Perspective

Perspective Perspective

Online Physician Reviews

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Online physician reviews have generated impassioned critiques both pro and con. Although physician online rating sites have provided an impressive volume of potentially useful feedback information, physicians had not necessarily responded favorably to the abrupt exposure to occasional negative reviews. This is in stark contrast to patient rights advocates who believe that doctors should be subjected to the same public scrutiny as any other service or business provider. There is value in receiving useful feedback regardless of one’s station in life. A potentially constructive reviewer, however, might be negatively balanced by a disgruntled individual intent on ruining a doctor’s reputation. In the context of a small sample size, one negative review can tremendously downgrade a doctor’s overall online reputation. This becomes more egregious when the patient’s reasoning involves basic disagreements on the doctor’s assessments and treatment recommendations.

Whether this all seems fair or not, online reviews for doctors are now considered the most important factor among many patients in choosing a new health care provider. Recent surveys indicate that online information has become more important in selecting a physician then another doctor’s referral. Similar surveys indicate that over 80% of respondents went online to read the reviews of a doctor after receiving the referral from another provider. None of this should be particularly surprising, considering the growing consumerism of health care, and the strong momentum created by the COVID-19 pandemic toward online activities. Digital preference for investigating providers existed well before the pandemic, but COVID-19 accelerated this process dramatically. In choosing a new primary care physician for example, approximately 50% of patients first go online to review the doctor, whereas only about 20% seek recommendation from another health care provider. According to Press Ganey, search engines such as Google are the most used digital references accessed by patients to find a doctor. The leading website destinations for a doctor search include WebMD, Healthgrades, Facebook, and independent hospital websites.

Somehow it seems reasonable to expect that patients who find their physicians online will also rely heavily upon online resources to provide feedback on those doctors. It is also equally logical to understand the skepticism felt by many doctors who worry that physician online rating sites encourage destructive acting out by begrudged patients who might not necessarily understand the technical aspects of health care delivery. Furthermore, there is justifiable frustration in that physicians are usually unable to refute negative reviews without jeopardizing patient confidentiality.

Patient empowerment and selfexpression in health care does not occur in a vacuum, as the Center for Medicare and Medicaid Services has an established set of core quality measures for health care, with patient experience being one of the critical domains. Furthermore, traditional government and health care organizations have routinely initiated surveys incorporating patient-reported outcome measures in their routine questionnaires. Within the context of these developments, physician online reading sites had become a consumer driven alternative and perhaps a cathartic outlet for patients to provide instant feedback on their health care experiences.

Even if one were to stipulate the argument that online review sites such as Vitals, Healthgrades, RateMDs, and

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Chengdu Gourmet (the beloved James Beard-nominated Squirrel Hill hole-in-the-wall Sichuan restaurant that regularly inspires pilgrimages from “ all over Western PA) is planning an outpost on McKnight Road at the site of the former Oriental Market, in the plaza next to Red Lobster. This will offer a much larger dining space – 6,000 square feet – and an expanded dining menu. Something to look forward to in early 2022.

Enjoy, and be safe.

Dr. Paranjpe is an ophthalmologist and medical editor of the ACMS Bulletin. She can be reached at reshma_paranjpe@hotmail.com.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

Improving Healthcare through Education, Service, and Physician Well-Being.

favorable online reviews from patients. Healthgrades, for example, has a policy encouraging doctors who have received unsatisfactory patient scores to encourage even more patients to go online and complete surveys based upon the presumption that more favorable reviews will mitigate the negative impact of the unsatisfactory reviews. This policy however is in violation of the National Association of Social Workers and The American Psychological Association Code of Ethics. Both associations state that it is unethical to elicit or solicit testimonials or endorsements from patients as this would be an example of undue influence and exploitation of vulnerability. The American Medical Association has no similar policy, but that is not necessarily an absolution.

The financial incentives for Healthgrades to increase their online traffic are obvious, as Healthgrades is owned by the corporation Red Ventures, an America media company owning several television media channels as well as having purchased Bankrate Inc. for $1.24 billion in cash in 2017. RateMDs, which is owned by the Canadian mass media company Torstar Corporation, has a protocol which will allow a doctor to ostensibly ‘claim’ his or her profile including all comments, and for a monthly fee of $179 can hide up to three negative comments, as well as place banner ads on the website for promotion. For a fee of $359 a month the doctor’s banner will appear in three times more spots than the lower priced package. The lack of transparency in this matter results in the public being unaware of the financial incentives at play.

The moral paradox in this high-tech gambit begs the question of whether doctor online rating sites are mindfully intended to provide the opportunity for consumers to share constructive criticism for the betterment of everyone concerned, as opposed to being part of a multimillion-dollar industry carefully formatted and designed to financially hold hostage the reputation of doctors. The other question at hand is whether we risk enabling a nefarious enterprise by our participation in it.

Online physician rating sites are not going away. I took a personal interest in this subject when I read a review suggesting that I received my medical degree from Amazon (the company, not the rainforest). Had I been so fortunate, it would have cost less, and would have been delivered to my house in 24 hours. The American Medical Association provides some useful suggestions on how to deal with negative online reviews. If you are somehow able to unobtrusively determine who submitted the review, you might consider contacting this individual personally just see if there can be amicable compromise which would motivate the patient to remove the negative review. Personally, I would be very selective as to who I would use a strategy with. Another option would be to establish your own online profile and encourage nonanonymous feedback. Eventually, one must address the philosophic question of whether one or two bad reviews would truly destroy your life or your reputation. The natural reaction when one’s feelings are hurt is to immediately respond. Often, this is what resulted in the patient posting the online response. Immediate emotional responses are often a mistake, therefore becoming angry in attempting to respond in turn would be an equally big mistake. It is also important to remember in the context of these situations that HIPAA always applies. A patient’s disclosure is not permission for the doctor to make equal disclosures. Finally, despite the natural inclination to do otherwise, don’t cognitively block the feedback outright. There might be an opportunity for growth. If not, you could always cheer yourself up and buy a medical degree from Amazon, like I did.

References:

Andrew M. Placona, Cheryl Rathert. (2022) Are Online Patient Reviews Associated With Health Care Outcomes? A Systematic Review of the Literature. Medical Care Research and Review 79:1, 3-16.

Lee, V. S. (2017a). Transparency and trust: Online patient reviews of physicians. New England Journal of Medicine, 376(3), 197-199.

Murphy GP, Radadia KD, Breyer BN. Online physician reviews: is there a place for them? Risk Manag Healthc Policy. 2019 May 15; 12:85-89.

Widmer RJ, Maurer MJ, Nayar VR, Aase LA, Wald JT, Kotsenas AL, Timimi FK, Harper CM, Pruthi S. Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses. Mayo Clin Proc. 2018 Apr;93(4):453-457.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.