The Peril of Online Physician Reviews

The Peril of Online Physician Reviews

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You may have heard that before you pick a doctor you are supposed to look them up online and see what other people have to say about them before you set up an appointment.

In the Age of Amazon this makes sense. Why wouldn’t you?

Allow me to give you a little insider information.  While they may well be a good idea in theory, Yelp.com and other online physician review sites have evolved in recent years to become the bane of my and fellow doctors existence. 

This past summer, Physicians Working Together, a non-partisan physician organization, started a petition on Change.org requesting Yelp remove online reviews of doctors.  To date, more than 30,000 physicians have signed it but I doubt Yelp will pay much attention.

Recently, the highest-level court in Germany ruled Jameda, an online physician rating site, must remove the name of a disgruntled physician.   A dermatologist from Cologne filed the case in the Federal Justice Court demanding Jameda remove her name due to the fact the anonymous nature of the rating site inspires the public to leave spiteful, vindictive comments.  Interestingly enough, in 2014, a gynecologist asked to be removed from Jameda, however the Court ruled the right of patients to be “well informed” about their doctor took precedence over freedoms of the physician.

What is the value of rating physicians online?  Are consumers becoming “well-informed?”

Patient advocates would argue rating sites for physicians improve transparency for consumers.   Physicians would counter with the argument that a medical clinic is not like a restaurant, hair salon, or shopping mall.  We engage in a highly personal way with the public that is quite different from sitting down for a meal.  The larger concern is whether or not Yelp.com patrons are actually “well-informed” by reading online physician reviews. 

After a little research, it appears the answer is no.  I used a local medical community as an example.  The reviews overall are not very good; on average the medical clinics are 3.0/5.0 stars.  Some reviews extol on physical appearance of the physician, be they female or male.  One reviewer discusses being offended by seeing a transgender physician, an element which has little to do with the provision of medical services.  At first glance, one might believe moving to Kitsap County, WA is akin to choosing between life and death.  Rest assured, most of the populace is alive and well. 

Online reviews are not a reflection of medical care quality.  Patients do not like receiving medical bills and do not like rude clinic staff.  They are unhappy if the physician disagrees with them, they abhor long wait times, and they detest prior authorizations, (news flash, so do physicians!) Yet these criticisms are not a reflection of the healthcare quality provided by the physician.  It is doubtful these grievances even have an impact on the mortality rate. 

According to “well informed” consumers, which qualities make a physician “good”?

Actually, the answer is amusing.  It is best if a physician is in fact, not a medical doctor at all.  It turns out EVERY naturopathic doctor, homeopathic doctor, chiropractor, and acupuncturist in my community is providing five-star-rated care.  One patron gave a few alternative practitioners only one star, but those reviews were more than nine years old; alternative medical practitioners were not as “well-accepted” by a “well-informed” public at that time.  As with other service businesses, the internet is unlikely to replace good, old fashioned “word-of-mouth” referrals. 

While internet ratings are not an accurate way to measure medical care quality, they are a way for angry individuals to air grievances, whether those are truth, lies, fiction, or somewhere in between.  For example, a one-star rating was left by a woman who did not like the way a staff member answered the phone at one clinic; she went on to give 5 one-star ratings to other physicians nearby at other clinics.  Interestingly enough, googling her name brings up a Yelp.com review describing her as having borderline personality disorder. 

What is the public being informed of exactly?  Not much.  Physicians may have difficulty responding to patient reviews without compromising protected health information, ultimately rendering them defenseless.  If the goal is to keep everyone accountable, where is the balance between physicians and consumers?  Should physicians have a database to rate patients?  Accountability is where the rubber meets the road and it cannot be found in online reviews of physicians.  Ironically, the lawyers in my community have very solid 5.0-star ratings, that is, unless they delivered a summons, then they were given a 1.0-star rating. 

Yelp and other physician rating sites should remove the physician reviews entirely because these entities are selling something they cannot deliver.  Until a physician wins a case against Yelp, Google, or another physician rating site, it seems wise to give every patient exactly what they ask for, never argue or tell them the truth, hire staff members who are like Mary Poppins and “practically perfect in every way”, and prioritize timely visits no matter if a patient is dying in the next room.   

Is it any wonder the U.S. mortality rate continues to fall? 

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35 Comments on "The Peril of Online Physician Reviews"


Member
Steven Findlay
Mar 13, 2018

Niran – thanks for this piece and your thoughts, as a doc. Useful. And many useful comments. There is of course the consumer perspective. Surveys have found broad consumer interest in ratings and consumer reviews of physicians. What has so far evolved in this space is less than perfect, to be sure. But there’s good reason to believe methods will get better.

For an academic dive into this subject, please see my piece in Health Affairs (April 2016, 35:4, page 688) — “Consumers’ Interest in Provider Ratings Grows, and Improved Report Cards and Other Steps Could Accelerate Their Use.” The new HHS folks under Trump (Azar and Verma) appear to be supportive of provider ratings….we’ll see what they do with Physician Compare. You can also access online, at Health Affairs, my October 2015 Policy Brief on Physician Compare. I’ll send you PDFs by email.

Member
Pesto Sauce
Mar 1, 2018

Physician in the trenches here…amongst myself & my colleagues we throw online reviews in the trashbin of history. When a doctor has TOO many good reviews, be suspicious, maybe friends or phony aliases wrote those reviews. Most people are who utilize these websites have an axe to grind, are disgruntled and feel power by posting their garbage online. Yelp! actively encourages bad reviews, good reviews are left lower down or on a different page, & their business model feeds on the “bicycle accident” drama of a bad review. They are also strong arm tacticians to advertise with them and get Yelp “star” reviewers in your boat. They are totally fraudulent. As a corollary, the patients that get brought in to practices from ZocDoc are totally clueless, noncompliant, lazy, and uncommitted–millenial fodder. More importantly I want a “patient review” site–the psychos, drug seekers, arrest-warrant and violent crew that disrupts clinics and cause mayhem every day across ER’s clinics and offices. I know a doctor who googles new patients before he sees them to find out if they have a criminal record or if listed in the county rolls for arrests or warrants and he will refuse to see them as they may pose a danger to himself and staff. We are often the target of violence and I don’t begrudge him doing this.
For me the last thing on my mind at night after the mental tapdance (throttling?) I receive from seeing patients daily, online reviews just don’t make sense and are truly garbage. You find your lawn service or restaurant that way, not the professional that is going to ‘scope your colon/probe your sinuses/burn off warts!!!

Member

Pesto, I was with you at the start: just like with a restaurant, too many positive reviews that are brief and generic or feel like ad copy are always suspicious. But your ZocDoc dig looks like just a grumpy person’s spite for a generation. I hope you realize that every millenial is online: whether or not they get a referral they are going to be looking you up online as well, and they like the convenience of setting up appointments online through a general site like ZocDoc (who doesn’t!?!).

The reviews you get through the physician review websites are no higher or lower quality than the reviews of restaurants and lawn services. It’s always the case that the disgruntled are more motivated to post something. Any business can get employees and friends, or hire a company, to post positive reviews as well. So using your logic, should we stop using online reviews of any service because they aren’t a true representation? The fact is that they serve a purpose as one part in the overall search.

Member
Mar 2, 2018

I will confess… I google patients ahead of time too. I also check out their facebook account before accepting them as a patient in the first place. Safety first.

Member

So patients should not look into your details online, but you should look into theirs?

Member
Mar 8, 2018

Patients are encouraged to look into details online, I do not believe reviews qualifies as “details.” I look online and am able to learn whether or not someone likes doctors in general, immunizes their children, or learn what the obstacles to establishing a relationship there might be.
Let’s take you for instance. From your comments, I gather you are not fond of physicians in general. It would be helpful to review your writings before making a decision whether or not to accept you as a patient. If there is no chance to establish rapport, then it is a fruitless exercise to try.

Member
Jul 15, 2018

I always check every last details of a physician online and even ask for friends recommendations.

Member
itstrue
Feb 28, 2018

I agree with the idea that online reviews are not a good way to find a doctor, but I don’t know of any other source of information aside from word of mouth. What are some alternatives?

A 1-to-5 star rating for something like online retail works decently. Doctors, and many other social goods, are too much a matter of preference and individual experience for stars.

How about this: A rating service that doesn’t let users ‘score’ providers, but simply gives patients (and the provider if they like) a 140-character field to say their piece. Have some moderation occur, build in keyword searches and other heuristics, and leave the rest to user judgment, without giving them an easy way out. I bet you could charge for that– including charging the providers for additional services, like a basic web page, appointments system, etc.

Member

I agree with you. Rating service can be easily manipulated.

Member
Mar 1, 2018

My honest answer is the best way to find out about physicians is to do a “meet and greet.” It is a short appointment, patients bring a few questions, and we talk. I can usually tell within a few minutes if a patient and I will be a good fit and I think they can tell also. Not every patient clicks with every physician, but when a physician and patient mesh… it is magical.

Member

A meet and greet is a fine thing to do. But it takes time. I don’t have time to meet and greet every physician I am considering using before actually using him/her. Also, it doesn’t cover everything. It doesn’t solve the problem of knowing the clinical skill and knowledge of the physician. The matter of “fit” is ironically one of the things that an online site can give information about, however imperfect it may be. Physicians who take the time to explain things patiently, don’t talk down to patients, etc., do generally get good reviews in my experience.

Here is how I have used these sites: I know I need a new physician. 2/3 of the time I don’t have a referral (new to the region) or don’t want one (not super happy with my current physician). Whether or not I have a referral, I want to know something about the physician before I make the effort and take time off work to go there in person. As someone else in this thread said, even docs who don’t have to take time off work will Google prospective patients. You want to know what’s out there, and part of what you want to know is how if this doc often gets into disputes with patients or creates an unpleasant experience more than usual. Every doc, just like every restaurant or lawyer, has a bad review. It may wound one’s pride, but patients know it happens to everyone, just like a medical mistake happens to everyone. It’s the trend that patients look for online.

Member
Mar 8, 2018

The way you are looking for a physician appears to work for you. Most people I take care of want a long-term relationship with a pediatrician. They are willing to make the time to have a “meet and greet” because I will be caring for their son or daughter for the next two decades. My practice is on the third generation for many families, so “fit” matters.
The point of this piece is whether or not physicians listen, talk down to patients etc… is not accurate when using the reviews. I find that fascinating. I think patients can find more out about the physician by reading what they write, looking at their website or even asking 10 friends who they see.

Member
Allan
Mar 8, 2018

Niran, I was dealing with three generations of patients as well. In fact, when I went on rounds with my son (an M.D.) in a different county we walked into a patient’s room and the patient looked at me and realized that we had met 20-30 years earlier when she accompanied her mother to my office. Apparently, she didn’t remember my last name until I walked in and she blurted my first name out in surprise and with affection.

My patients were mostly recommended by their neighbors. The rapport was a wonderful thing as it made diagnosis much easier especially since there was a great deal of trust. I never relied on insurers and was one of the few never to join an HMO because IMO they substantially interfere with the physician’s primary interest, the patient.

I would probably treat Halvorson, but I would leave the door wide open.

Member
Mar 8, 2018

Allan, keeping the door wide open with an adversarial individual would be a necessity. I agree with you completely.

Member
Barry Carol
Mar 3, 2018

After I retired, I needed a new PCP near where I lived. There was a five or six physician group practice in the same building as my ophthalmologist so I asked him what he thought. He said they had a very good reputation. I went over to make an appointment and the receptionist asked which doctor I wanted to see. Since I didn’t know any of them, I said let me tell you how I think and you tell me which one would be the best fit. I told her I like to ask questions, I care about costs even when insurance is paying and I don’t like a lot of unnecessary defensive medicine. She said oh, you want Dr. X. Sure enough, Dr. X turned out to be a great fit with excellent diagnostic and communication skills.

As for reviews, I can see both sides. I only posted a review of any sort once which was about my then newly installed whole house generator and the contractor who installed it.. It was very positive. The doctor who performed my ablation is very highly regarded. However, some people complain that the wait in his waiting room can be pretty long before being called in for a consult or checkup. Most people, including myself, shrug that off in the belief that he’s worth waiting for.

Member
Barry Carol
Feb 28, 2018

While I’m not a fan of online physician reviews either, I wonder how much effort doctors put into providing prospective patients with information about themselves that they think it would be important for them to know if they were the prospective patient. Where they went to medical school and did their residency and, if applicable, fellowship training is good to know. So are Board certifications. Personally, I would also like to know how many doctors and nurses they have as patients in absolute numbers and as a percentage of their total panel and how that compares to their peers. For pediatricians, how many children of doctors and nurses they have as patients would be good to know. After all, doctors are nurses are presumably more knowledgeable than the general population about which doctors and hospitals are good and which aren’t.

I’m not a big fan of word of mouth referrals either. Why should I have any confidence in what a neighbor or friend says about the quality of a doctor when their knowledge base may be minimal and what they value may be very different from what I value?

While I understand the complaints about online reviews, I think doctors would be on firmer ground if they offered patients some viable alternatives on how to find good doctors, especially if they are new to the community. A physician referral service that provided more than a list of available doctors could be useful if it is willing to operate like Consumer Reports magazine.

Member
Mar 1, 2018

Barry, sometimes I feel like you have come so far and sometimes it is hard to believe how you think this way. Physicians who are employed are “strongly encouraged” to see physicians working for the same employer. So the more important question is how many independent physicians have their children seen by the pediatrician? You, of all people should understand market forces. Over the years, I have taken care of many physicians children and interestingly enough, have taken care of many pediatricians’ and pediatric specialists’ children. I am not sure it means anything specific about me though.
As for nurses, many of my patients are children of nurses, but again, I am not sure that indicates quality either. As far as a viable alternatives, the best way is to see the doc first and make a decision for yourself. Do they listen? Do they speak to you in a way where you can understand what the diagnosis is? etc…

Member
Allan
Mar 1, 2018

Niran, I treated a lot of the parents of physicians that lived and taught outside of my immediate area. I treated a good number of parents of physicians locally and a number of physicians as well. I don’t know that I was any better than anyone else. I refused almost all entanglements and was always willing to help the patient find a replacement for me. I listened and referred to those I would send myself or my parents to.

That is a very hard task and nearly impossible for any young doctor trying to start a practice in today’s environment. The business community has placed easy to calculate numbers and certain profitable incentives ahead of intellectual honesty which I believe to be all important. I thought the best Internist for my family when I was in training was not the smartest doctor at the hospital. He was the one who listened and never hesitated to get the best second opinion or to give advice that might cost him the patient. If one doesn’t listen one might never know the problem.

All those numbers Barry is looking for would never have led a patient to his doorstep, but I also noted that his outcomes seemed to be among the best on the ward and the patients actually did what he told them to do.

Member
William Palmer MD
Mar 4, 2018

…”the one who listened and never hesitated to get the best second opinion…”

Thank you. Your words are very true here, Allan. One of the best docs I knew was the doctor for Edward Teller, the so-called father of the H Bomb. He would come to our hospital in Berkeley once in awhile and his doctor was quite average, or even banal, or so it seemed on the surface. What was going on was that she was consulting with everyone about her cases: all the in-house physicians and many informal docs in the coffee lounge and many formal second opinions. She would also call her patients at home all the time and do many house calls. The result of all this was a great reputation and terrific patient appreciation and very good outcomes.

I guess it is like everything else: you have to get outside yourself to achieve your best.

Member
Mar 2, 2018

Allan, I suspect we are kindred spirits. I cannot disagree with anything you said above.

Member
Allan
Mar 3, 2018

We are, Niran.

Member
Barry Carol
Mar 1, 2018

Niran, all fair enough. When I think about it, though, there are some important differences between choosing a primary and specialty care doctor. For example, for primary care, I’m interested in good diagnostic and communication skills or at least good enough to inspire confidence, reasonably close proximity to my home, ability to get an appointment on a reasonably timely basis, and good or at least good enough personal chemistry. Hopefully, the doctor also has a good specialist referral network but as a patient, I don’t have a good way to evaluate that. If the doctor is employed by a large health system and faces pressure to keep as much care as possible within the system, that may not be in my best long term interest either. At the end of the day, if I find that the relationship is not working as well as I hoped, I can leave the practice and try to find another doctor that suits me better. How do most independent primary care doctors develop specialist referral networks in the first place?

Suppose I need a cardiac or orthopedic surgeon. If there are five or six in my area, all are Board certified, all have at least 10 years of experience and all do enough procedures per month or per year to keep skills sharp, is it reasonable to assume that I would be in good hands with any of them? How much outcomes variance is there really and can that even be measured well given the huge variance in patient complexity and risk profile?

Member
Mar 2, 2018

Barry, the recommendation from an independent primary care physician is the most pure without question. I have the freedom to recommend ANYONE I want, Usually, when I refer to specialists, those are the very same specialists I would see myself, or take my own children to see. I use the information I hear from my patients and their parents and usually have an up to date rolodex in my head of the BEST physicians for each medical problem. There are no kickbacks and no loss on my part to give a patient the most honest answer about who is the best.

Member

Niran, the key here is “independent.” There are all kinds of ways in which primary care physicians may not be independent in a way that makes their recommendations the “most pure.” How is the patient to know whether you are golfing buddies with a specialist you recommend, or are part of the same sprawling health system, or have any of a number of relationships and biases that go beyond the purely clinical?

Member
Mar 8, 2018

In answer to your question, why don’t you just ask the physician if the doc they are referring you to is their golfing buddy? Or you can ask them if it is a “pure” recommendation. As far as “relationships and biases that go beyond purely clinical”, I am not sure what you are implying, but it sounds a little jaded to me.
As a pediatrician, the specialists are few and far between locally; if I refer patients, it is because I would take my own child there if necessary. Maybe I am not “independent” according to you because when my child swallowed a coin, I took him to the independent radiology place and I liked their service. If we are not allowed “biases” as you say then the whole referral thing is just hopeless and no one can meet your high standards. That is too bad.

Member
Steve2
Mar 1, 2018

Outcomes can still vary widely given the parameters you cite, but in general they will probably be at least OK (there are exceptions). We have talked this over before and I still don’t think there is a surefire way to figure out who is best. You can hope for some help from your PCP, but that won’t always work either. Hope that you know someone in the field.

Steve

Member
Barry Carol
Mar 1, 2018

Thanks Steve. Informative feedback as always. Over the last 25 years, I’ve had six surgical procedures of which three were heart related. I was well satisfied with five of the outcomes and somewhat disappointed with one. There probably never will be a surefire way to figure out who is best and it’s likely that no surgeon bats 1,000 even if he / she is considered the best or among the best.

Member
Res Morgan M.D.
Mar 1, 2018

Seriously, you expect me to go through my active patients (a constantly changing list) and one-by-one determine who is an MD or married to one or the child of one or the parent of one and tally that up and keep it updated and make it available to whomever? Seriously? That’s how I should be spending my time?

Member
Mar 1, 2018

I am with you Dr. Morgan… pretty soon, we will spend 3 hours for every 1 hour of patient care… in a given day we will see 5 patients, type for 6 hours and go home. Hmmmm do you think the physicians shortage will get any better? Doubtful.

Member
Allan
Feb 28, 2018

Maybe it is different where you are Barry, but I have never been in a physicians office that didn’t have all the things regarding licensing and degrees you ask on the wall. You have a right to ask for the information you are requesting if you don’t see it.

What else do you want and why do you place the onus on the physician? You seem to adhere to heavy state control so the license to practice medicine provided by the state would seem to mirror your objectives.

Many people are trying to get an appointment with a doctor and not a physician extender (nothing against physician extenders) or nothing and have difficulty doing that when their illness is acute. I would think a greater focus would be placed on that problem than I want the best doctor (whose fee, of course, is limited by Medicare).

Member
Allan
Feb 28, 2018

The rating system promotes drug abuse and all sorts of bad care. ‘Doc, I need OxyContin for that back strain I had 1 month ago and you didn’t give it to me. I’m going to give you a low rating. Doc, what do you mean I can’t get those special shoes to prevent diabetic ulcers when my circulation is perfect? I’m going to give you a bad rating. Hey doc, enroll me in that free physical therapy program. All you have to do is put an X next to the box that says medically necessary and then sign the form.’

Member
Mar 1, 2018

Allan – exactly correct. If some do not get what they want or have to pay their balance… it is a 1-star-rating all the way….

Member
William Palmer MD
Feb 28, 2018

I agree that medical care can be driven to “pandering care” if patients find out this works….which they soon do.

I guess we cannot stop speech reviewing others. But maybe, also, we can find some right or legal reasoning allowing docs to opt off of yelp, etc.? This would seem fair as they gain by not being wrongfully criticized but they would lose by losing the publicity. But finding a legal basis for this might be difficult.

The main answer to this problem is, I think, to require less anonymity in the criticizers. There is too much mischief. Fake names or no names of the critical patients. Competing physicians can send in spurious complaints. Revenge complaints from disgruntled employees of the doctor’s office….all this kind of stuff.

….Some way to authenticate that that commenter was really a patient of that doctor.

Member
Mar 1, 2018

I think it would be GREAT if we could opt out of yelp etc… the legal argument is part of the problem however. Also we cannot defend ourselves when someone writes lies about care we “provided.” It is frustrating. If the user could be verified, at least, that would help considerably and patients could be held accountable

Member
William Palmer MD
Feb 28, 2018

Or maybe make it such that the doctor always has a right to answer any comment expressed online. The anonymity problem still would need some solution. I notice Amazon checks to be sure the buyer was a verifed purchaser of the product.