OR WAIT 15 SECS
You do have some control over what's being said about you on the web.
Dr Levine is Practice Director, CCRM New York, and Attending Physician, Lenox Hill Hospital, New York. He has no conflict of interest to report in respect to the content of this article.
In 2016 it’s hard to imagine opening our wallets without first opening a web page. We are hunter-gathers of crowd-sourced reviews of movies on Rotten Tomatoes, restaurants on Yelp, hotels on TripAdvisor, and technology on CNET. Getting educated and making informed purchases is what it’s all about. Websites such as Amazon cater to our desire to be advised and they place consumer reviews directly below product descriptions.
It’s no surprise, then, that our patients are also doing their "homework" about us before coming to our offices. A recently published study of online reviews of orthopedic surgeons found that those in academic practice had significantly higher ratings, as did those in practice for 6 to 10 years; neither physician gender nor geographic region played a significant role in online rating scores.1 Similar results have also been published in reviews of urologists whereby no difference in online ratings was found when gender, region, or city size were compared.2
In another study of online ratings of orthopedic surgeons, the authors sought to identify key differentiators in overall ranking scores. An analysis of website traffic found that the 8 busiest physician-rating websites were AngiesList.com, EverydayHealth.com, Thirdage.com, Yelp.com, HealthGrades.com, Vitals.com, UCompareHealthcare.com, and RateMDs.com. Upon further analysis, 4 websites were excluded from the study due to "inaccessible or unreliable data," leaving HealthGrades.com, Vitals.com, UCompareHealthcare.com, and RateMDs.com, with 2185 total reviews for their in-depth analysis in a major metropolitan region. The significant variables that led to positive/negative scores were ease of scheduling, time spent with patient, wait time, surgeon proficiency/knowledge, and bedside manner.3
Interestingly, the authors of both studies found that the average physician had an average score.2,3 In fact, it is the Internet norm for physicians to have favorable reviews! In a 2011 study of nearly 5000 individual online ratings, the average rating was 77/100 on a 100-point scale, 3.8 on a 5-point scale, and 3.1 on a 4-point scale.4 This may be because most patients are content with the care they receive and don't feel compelled to rave or slam a physician. It may also be due to the fact that because there are so many websites, it is hard for the information to be appropriately consolidated into one forum.
In a creative study, researchers presented subjects with a Web-based questionnaire containing a short description of a dentist search scenario and the manipulated reviews for a fictitious dentist.5 What the authors found was that a higher number of reviews resulted in a more positive attitude toward a physician, and that fact-oriented reviews induced a more favorable attitude toward a physician compared to emotional reviews, but there was no such effect when the physician received many reviews.5 This is concerning because it suggests that despite the quality of the reviews (ie fact-oriented or not), a low number of reviews led to a significant difference in perceived credibility, regardless of the content of the review.5 The converse also appears to be true. On RateMDs.com, where the average number of ratings per physician is 3.2 and approximately 50% of all physicians had only one rating, a single unfavorable rating on overall score can decrease the physician’s average score and "make an otherwise high-performing physician appear mediocre."6
Despite the fact that most physician reviews are positive and that the variables entirely within physicians' control (wait time, bedside manner, time spent with patient, etc.) are the metrics most highly weighted by patients, physicians tend to have an innate discomfort with online review websites out of fear of a negative review. This fear is not unfounded. In 2012, a nationally representative sample of the U.S. population was surveyed about their knowledge and use of online physician rating websites and researchers found that 35% of all participants reported selecting a physician based on good ratings and 37% had avoided a physician with bad ratings.7 In a 2014 Wall Street Journal article, a patient asked about his experience with online physician review websites answered that most websites are "helpful" but that the "ones that are negative [he] always take with a grain of salt."8 The respondent goes on to say, "but if there's a bunch of negative reviews, then OK, maybe something's going on."
So what do you do about a negative rating? If a website (such as Yelp or Google) allows for responses, you can directly respond to the review. However, that should be done with extreme caution. For example, you do not want to respond by violating HIPAA or making yourself look worse by saying something like, "I'm so sorry you had to wait, the patient before you had a placenta previa and she started bleeding after my digital exam." In fact, I recommend not responding to any review publicly and instead reaching out to the patient privately through secure communication.
If you notice a slew of negative reviews, take the advice to heart and start to see if you can make changes in the identified "problem areas." After implementing the changes, don't be ashamed to ask patients to write online reviews. You can even print business cards with the web address of your profile and ask patients to go to the website and review their experience that day.
If a review is completely unfounded, vindictive, or malicious, you can contact the website to ask for it to be removed. However, be careful not to disclose any protected patient information. On websites such as Angie's List, dealing with negative reviews and arbitration is part of the membership agreement. In the agreement, it explicitly states that "If the Service Provider agrees to your desired resolution or supplies a counteroffer that you find acceptable, the case is considered resolved, your review regarding the Service Provider will be removed, and you will have the opportunity to submit updated feedback about your experience."9 While this site is meant more for home services, and this policy is most appropriate for getting a refund from a gardener who killed your petunias, it does demonstrate that review websites may be ok with quid pro quo when it comes to review management.
Hospitals and soon the government will be sourcing Internet-derived patient-reported data. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS, pronounced “H-Caps”) is a standardized survey and data-collection tool designed to measure patient opinions of hospital care in 11 categories.10 Through use of natural language processing technology to analyze Yelp reviews of hospitals, a recent study identified 12 additional categories that are not currently covered by the HCAHPS survey: cost of hospital visit, insurance and billing, ancillary testing, facilities, amenities, scheduling, compassion of staff, family member care, quality of nursing, quality of staff, quality of technical aspects of care, and specific type of medical care.11 This study, the first of its kind, elegantly demonstrates how technology can be harnessed to turn highly subjective reviews into actionable data.
However, all review websites are subjective and subject to the quality of the information provided by the patient/consumer/reviewer, ultimately leaving the "online reputation" of the physician in the hands of reviewers and anonymous (and hard to reach) website administrators. In a refreshing twist on how a physician review website should look, feel, and behave, Jake and Deb Anderson-Bialis created FertilityIQ, an objective site of subjective reviews.
On the surface, FertilityIQ appears to be just a niche fertility-focused physician review website. However, the site is focused on obtaining the facts about the patient-provider experience and turning the subjective into objective. Patients are asked to do more than just click stars: They can add their own fertility history; share their experiences and outcomes with doctors, nurses, and clinics that treated them; and skip any answer they want. And while the first part is already enough to set FertilityIQ apart from generic physician review websites, the fact that reviewers’ authenticity is confirmed, is truly incredible. According to the website, "after you complete an assessment, you email us something to show that you were a patient at the clinic you rated. We ask that the clinic name and your name be legible, and no sensitive information is required. This can be a forwarded e-mail message from someone at the clinic, a partial bill, a screenshot of a patient portal, or anything that shows you were a patient. Once we receive your document, your assessment will be marked as ‘verified’ on FertilityIQ.”12 The patient/reviewer-derived data are compiled to show how likely patients are, on a scale of 0 to 10, to recommend a doctor to a friend, in addition to metrics of quality of communication, degree of individual attention, and responsiveness.
Patients' and providers' interests are aligned; we all want more and better data. Consumer-level sites such as Yelp and Google weren't designed to review medicine and as such, these reviews should not drive patient decisions about who to see, and should not lead physicians to make false assumptions about the quality of their care. Furthermore, while websites such as HealthGrades, Vitals, UCompareHealthcare, and RateMDs are designed for healthcare, the lack of oversight combined with the power of a vocal minority of reviews can misinform patients and providers and lead to dangerous outcomes. FertilityIQ is just the first of what likely will be many websites that are introducing multi-dimensional reviews with requisite patient verification. Sites such as these have great potential utility when applying for hospital privileges, negotiating insurance contracts, or simply considering hiring a physician.
1. Frost C, Mesfin A. Online reviews of orthopedic surgeons: an emerging trend. Orthopedics. 2015;38(4):e257-262.
2. Ellimoottil C, Hart A, Greco K, Quek ML, Farooq A. Online reviews of 500 urologists. J Urol. 2013;189(6):2269-2273.
3. Bakhsh W, Mesfin A. Online ratings of orthopedic surgeons: analysis of 2185 reviews. Am J Orthop (Belle Mead NJ). 2014;43(8):359-363.
4. Kadry B, Chu LF, Kadry B, Gammas D, Macario A. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating. J Med Internet Res. 2011;13(4):e95.
5. Grabner-Kräuter S, Waiguny MK. Insights into the impact of online physician reviews on patients' decision making: randomized experiment. J Med Internet Res. 2015;17(4):e93.
6. Ellimoottil C, Leichtle SW, Wright CJ, et al. Online physician reviews: the good, the bad and the ugly. Bull Am Coll Surg. 2013;98(9):34-39.
7. Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014;311(7):734-735.
8. Sumathi Reddy. Doctors check online ratings from patients and make change. Wall Street Journal. http://www.wsj.com/articles/SB10001424052702304422704579571940584035918. May 19, 2014.
9. Angie's List Membership Agreement. Last updated on May 9, 2014 https://www.angieslist.com/angies-list-membership-agreement.htm
10. CAHPS Hospital Survey. http://www.hcahpsonline.org/home.aspx.
11. Ranard BL, Werner RM, Antanavicius T, et al. Yelp reviews of hospital care can supplement and inform traditional surveys of the patient experience of care. Health Aff (Millwood). 2016;35(4):697-705.
12. FertilityIQ. https://www.fertilityiq.com/. Accessed April 12, 2016.