There's been a fairly vigorous reaction to health minister Ben Bradshaw's proposal to allow patients to rate and review their general practitioner on the web.

Reading the blogs and the newspapers, I'd say the vote is probably running 4 to 1 against, with many familiar - and valid - arguments on both sides. Yes, we want more openness, more accountability for apparently aloof professionals. No, we don't want medical decisionmaking to pander to all demands, a site that encourages manipulative behaviour, spurious statistics.

One of the strong themes running through the critical comments - from both doctors and patients - has been a strong resistance to the idea of patients being asked to act as customers. 'We don't want to read or write reviews, nor score our doctors,' say the patients. 'We just want our doctors to be good, and trust them.'

But is asking patients to behave as customers what Ben Bradshaw had in mind when he announced the policy? Well, yes, it seems to be. For example, the Guardian reported:

'I would never think of going on holiday without cross-referencing at least two guide books and using Trip Adviser,' said Bradshaw. 'We need to do something similar for the modern generation in healthcare.'

Fair enough - but, in 2009, isn't this starting to feel a little Web 1.0? Is the 'Choosing what to buy' metaphor the best we can do?

Web 2.0 (this isn't exactly news) offers much more - the chance to move from customer to community, from me to us, from buying something to building something, together. As Ivo Gormley's recent film Us Now makes clear.

Our resolution for 2009 is to find ways to use the web to move from feedback on the web to change in the real world.

There have been some interesting questions raised recently, on the back of the Darzi review, about whether patients actually want to choose where they are treated.  Jennifer Tracey recently asked visitors to Radio 4's iPM blog "Do you want to choose the hospital you're treated at?"  The majority of responses were negative  and reflect the argument held in opposition to focusing on choice, that we should be making sure quality of care is the same wherever you go for treatment.  I thought I'd share some of the comments with you so you can see what I mean...

Do you want to choose the hospital you are treated at?

• "No.  All I want is good quality treatment, reasonably quickly, reasonably close to home.   These the are fundamental requirements of ALL hospitals, and we should be striving to acheive them in all hospitals.  Choice is a pointless concept that we don't need, and which detracts from the real issues."
• "No thanks. Just knowing I'd get good treatment at any hospital, ideally my local one, is all I ask for. "
• "I do not think we should be able to choose our hospital, as every hospital should offer the same outstanding level of care."
• "No - unless it is filthy; has nurses with attitude; doctors who ignore their pagers and turn up three hours later; admin staff who chat together while you are waiting to present for an appointment - oh hang on - that's most of my local hospitals. I'll change my mind - Yes I do want to be able to choose my hospital - preferably one in Australia or the USA please."

A particularly interesting comment came from someone obviously outside of the UK - "You mean to say you in Britain don't get to choose? What if the service you get is incompetent? What if the hospitals are flithy? You pay for it, why don't you demand better?"

These are the same comments and attitudes coming from our blogging clinicians and GPs - The English Physician says "Even for cold cases most will choose the nearest hospital, provided only they are confident they will be managed accurately and efficiently. For urgent serious illness, the shortest journey to the nearest capable unit is mandatory.  Where appropriate, choice is discussed as a part of good practice anyway."  Dr Grumble thinks its all a red herring, "...the government needs some way of getting patients to go to providers outside the NHS. It's all about back door privatisation. And the mechanism is patient choice and Choose and Book. It's not about patients. It's about government."

Its interesting to see in the latest national patient choice survey published by the Department of Health, that people were broadly happy with the hospital they went to, whether they'd had a choice or not, and that "...the process of being offered and discussing choice helps patients to decide a preferred hospital", which seems vaguely circular to me...

Recently data on survival rates (or death rates...) in hospitals is being made available by NHS Choices, run by Dr Foster, to help patients know how well a particular hospital is performing.  Presumably not the type of information you're desperate to have access to if you are having a mole removed, but you can listen here to both the opinions of Dr Foster's Tim Kelsey and Bernard Ribeiro of the Royal College of Surgeons on making this data available.

Ben Bradshaw, Health Minister, has had some flack for his statement about a patients legal right to choose their GP.  The Darzi review is responsible, of course, for this renewed interest, by commiting the NHS to allowing patients to choose their GP.

Choice is contentious is education as it is in health, with some believing that "... ‘patient choice’ is a cover for the government’s desire to whip the health service into shape by introducing more and more externally imposed, soul-destroying, managerial targets."

But what happens when we look at choice from a patients perspective?  Ignoring for a moment the potential consquences GP choice may have, how do patients feel about the choices they have now?  Looking at responses from patients on the Patient Opinion site, it's clear that some feel frustrated by the process.  But where it works, it works very well.