If a web site touted misleading health care information, you’d hope the government would do something about it.  But what do you do when the government is the one feeding the public bad information?

Last week, the Obama administration launched the new Healthcare.gov.

It’s mostly an on-line insurance shopping site.  It is very much a federal government version of sites like eHealthInsurance.com or Massachsetts’ HealthConnector site, which have been around for years.  So when HHS Secretary Kathleen Sebelius, in announcing the new site, claims it gives consumers “unprecedented transparency” into the health care marketplace, you should wonder what she means.

But that’s not the big problem with this site.

Right there in the middle of the top of the page is a big tab that says “Compare Care Quality.”  If you click on it, you are taken to an “interactive web tool” that claims to show you “44 quality measures” about hospitals.  The site says it will help you compare the quality of care hospitals provide.

I decided to look at hospitals in the area where I live, Boston, Massachusetts.  It gives you a list of hospitals in your area, and gives you options to compare hospitals based on medical conditions and surgical procedures.

I decided to compare the Brigham and Women’s Hospital in Boston with the Hallmark Health System in Melrose.  If you don’t know these two facilities, the Brigham is a Harvard teaching hospital, justifiably world-renowned in many areas of care.   The Hallmark Health System is a network of community hospitals, which I suspect most people even in the Boston area aren’t familiar with.

I decided to run my search based on the idea that I was trying to help someone with breast cancer.

The first problem I ran into is this: they don’t have any data on breast cancer.  Actually, they don’t have data for cancer at all.  The only things they can tell you about are chest pain, heart attack, heart failure, chronic lung disease, pneumonia and diabetes in adults.

How about a search on surgical procedures?  Nothing again.  My only option is a “general” search.

Ok, well, I guess it’s a work in progress.  So how do the two hospitals stack up?

They give you a few ways to compare, but the one that I think most pertinent is “outcome of care.”   If you click on that you see that “outcomes” are based purely on how many people died who had a heart attack, heart failure, or pneumonia.  So much for my “general” search (and my cancer patient).

So how do they stack up?  You can’t tell the difference.  Both hospitals are “no better than the national average” in two categories, and “better than the national average” in one.

You get more detailed information – but it only makes things worse.

For example, in death rates for heart attack, the Brigham and the Hallmark hospitals are both “no better than the national average.”  Is that good?  It turns out that that “above average” hospitals are as rare as four leaf clovers – out of 4,569 hospitals in their data set, only 95 are better than average (2%). Only forty-five (1%) are worse than average.  Two-thousand seven hundred and forty four (60%) were “no better than the national average.”

The other 1,685?  They don’t have enough data to figure that out.  The smart money says they’re all “average,” too.

Maybe if I just compare them to other Massachusetts hospitals I will get a clearer picture.  Nope.  Out of 65 hospitals measured in Massachusetts, only nine were better than the national average (14%).  Fifty-one were average (78%), and zero – zero - were worse than average (5 didn’t have enough data).

I know health care in Massachusetts is good -but not a single hospital is below average?

It is deeply misleading to consumers to suggest they inform their health care decisions in any way shape or form by this kind of data.  It’s not that the data is incomplete – it is – it’s that even within the data you can’t tell the difference between a major teaching hospital and a local community hospital.

I’d love to know if the people presenting this as a useful tool for consumers think it really is.  It leaves you knowing less about the differences among hospitals than before you use it.  That’s shameful because the site encourages people facing medical situations to use it for that purpose.  The only thing it is going to do for sure is heighten patients’ anxiety, and make their decision-making more difficult.

Last night, I saw a commercial produced by the federal government.  Called “Questions are the Answer,” it’s a call for patients to be engaged in their medical care, to ask questions of their doctors in order to be sure of their medical condition.

The commercial was excellent – it showed a man asking dozens of increasingly arcane questions about a cell phone he was thinking of buying.  Then, it showed him in his doctor’s office, apparently after getting a diagnosis.  “Do you have any questions?” the doctor asks.  “Nope,” says the man.

The government agency that produced the commercial is the Agency for Healthcare Research and Quality.  There are a series of other videos and tools that can help you be a better, more informed consumer if you get sick.

The only catch:  it’s almost impossible to find any of this great material.  The front page of their web site – if you should somehow manage to find it – is an enormous list of bullets and subcategories.  There’s a good consumer-oriented video on the right side (featuring Fran Drescher), but the screen is quite literally smaller than a postage stamp.

Those excellent TV ads?  Hidden several clicks away from the front page.  And what’s worse, you can’t embed or share them, they seem to only be available to watch locally.  In other words, all this good work is going to waste.  From a social media perspective, this most effective part of AHRQ’s web site pretty much doesn’t exist.  I noted this back in May, and it’s unchanged since then.

But the AHRQ should know: it’s never too late to get involved in social media.  Please, re-think your web site and get a social media strategy.  It’s never to late to get this important message out there.

Attention doctors:

Your patients are talking about you.

They tell their friends, family and co-workers about you.  They talk about you in public places where people they don’t know might overhear them.  Probably every doctor understands this.  But for some reason, once all this talking starts happening on the internet, some doctors do odd things.  Like trying to get patients to sign “gag orders” before agreeing to treat them.

It’s a mistake, and a missed opportunity.

The Washington Post reports on efforts by some doctors to “quell criticism.”  But in the age of the internet, you simply can’t squash criticism.  Indeed, in trying, doctors risk not only undermining the trust that is necessary for a good relationship with their patient, but they also miss out on an opportunity to improve their practices– and our health care system.

Here’s what I mean.

Jeff Jarvis, blogging pioneer and author of the best-selling book What Would Google Do? thinks your angriest customers are doing you a great favor:

Here’s some free advice: Go to Google (GOOG), enter any of your company’s brands followed by the word “sucks,” and you will see the true consumers’ reports. Brace yourself: It won’t be pretty. Wal-Mart’s (WMT) unofficial Google Sucks Index turns up 165,000 results; Disney’s (DIS) 530,000; Google’s 767,000. What’s your number?

Now don’t get mad at these people. Instead, help them get even with you. These angry customers are doing you a great favor. They care enough about your product or service to tell you exactly what went wrong. Other customers may just desert you and head to the competition. But these are telling you what to fix. Listen to them. Help them. Respond to them. Ask their advice—and they’ll give it to you.

It’s about “co-creating” with your customer, figuring out what is important to them and whether what you’re doing serves that need.  It sounds like the practice of medicine, but it’s also about the very personal and subjective nature of the doctor-patient relationship.

What you want from your doctor is pretty simple- you want the doctor to pay attention to you, think about you, answer your questions, and help you understand your condition. Truthful feedback in these areas can be very hard to come by.  No government agency is going to measure it.  But patients are happy to share their views.

So shouldn’t doctors embrace web sites that give patients the chance to say what they think?

Some doctors don’t think so.

One, Dr. Nancy Falk, told the Washington Post that the “people least capable of judging the quality of care are patients”  (she is wrong about this, by the way).  She also said wishes there were a “Web site where I could complain about patients.”

Now, what do internet commenters have to say about Dr. Falk?  The Post says commenters called her “curt and intolerant of questions.”  Falk denied those descriptions, but her quotes make it sound like maybe there is something to them. Still, other commenters had equally strong positive recommendations.

Could she improve the quality of her relationships with her patients if she asked each one if they thought she was “curt and intolerant of questions,” and really wanted to know their honest answer?  If her practice is like any other business that asks its customers what they think, the answer is yes.  In a world where patients are increasingly encouraged to “shop” for medical care, doctors who don’t do this will lose out.

But there’s an even larger point that these doctors are missing.

Modern doctors are some of the best educated and best trained people the world has ever seen.  But our health care system, which forces them to spend too little time with each patient, systematically undervalues all of the things patients really want.

Doctors should embrace any technology, any system that lets the voice of the patient be spoken more loudly.  Doctors should encourage the collection of all of the stories from patients about how they feel their doctor doesn’t have enough time, or was harried, or curt, or distracted by some insurance or government requirement.  They should take this information and show it to insurers, legislators, the media.  And they should make a simple point: we don’t want to work under these conditions, and our patients don’t want us to, either.

Making our health care system work to serve these purposes is what it means to put patients first.

At healthreform.gov, the Department of Health and Human Services publishes data on the “Health Care Status Quo.”

It reads a bit like what would happen if you took the Dartmouth Atlas of Healthcare and buried it in Stephen King’s Pet Sematary.

The front page of healthreform.gov now has a map of the 50 states where you can click and read about the “current status of health care and the need for reform.”

(I should add that DC is included in the map, too.  But as of the time of posting the link doesn’t seem to work).

It lists a grab-bag of categories of information on each state.  But no matter what the data shows in a state, the HHS report always concludes the same thing.   Fifty times out of fifty:

[Insert state name here] families simply can’t afford the status quo and deserve better. President Obama is committed to working with Congress to pass health reform this year that reduces costs for families, businesses and government; protects people’s choice of doctors, hospitals and health plans; and assures affordable, quality health care for all Americans.

A good example are the reports for Massachusetts and Texas- two very different states with very different data.

• 25% of Texans are uninsured, while only 2.6% of “Massachusettsans” are.

• Overall “quality of care” in Texas is “Weak,” while in Massachusetts it is “Strong.”

• The percentage of people with employer-based coverage in Texas dropped from 57% to 50% from 2000 to 2007, but held steady at 72% in Massachusetts

• 20% of Texans reported not visiting a doctor due to high costs, but only 7% of Massachusetts residents did, and “this has significantly improved since 2007.”

• Average premiums for health insurance are about 5% cheaper in Texas, even though the market is described as being less competitive than Massachusetts

• 27% of middle income Massachusetts families spend more than 10% of their earnings on health care, compared to 17% in Texas

What’s going on?  The HHS doesn’t seem terribly interested in exploring it.  It just says it wants some kind of unspecified health care reform, this year.

I suppose this is the way the political process works.  Make the case there is a serious problem, and seek support to do something – anything – about it, now.  As Secretary Sebelius put it:  “we cannot wait to pass reform that protects what’s good about health care and fixes what’s broken.“  I don’t think anyone really knows what this means, but maybe that’s the point.

It’s a strategy for a political victory, but not for real, needed reform of our system.

Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?

Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?

Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.

“It’s the doctors, stupid,” he begins his column today.  At once, he recycles the tiredest of political phrases and tells his readers exactly what he thinks of them.  But it’s not the column that is most telling, it’s the live web discussion that followed.  I participated in it, and can share with you the highlights.  It’s a revealing insight into the thinking of a mainstream DC columnist.

To save you the trouble, here’s a summary of Pearlstein’s views:  Doctors learn a craft that they owe to the rest of us as a public good.  But instead of doing this, they take advantage of knowledge to make as much money as they can.  They do it willfully – like an insider-trading stock broker – but they also do it because they just aren’t all that competent at what they do.

Think I’m making this up?  Read:

On medical school debt:

I think we allow doctors to make too much of their debt. . . In major metropolitan areas, that debt looks pretty small when compared to the lifetime earnings that doctors accumulate in private practice over many years.  They more than make up for their investment, as it were.  But they use this debt to justify their elevated incomes for the next 30 years — and make no mistake about it, doctors in the U.S. do make ALOT more than docs elsewhere, on average. . . . My suggestion is that we socialize the cost of medical education, that is have the government pay for it, in exchange for a couple of years of community service.  That way, we get the community service and we eliminate the No. 1 reason given by docs to justify getting paid more than docs everywhere else.

According to the Bureau of Labor Statistics, a freshly minted family care doctor has a median wage of less than $140,000 a year.  According to the AMA, these same doctors have, on average, about $140,000 in educational debt.  Thirty years seems about how long it would take to pay off that debt, and you can forget about buying a house, a car, or paying for your own kids’ school under those circumstances.  I’m sure many medical students would love the Joel Fleischman plan, but we should do that because maybe it will help more people become doctors, not because we think doctors are exaggerating the impact of debt equal to 100% of your gross pay.

On how our system ought to allocate medical resources:

There is no reason why people can’t travel an hour to a big hospital to have a baby, for example, in a big modern maternity ward that does lots of deliveries and has enough volume to be able to afford all the latest equipment in case something goes wrong.  I mean how many times in your life do you have a baby that you can’t drive an hour to have it done, rather than insisting that every community hospital have its own maternity ward.  It’s just one example of the inefficiency built into the system by people — that would be you and me — who insist on things that, in the end, don’t have ANY impact on the quality of care.  In fact they have negative impact.

I don’t know if Pearlstein has ever had a baby before, but just being an hour away from a hospital is unthinkable for most expectant moms in the weeks prior to delivery.  And what is someone to do who lives an hour away and has a complication during the pregnancy?  Pearlstein’s prescription seems to be that they should eat cake.

On the freedom of patients to choose their medical care:

The emphasis on being able to choose your own doctor in every instance is another, as if most of us have a clue as to who are the best docs and who aren’t.  These are the kinds of irrational things we need to try to work out of the system, because they wind up being very costly.

Yes, for goodness’ sake, let’s get rid of the irrational desire of a sick person to want to pick their own doctor.  Even Senator Kennedy’s “American Choices Act” guarantees the right of patients to choose their own doctor.  I don’t know where Pearlstein is on the political spectrum with this view, except perhaps a certain territory between China and South Korea.

On how doctors are hopelessly conflicted in giving medical advice by their desire to make money:

But first we need the evidence to show that it isn’t a good idea.  Then, once we have the evidence the doc has to follow the protocol and explain to the family why it’s not a good idea and not merely blame the big, bad insurance company for being so heartless–which, by the way, a lot of docs do, so they can look like the good guys.  Of course they’d love to do the surgery in many cases because they’d like the business and the extra income, so they are hopelessly conflicted. . . . .

[B]uying medical care is not like buying lawn furniture. . . in medical care you rely to an extraordinary extent on the advice of the doctors (i.e. the sellers).  And its also not an area where you are inclined to be very price-sensitive — is anyone going to go the the Wal-Mart of surgeons if they think their life may depend on it. . . . But it is NOT true that a well-informed consumner will always make the right choice about medical options — they still need the advice of doctors, who under the current system have a very noticeable conflict of interest.

I’m actually not sure that Pearlstein has even been inside of a Wal-Mart.  Because they consistently have high quality merchandise at the lowest prices.  In fact, if more hospitals worked like Wal-Mart the problems that plague our health care system today probably wouldn’t exist.

Responding to a commenter who said that the notion that defensive medicine is a large expense is “totally false:”

Indeed.  But doctors don’t believe this, no matter what evidence you present them.

Yes, evidence is like kryptonite to doctors.

I asked Pearlstein if a doctor ran over his dog or something.  He didn’t directly respond, simply saying “Maybe you should talk to Atul [Gawande].”

Now that’s the only sensible thing he said.

Doctors have a right to be mad about medical malpractice claims against them.

Is there a creative solution to this mess in an old tenet of nuclear deterrence?  What if doctors aggressively went after patients who sued them, and pre-emptively warned them about even complaining on the internet about their experience?

On the surface it sounds attractive.  The doctor lets his patients know the rules of the game: I do my best, and you agree that if things don’t work out, you won’t turn on me.  But a closer look reveals how destructive it is.

If you read about the North Carolina company that has been leading the charge in this area you’ll see why.  Called “Medical Justice,” it has been getting a quite a lot of attention with something they call the  “Deterrence Plan.”  If a doctor buys one of these plans (the “recommended” plan is about $3,000 for the first year and $1,000 a year afterwards, depending on your specialty), and is then sued for medical malpractice, the company may spend up to $100,000 to counter-sue the patient.  They will even go after any expert witnesses hired by the patient, filing complaints at any of the medical associations, specialty societies, licensing boards or others they think are appropriate.

But wait, there’s more.  For an additional fee ($495 a year, $350 every year after), the company will give you its  “Web Anti-Defamation Package.”  This includes what they call a “mutual privacy agreement.”  The doctor presents his patients with a contract that they have to sign in order to be seen by the doctor.  Under it, the patient agrees they will not make anonymous comments on the internet about their experience with the doctor, and that if they do make any comments on the internet they will only be on sites that meet some company-defined “minimum standards of credibility.”  If a patient does it anyway, they’ve broken the agreement and are now subject to being sued.

Think about what it would be like to be presented with these “Patient Contracts” at the doctor’s office.  You’re there trying to get help from the doctor, and he responds by treating you like an adversary.  Yes, some patients sue, but most don’t, even if they have a bad outcome.  But treating every patient as if they might is deeply destructive of the most important aspect of the doctor/patient relationship: trust.

Lawyers (disclosure: I am one) do this sometimes.  They’re very good at telling you you should never rely on “trust” in business dealings, that all you really have is what you have in writing.  But the relationship between a doctor and a patient is fundamentally different than most any other relationship we enter into in life.  In that relationship, trust is the most important thing you can have.

We should be looking for ways to strengthen the bond between doctor and patient, not for ways to twist it into an arms-length commercial transaction.

This morning, the Department of Health and Human Services tweets to promote its two new reports on quality.

It says “Secretary Sebelius Highlights Two New Reports on Health Care Quality, Says Improving Quality is Key Component of….”

The post is then cut off because it exceeds twitter’s 140 character limit.

It also has a bad link.