The Internet provides plenty of opportunities for consumers to rate the quality of professional services they receive. A quick search can help you find recommended plumbers in your area, or suggest that you steer away from a certain roofing contractor.
Similarly, there are lots of online physician rating websites that offer the same service to consumers: check and see which doctors in your area are recommended by other patients.
I’ve watched the mushrooming of these “rate-the-doctor” websites with interest. While they provide an opportunity for patients to provide feedback to doctors and other patients, some elements could use improvement.
1 – They’re anonymous
Who is writing the reviews? While most come from true patients, there’s nothing to limit one single patient from sending 8 reviews about the same experience. For that matter, who’s to say good reviews aren’t from the doctor, trying to boost her image?
Physicians who are also small business owners (like me) from time to time terminate poor-performing employees. After a firing, does a spike in negative reviews of our practice reflect coincidence, or an ex-employee trying to retaliate anonymously– especially if the review contains “insider information” that our average patient wouldn’t be aware of?
2 – It’s not clear the patient is really a patient
When I read travel reviews online, I’m struck by how many reviews come from people who admit in their review that they didn’t actually stay at the hotel or eat at the restaurant. The review will read something like “I wanted to stay at this hotel because I’ve read so much about it, but when I clicked on the Reservations tab, I was shocked at the room rates. I couldn’t believe this hotel would charge so much for so little.
“They will never get my business!”
While the consumer is giving feedback to the hotel (“I think the market won’t sustain your prices”), this one-star comment hardly addresses what most travelers want feedback on (cleanliness of the rooms, friendliness of the staff, quality of the restaurant), since anyone can look up the prices for rooms.
Similarly, anonymous patient reviews don’t distinguish between a patient who came once, a long-term patient, and a prospective patient who has never been seen.
The latter’s comments are usually about a perceived access barrier to care, like: “I was new to town and needed a pediatrician. My son had terrible ear pain so I called to see if anyone could phone him in some antibiotics before the weekend. They were so rude and refused to help me out. I will never go there.”
Since I never had an opportunity to meet the family myself, never established a physician/patient relationship, and certainly never had an opportunity to explain, I don’t really consider this a review from a patient – but it’s in there with the rest of them.
3 – There’s no way to respond.
Some consumer rating websites, like Trip Advisor, allow the hotel or restaurant to respond or comment to a particular review. Many doctor rating websites don’t have a similar feature.
I don’t have an opportunity to apologize, or set the record straight, or offer to make my patient’s bad experience right. The patient can vent, surely, but I’d rather to try to reconcile the relationship.
4 – Patient privacy is protected.
Even if I can figure out who wrote a particular negative review, I can’t respond specifically in public with patient-specific information. Let’s say a mother posts a comment that I misdiagnosed her child’s ear infection: “even though Dr. Berman said Caleb’s ears looked great — later, when I took him to the ER, they said his ear was terrible.”
I review the child’s record: indeed, I examined the child in my office, who had clear ears. The child indeed went to the ER for worsening ear pain — five days later.
To me, this doesn’t speak to misdiagnosis as much as it does a common medical problem of kids: good ears sometimes go bad. I’d like to post something to clarify this online – to take the opportunity to educate families that ear exams can change over a period of days – but I can’t.
Simply, if I post any public health information about Caleb on the Internet, I’ve violated patient privacy laws (HIPAA). I can try to contact Caleb’s mother privately to make this same point, but she may or may not see fit to alter her online statement.
5 – Even the “neutral” information can be wrong.
“Rate-the-doctor” websites usually contain some basic demographic information, like the physician’s address, board certification status, age, gender, and so on. This information is often out-of-date, if not completely erroneous.
I’m amused to sometimes find that, according to some websites, I’m not board certified or that I practice at an address I haven’t worked at in seven years. Again, there’s often no mechanism for me, as the actual physician, to contact the site administrator to ask that my information be corrected.
So patients who come to these websites to get information about physicians may read bad information even before they look at the reviews.
Once it’s on the Internet, it’s there forever.
Our office periodically reviews our online reviews. A while ago we found one from a dissatisfied patient, rating us 2 stars out of 5, and concluding, “If there’s another place to take your kids, you should probably take them there, and not to this office.” The review was dated about 9 months prior to our discovering it.
The mother had left enough personally-identifiable information in the review for us to figure out who had posted it. Interestingly, in the 9 months since she felt dissatisfied with us, she was continuing to bring her son to us, and in fact had had a newborn daughter, whom she was bringing to our office for care.
We were puzzled that, if she were that displeased with our office, she hadn’t followed her own advice and transferred care to another practice. The next time she was in the office, we gently asked her about her review.
At first she looked blank; she’d completely forgotten she’d posted it! Finally she said, “Oh – that. Yes, I was dissatisfied with your office a couple of times, but since then I’ve kept coming, and now I’m much happier to be a patient here.”
We’re happy that she’s now more comfortable with us. Unfortunately, her review is still on the Internet, forever, and possibly no longer able to be amended.
Doctors are starting to fight back, and it’s not pretty.
While patients have the right to post opinions on the Internet, doctors who feel an opinion crosses the line have sued for defamation, slander and lost income. Doctors who respond in this way have drawn a lot of media attention – and many of them have a sudden increase in negative reviews posted.
This suggests that many of the newer respondents perhaps aren’t patients at all, but rather many readers are angry that a doctor would try to sue a patient for expressing her opinion. As far as a doctor trying to enhance her online reputation, it doesn’t seem to be a very effective method.
So what’s better?
Our office collects anonymous periodic surveys of our patients to learn how we’re doing and how we can improve. We ask patients to rate us on timeliness, friendliness, professionalism, and so on while they’re in the office as part of a visit.
This assures us that the reviews are being completed by actual patients, and that they’re being completed at the time of the visit, while impressions are still fresh.
Because we design the survey, we can make it specific as needed to help us identify problem areas: for example, rather than asking if “staff” are rude or friendly, we can ask for separate feedback on receptionists, nurses, doctors, billing staff, etc.
We’ve started sharing the results of our surveys with our patients, and we’re going to post future results on our practice website as well.
While our patients are free to comment about their experiences on rate-the-doctor websites, we believe posting results of our surveys will provide an equivalent service, and will be a more complete representation of our patients’ impressions of our practice.
Suzanne Berman is a practicing general pediatrician in rural Tennessee.
Counseling patients about safety issues is one of the most important parts of my role as a primary care pediatrician. One of the main goals of working with my patients is to reduce the risk of injury to children in the environments in which they live and play.
Thus, I spend time discussing potential problems related to seat belt use, tobacco exposure, storage of household chemicals, swimming, sun and playground safety, and more.
Talking about firearm safety and storage is part of this conversation as well.
The answers I get to questions about firearms are fascinating. Many people say, “We don’t own guns, so we don’t worry about this.” When asked if they know if there are guns in the houses of children their kids play with and if their kids would know what to do if they saw a gun, they often answer, “I hadn’t thought about that.”
Those who do have guns have a chance to talk about safe storage, and often have tips that I can pass on to other families, such as where parents can find good training courses for their kids, when appropriate.
I believe talking about gun safety and other safety-related issues is an important part of the preventive counseling I provide patients and their families. When the government tries to dictate what a physician and his or her patient can and cannot discuss in the confidential setting of an exam room, I no longer can perform the preventive aspects of pediatrics expected of me.
Thus, I applaud the decision of the U.S. District Court for the Southern District of Florida.
The Florida chapter of the American Academy of Pediatrics, along with other groups, sued to block the law. Recently, a federal court declared the law unconstitutional, saying it was a violation of physicians’ First Amendment rights to speak with their patients about gun safety.
To learn more, read the court’s decision.
Dr Seth D. Kaplan, who practices general pediatrics in Frisco, TX, but finds every excuse he can to get out to the ballpark. Go Rangers!
Dr. Kaplan posts topics on Facebook at TLC Pediatrics of Frisco.