SEPTEMBER 5, 2011
“Why Doctors Hate Online Reviews”
Rahul Parikh, MD
Dr. David McKee, a neurologist in Duluth, Minn., didn’t much like an Internet review that called him “a real tool” and suggested he didn’t care about his patients’ comfort. So he filed a defamation suit against the patient’s son who wrote the critical piece, which also alleged McKee wasn’t interested that his dad’s gown was hanging from his neck with his backside exposed.
A judge ultimately dismissed the case, stating that “the court does not find defamatory meaning, but rather a sometimes emotional discussion of the issues.” But it’s not the first time a physician filed a suit against a consumer for a bad Internet review — and probably won’t be the last. A physician’s reputation is all he or she has, and a sour review on the Web can make us very anxious.
Online review sites, of course, are imperfect and open to manipulation. But we all head to Google nevertheless in search of information and advice, whether we’re shopping for a book or a new physician. So how do you know whether the doctor you’re seeing is any good? And how do I know how good a doctor I am?
I recently Googled myself to determine how I fared on sites like Healthgrades, which exclusively rates doctors; and Yelp! and Angie’s List, which grade doctors alongside restaurants and plumbers. The results were inconclusive. Many sites had me listed but not rated. However, on Vitals.com I earned a mere one-star review (out of four). I had no idea who had rated me, or why I earned such a subpar grade. Some of the other information on the site was correct and some was not.
All of which suggests the amount of information online about doctors and the growth of ratings sites doesn’t make it any easier to figure out whether your doctor is brilliant or a quack.
The main reason for this is because it’s hard to figure out what “good” means. On one hand, it could mean delivering safe and effective care. Let’s call this high-quality care (though even defining “quality” this way is also sure to raise debate). Practically speaking, this could mean that if you bring your child to me with fever and an earache, I have the skill to diagnose an ear infection (an accurate exam) and prescribe the correct treatment (the right dose of the right antibiotic for the right number of days). On the other hand, “good” can also mean determining the kind of service I provided. When you brought your child to see me, did I greet you with a smile, listen, show some empathy? Was my office staff courteous and professional? Was it hard to find parking? Did you wait too long? Ideally, we want our doctors to give us both the highest-quality care and service. In reality, that’s almost impossible to judge.
Vitals and other sites have collected lots of anecdotal information about service — indeed, it’s one reason why the site was launched. “I was about to get my Achilles’ tendon repaired. On the table, the doc said, ‘I’m excited to do one of these. It doesn’t happen to me that often.’ That’s not the info I wanted to know then,” said Mitch Rothschild, the CEO of Vitals. “So we started Vitals to help people get that info ahead of time — when they are deciding, not when they are in a hospital gown.”
Rothschild said that we “are a social species — we care what other people think. And many of us make decisions not empirically, but by soliciting other people’s opinions.” Online sites are often the easiest place to speak out as well. After all, how many of us know where and how to file a formal complaint against a doctor or hospital?
But even with the best intentions and rationale, ratings sites have taken fire from the medical community. Much of this has to do with the traditional culture of medicine — new-media transparency causes a clash between the conservative and hierarchical nature of medicine and the forces that are trying to level the playing field between doctor and patient. In our guts, doctors are deeply uneasy about transparency; no one wants their strengths and weakness splayed for all to see in even the smallest open square, let alone anyone who Googles us. We want to care for patients in the best ways possible, despite all of the modern factors (insurance, bureaucracy, cost, risk) that have made this harder than in the past. So a negative review, while usually not leading to a lawsuit, often leads to anxiety, a crisis of confidence and concern for our reputation.
These sites also do very little to help me get better as a doctor or improve the doctor-patient relationship. Did my one-star review come from someone who felt I was rude or from someone who demanded a prescription but didn’t get one from me? With anonymity, it is impossible to tell. And even if I wanted to respond, federal privacy laws would not allow it.
Perhaps the biggest limitation with Vitals and other sites has to do with the paucity of reviews. While Vitals claims it has information on some 720,000 doctors, according to Rothschild, each doctor has only an average of four ratings. In another study of physician rating sites, researchers found that only three out of 250 doctors had been rated five or more times. Given the thousands of patient visits one doctor will take part in each year, one-to-four opinions hardly counts as the wisdom of the crowd.
Perhaps “how good is your doctor?” is the wrong question to ask. Given how complex medicine and medical care is these days, no single doctor can know it all and do it all. Instead, it may be better to look for a system of care — primary care, specialists and other members of a team — that works to provide quality care and multi-star service in a coordinated fashion. A few such systems exist around the country, and as healthcare reform continues, we’ll probably see more sprouting up. If you’re skeptical of that view, just look at the scandal in the military at Walter Reed Hospital. That shameful service and quality wasn’t because of a single doctor, but because the entire system meant to take care of wounded soldiers was in shambles, leaving patients out in the cold.
Mobutu: Same Old Same Old. Every professional prefers the safety of peer evaluation. Do college professors like to be rated by know-nothing students? No. Do professional politicians like to be evaluated by ignorant voters? No. Doctors are no different. But they are playing with the lives of their patients, and these people need to make their voices heard, because to them it could be a matter of life or death.
Allen3: Doctors need to be proactive. IMO, health care providers should be proactive on this issue by collecting and publishing feedback and ratings, rather than waiting for outside organizations such as Vitals.com to do it
Dr. Stan: MD’s are as a whole over paid whiners. The primary reason, according to research, people go to med school is “to make money, lot’s of it”. In addition the state medical boards regularly fail to discipline incompetent and unethical medical practitioners. Consequently they are not held in high esteem, which they feel is their “right”. If the medical boards did their job and weeded out the poor performers the need for these ratings would disappear.
Bigguns: I can understand your frustration with an anonymous person giving you one star without explanation. I might hesitate to hire you based upon a one-star review. Professionally, I don’t like working with doctors. They don’t listen well. They think they know better. They’re like you, doc.
Elian Gonzales: Puh-leeze! “It’s unclear how that number was calculated.” Really? Here’s something to do on the rest of your vacation: go to some doc’s office and quietly ask how long people have been waiting. The drug reps get in before the patients and *NO* doctor looks at an appointment time as anything to keep but a recommendation.
Aunt Messy: I see the whining has started. The problem with online reviews is that people who are happy with their doctors don’t write them. As with any type of rating, the only ones that bother are the ones with something to bitch about. I’m beginning to think I’m about the only one in the world willing to take ten minutes to go to a rating site and tell the world that I’ve happened on a fabulous doctor. I’ve had three or four bad doctors over the years and I fired them. It’s easy to do, you know. It’s really irritating when I hear someone complain endlessly about their GP (or whoever), but refuses to go shopping for a new one. I’m not interested in hearing the whining if you’re not going to do anything to fix the situations.
Sedan Chair: How bout this? I’ll review doctors scientifically when doctors start prescribing medication scientifically.
Odin’s Legacy: After more than four decades in a classroom, I notice that a little respect for the students goes a long way in getting a good review. Our sawbones might heed that. Having made that comment, I have to say that the younger doctors are much better at bedside manners than those my age. But I do agree about the anonymous part. Patients and students should be up front. Don’t unload on the receptionist about the wait time; wait until you’re in the room with the boss. Same with the prof. If teacher or dr flares up, then it’s time to look elsewhere.
DrSteevo: My Schedule is my review. If it is full, then I am doing a good job. I don’t care what online reviewers say about me, and neither do most of my patients. Word-of-mouth is far more important to a doctor.
Skeptonomist: If physicians don’t like popular ratings and being held accountable by lawyers, maybe they should accede to some real ratings and policing systems. Patients can certainly rate physicians on various kinds of unprofessional behavior, which is quite common and for which there is otherwise little accountability in private practice.
St. Simeon: These websites are not about honest, useful reviews of much of anything. They’re more bullshit designed to sell advertising. Have you seen the unbelievable nonsense people put on the internet? It’s all about making money and suckering people into thinking they’re getting something useful. Craigslist is one of the few sites I might actually trust, and that’s because – obviously – they aren’t trying to sell me anything.
Odetteroulette: Who cares if it’s “scientific?” The reviews are not there to be scientific. They are opinions. Opinions aren’t scientific. Duh. The thing to watch for, and to notice, is repetition and really, astoundingly bad reviews that repeat themselves. Then, you can be wary. But, transparency is a good thing. If you have a lot of low reviews, instead of writing fake reviews to ‘up’ your score, how about reading the reviews and really analyzing your work, to see if the criticism has any truth to it. Of course, if your office is full, then what do you care? Honestly, the reviews aren’t for YOU anyway.
Alien in Reno: Yes, the criteria used for these ratings are arbitrary, and, given that satisfied patients rarely write reviews, easily skewed. However, I think publicly available evaluations of a doctor’s effectiveness are way overdue. After all, we subsidized your education, and pay your wages, why should we be denied a means of gauging whether we will get skilled care? At my workplace, we now have a ‘consumer driven, high deductible PPO’ – this means we are expected to pay 100% of costs until we reach our $2000 deductible. So, shopping around a few doctors, at who knows how much per visit, quickly adds up. In the absence of a personal recommendation by someone who has the same condition, how on earth are we supposed to know if a doctor has done one hip replacement, or a thousand (or a thousand crappy hip replacements, for that matter)?Trust me, this is coming, and you’d better get used to it – you are very well rewarded for what you do, and you should expect a high degree of scrutiny and accountability to go with it.
Aquatic: I’ve found doctor reviews to be invaluable and I make a point to post reviews especially of good docs. Because at the end of the day we read the reviews to find the good ones. Without these online reviews, unless you are lucky enough to find enough information by word of mouth you are truly choosing blindly for some of the most important decisions in your life. A bad doctor can kill you – literally. Hell, they don’t even have to be bad, just uninterested and negligent. Can you tell I’ve met a few? There needs to be some source of accountability and publicly available information beyond reporting someone to the medical board. Dr. Parikh, if your concern really is to be a better doc then don’t let that one star review trouble you. Instead set up a process to solicit feedback from your patients. I have no doubt it will be helpful and your patients will feel heard and valued and so then value you even more. And one day you’ll check that ratings site and there will be five star reviews from patients saying – wow, my doc cares so much that he has us give him feedback on purpose and this is really a patient centered practice.
Jberejik: Go with the simplest explanation. We patients come to office on time, and then we wait. If you ask, without exception every one of your patients will complain about this. It is the one constant in American medical care. Fix this and you’ll get five stars across the board.
Jberejik: Dear Doctor, please read and take seriously the under current of anger and frustration in these responses. The relationship between doctor and patient is fundamentally broken in our society. Write about that. Try to understand why we are so upset. You listed a number of possible and seemingly illegitimate reasons why you didn’t get five stars – e.g. parent wanted drugs that you would not prescribe. But we are saying something different. Very different. Please, please, work and write and think about how this mess of a medical system itself requires healing.
Fernie: A doctor suing a patient’s relative for speaking up on a website? These are the same so-called “professionals” who are trusted with people’s lives, expect to be highly regarded in society, and in most cases honestly believe people look up to them. You are doing more to damage patients’ trust than you know, and if I was in the market for a pediatrician I certainly wouldn’t go to you after reading that about your response to your rating, because it looks like you are desperate for business and perhaps too self-conscious to be good at much. Now I would not trust you to wash your hands unless I directly observed you doing so. No competent conscientious professional should try to suppress their patients from sharing information.
Jeremy: If doctors made it easier for bad doctors to lose their licenses the medical profession would be much better off. Instead, they all band together and make it near-impossible get rid of a bad doctor, and impossible to sue them when they’re incompetent.