The Hardest MMI Stations, Part 2 - Rate My Doctor

rate_my_doctor_MMI_station

By: Ryan Kelly

If you’re like most pre-meds, you’ve used Rate My Professors to determine the right instructors for those important pre-reqs and easy-A electives.

But imagine there was a similar website where patients could anonymously review their doctors (minus the chili pepper, if that makes you uncomfortable). How would physicians react to this phenomenon? That’s what we’re about to explore in our sample MMI station.

With the increasing prevalence of technology, customer reviews, and efforts towards quality assurance, a “Rate My Doctor” MMI station feels like a nice, topical way for the schools to test your response to feedback and criticism.

To protect the artistry of admissions committees, I have chosen not to replicate the exact prompt; rather, I’ve “spiraled” the situation presented. I’ll convey the essence of the dilemma to give you a chance to develop your own strategy for navigating tricky MMI stations.

Example MMI Station:

You’ve received bad reviews on “Rate My Doctor”

A co-worker shows you the “Rate My Doctor” website, where many of your patients have anonymously complained about your apparent lack of concern about their health and the high cost of your services. What would you do?

Like most pre-meds, you’re not a big fan of surprises. So, if you get a wonky MMI prompt, consider why a strange question is being asked, and make your answer stand out for the right reasons.   

During recent mock MMIs, I asked two different candidates to answer the “Rate My Doctor” prompt.


STUDENT A’s RESPONSE:

Patient satisfaction would be my top priority as a physician, so this news would be unsettling. I would take some time to reevaluate my approach to patient care. I would try to improve by taking careful notes after each future patient visit, so I can better gauge the quality of the interactions over time. I would possibly try being more upfront with patients during visits, and if appropriate, ask for their personal feedback about their care.

I would consider instituting some kind of anonymous survey system at the clinic, where patients could express their concerns and feedback directly to the providers, as opposed to a third-party website.

I would want my patients to feel comfortable confiding in me and openly divulging their private concerns. So overall, my goal would be to communicate more concern and investment.

Critique of STUDENT A’s answer:

One of the challenges of ethical dilemma MMI stations is that they lead you towards certain assumptions, and if you’re not careful, you’ll overlook something and jump to conclusions.

For example, Student A immediately assumes that he or she has indeed done something wrong. But in order to properly assess the situation, the student would need to do some thorough research into the “Rate My Doctor” website.

For this MMI example station, Student A never stops to consider the reputability of the website - is it new or long-standing? How many doctors are on file? How much online traffic does the site receive? Do you have four patient reviews on the site or 40? How detailed are they? Are you able to find any trends in the criticism? Are the complaints about issues that are actually within your control as a provider? How many negative reviews do you have compared to other doctors?

Ethical dilemma prompts will often omit key information to make the solutions less clear. It’s up to you to fill in that missing info. Ask yourself, “What else would I need to know to decide my course of action?” It’s smart to use if/then conditional statements that would explain your possible solutions based on different criteria.

For example…

If I reviewed the website and found only a small amount of anomalous complaints, then I would avoid an overreaction, make a mental note of what I could change, and then continue monitoring the website in the future.

Or…

If most of the patients’ complaints were about financial issues beyond my control (like insurance coverage), I would make a point to have discussions with patients individually to see how we could optimize their coverage and work within the system together.

If/then conditional statements will make it harder for you to screw up your answer, because you’re the one interjecting the criteria and controlling the factors at play. It also shows you as anticipatory, since you’re able to present several potential outcomes. Considering all the different criteria also allows you to extend your answer by covering what’s hidden under the surface of the prompt. Talking for six minutes during an MMI station can seem like an eternity if you don’t have enough angles or facets to discuss.

Student A’s potential solutions are good, especially implementing an in-house survey and striving for more transparency as a provider. But the response is too short and one-dimensional. Like Rate My Professors, this website’s anonymity calls its credibility into question, and it’s bound to have unreasonable or unsolvable complaints. It’s important to recognize a doctor’s limitations while also proposing different strategies moving forward.

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STUDENT B’s RESPONSE:

Through my shadowing and volunteering, I have seen doctors receive a lot of scrutiny for their actions, whether it be from anxious family members or overworked nurses. I’ve even had discussions with physicians about their experiences with malpractice lawsuits, often regarding issues beyond the scope or control of the hospital and staff.

It’s easy to receive blame when things go wrong, since doctors are perceived as having all the answers and solutions. But the truth is that they’re working in imperfect conditions, and it’s often not as simple as one right or wrong decision from the doctor.    

Even more so than other professions, one’s reputation in medicine is paramount. If a doctor is not viewed as ethical, competent, or compassionate, he or she will lose credibility and trust with patients, who would likely switch providers and be unlikely to recommend him or her to their friends or loved ones. In a career with such high stakes, with people’s livelihoods on the line, it can be difficult to restore one’s reputation once it’s tarnished.

As such, I would not take the criticism from “Rate My Doctor” lightly. If I felt like any of the reviews or complaints were unwarranted, or outside of my responsibility and control, I would try to issue a formal response on the website to provide more information and clarity. If needed, I would want to exonerate myself before anything becomes accepted as popular opinion.

I would also bring the website up casually in conversation with patients, to ask them if they’ve heard of it or ever read reviews on it. This would help me gauge how much of an effect the website could have on my future practice, and it might encourage some patients to visit the site and leave positive reviews.

If I could ascertain which patients had left the negative reviews, based on the specific information presented, then I might pay special attention to their areas of concern during their next visits.

Overall, I would do everything within my power to protect my name and reputation, so that patients could continue seeking my medical advice and treatment in good faith.

Critique of STUDENT B’s answer:

Although Student B’s answer to our example MMI station is longer and more detailed, it definitely has its fair share of problems. It’s unnecessarily negative and dramatic, bordering on an overreaction. It has lots of negatively charged language like “anxious family members,” “overworked nurses,” “exonerate myself,” and “popular opinion.” It compares Yelp-style online reviews to malpractice suits, which is definitely an apples-to-oranges analogy.

Bringing up his or her real-life healthcare experiences is fine (in small doses), but all the editorializing about medicine and life as a doctor sounds a tad pompous--a know-it-all tone that actually comes across as naive. It’s good to sound mature, but don’t pretend to have it all figured out. Since Student B draws upon discussions with physicians, it would make sense for him or her to seek advice from colleagues and mentors in the hypothetical “Rate My Doctor” scenario, but that’s never brought up as a possibility.    

Due to all of Student B’s overcompensation, he or she comes across as someone who cares WAY TOO MUCH about what people think. Don’t get me wrong - you want to have a good reputation, but Student B seems to prioritize it above all else, as if he or she couldn’t possibly proceed without clearing the air first.

This is further evidenced by Student B’s ill-advised choice to interact directly with the “Rate My Doctor” website. In some ways, this is equivalent to pre-meds repeatedly bringing up excuses for their B- in Freshman Biology in their secondary essays. The more attention you give to shortcomings, the worse they can appear. By directly addressing the criticism on a public forum, you might seem desperate or neurotic, which in turn might give more credence to the review. As tempting as it would be to defend oneself on the website, it’s hard to imagine that approach going well. Plus, you’d run the risk of violating patient confidentiality.

Last but not least, Student B’s response to our example MMI station lacks the proper amount of humility and outward thinking. The focus should be on determining best practices to provide optimal care, as opposed to self-interested motivations like reputation or popular opinion. Student B proposes some interesting solutions (like tactfully trying to encourage positive reviews on the website), but overall the response is too presumptuous, aggressive, and superficial.

Student A might have been able to squeak by in this MMI station, but Student B would be sunk. 


Best Way to Respond:

There’s no perfect formula, but both Student A and Student B’s responses would have benefitted from more structure and totality. Here’s a 5-step approach to handling any MMI ethical dilemma that’s thrown your way:

1. Restate the prompt

By using this strategy, you can take up time, communicate a full understanding to the interviewer, clarify your thoughts (and maybe even think of new ones), avoid misinterpretations, and reveal assumptions.

2. Present the competing ethical stakes

In this case, the dilemma would stem from you discovering dissatisfaction with your performance and having to address it in an appropriate way that maintains professional boundaries and facilitates improvement in the long-term.

3. Discuss what else you’d need to know to make your decision (if/then statements)

This is where you’d discuss your exploration of the website. Based on what you find (very few vs. many reviews, legitimate vs. questionable criticism, what’s in your control vs. what’s not, etc.), you’ll want to isolate possible trends in the feedback and create concrete plans of action. Use if/then construction to present different likely scenarios. Don’t feel the need to discuss every single potential factor at play, but it’s okay if you have three or four conditional solutions.   

4. Take your stance and explain your steps towards resolution (can be conditional based on criteria in #3)

The criticism of Student A’s response provides a few solid examples of this step.

5. Cover your bases by including any ethical, legal, professional limitations/restrictions you'd need to uphold

This is where you’d discuss the issue of patient confidentiality, and the ethics you’d strive to uphold in terms of respecting the anonymity of the reviews. It’s not wise or appropriate as a physician to address the website’s criticism publicly or directly in your future patient interactions. You want to create concrete plans that help you be more conscientious, so that you can ensure your credibility through your actions.

Here’s some more useful reading material as you prepare for the MMI:

Stay tuned for Part 3 of my “Hardest MMI Stations” series. In the next post, I’ll be examining the “Epidemic Outbreak” prompt, so be prepared to deal with some hypothetical contagions and mass hysteria. It should be a good time. Don’t miss out!