviews; hooray for me. But popularity, and especially online popularity, is ephemeral. Does this change how we practice? Does it change how we share the truth or protect our staff or other patients from toxic people? Does it mean that standard medical ethics are replaced by the business model of “the customer is always right”? How do we even try to change the cultural authority of anonymous (or nearly so) online reviews? I don’t like how it may impact the way I now practice, but I must accept its presence and deal with its ramifications. For those who face remarkable burdens to practice ethically and honestly within their professions, it offers one more sobering burden to doing just that.

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