Wednesday, April 25, 2012

The Value of Amazon Book Reviews

I have a confession to make. I purchased books on amazon for more than 10 years and not once did I bother to leave a book review. I read the reviews and often used them as a tool to evaluate prospective purchases, but never contributed myself. Why not? Several reasons. Who cares what I think? This book already has several reviews, another won’t make a difference. Too much of a hassle.

I never really understood the value of amazon reviews until I found myself on the other side of them. Your reviews are much more powerful than you think. Fifty strong reviews can help catapult an unknown author up the charts. A few negative reviews can kill an indie author’s dreams, or at least help them face the harsh reality that they’re a hack.

Reviews can influence a book in several different ways. Customers can organize book lists while they are browsing to weed out low-rated books and place highly rated books at the top of their genre lists. In this way, higher rated books become more visible and attract more customers and books with low ratings drop off the radar.

A book’s average review rating along with the number of reviews submitted is displayed prominently next to the title and has a strong influence on a book-browser’s first impression. “Wow, a hundred people reviewed it! It must be fantastic.” Or, “Oh, only 6 reviews and an average of 3 stars? This isn’t worth my time.”

Customers can vote on individual reviews and indicate the review’s value. A single well-written rave review can convince hundreds of “on-the-fence” book browsers to at least download a free sample, and if these customers indicate the rave review was helpful, that review gets displayed more prominently so more people will see it. A single harsh review can have the exact opposite effect.

So next time you enjoy a read, consider contributing your own review. Keep the following things in mind:

-          Always be honest but try not to be brutal.

-          Amazon allows you to create a “pen-name” for your reviews so you can remain anonymous (you have to navigate through your account settings to create your alias, but it is fairly simple to accomplish.)

-          Don’t give a book five stars unless it truly deserves it.

-          If you give a book less than 4 stars, try to be specific about why you didn’t like it.

-          If there are already several reviews and everyone has already said what you want to say, leave your own review anyway. Your review still holds a lot of value because it adds to the number and affects the average. Think of it as a way of thanking the author for their hard work, or punishing them if you felt ripped off. Trust me, authors pay attention to their reviews.

Happy reading!

Friday, April 20, 2012

Who is Performing Your Surgery?

This is a legitimate question. Is it an expert attending physician who has performed over a thousand cases? Or is it a resident physician who has performed five? If you could choose, who would you rather have? Should you have a choice? Do certain people deserve to have a choice while others don’t?

Here is the problem: surgeons must be trained, but training them is risky. Who should bear that risk? Who should be a resident’s first case? Should it be a volunteer? Or should it be an unwitting patient who has no idea they are about to be a young surgeon’s first case? When you sign permission for your surgery, do you deserve full disclosure about whether or not a trainee will be operating on you? Do you deserve the right to opt out of having a trainee operate on you?
Well, let me tell you how things really are.
Every expert surgeon began with their first case. Every expert surgeon had more complications when they were beginners, and then they got better over time. We call this the learning curve. Patients who find themselves at the beginning of a surgeon’s learning curve are at a greater risk of having a poor outcome or complication. That’s just how it is. There are ways to reduce this risk, but the risk will always be there. Take any teaching hospital and see if you can find their morbidity and mortality statistics. I’ll bet you anything the worst months are July and August. Why? Because that’s when the new first-year residents start taking care of patients.
So how risky is it to be at the beginning of a surgeon’s learning curve? The risk of the learning curve is the pink elephant in the room. Institutions that train residents are often reluctant to study it or measure it because if word gets out that the risk is large, they will lose customers. And they don’t like to explicitly inform their patients about the degree of resident involvement because most patients in their right mind would want to opt out of a trainee performing procedures on them. But if patients all refuse to allow trainees to be involved in their care, how can we possibly train our young surgeons?
So how does our current system handle this problem? Here are the strategies currently employed:
1)      Be as vague as possible about the level of resident involvement in surgeries so as not to scare away patients. Some attending surgeons don’t mention it at all. Others bury the facts in the fine print of the consent forms. Very few take the time to explicitly explain the degree of trainee involvement and whether or not this imposes any increased risk.
2)      Try to shift most of resident training over to county hospitals or similar types of systems where the patients don’t really have much of a choice about their care. These captive patients are less likely to ask tough questions about who their surgeon is because they are just happy someone is doing their surgery. And they can’t go elsewhere to get their care even if they want to.
3)      If someone tries to buck the system by saying the above strategies are unethical and a form of social injustice, ignore them, or minimize their concerns by justifying the means with the obvious need to train our surgeons.
Tell me, do you think it is ethical to force the uninsured, under-insured, or underprivileged patient populations to bear the brunt of the risk of the surgical learning curve? Or should this risk be spread evenly across the population?
Do you think every patient deserves to be explicitly told whether or not a trainee is operating on them? Or is it okay to hide this fact from patients?
Society has a dilemma here, and in my humble opinion, we aren’t handling it fairly.