How doctors should deal with physician rating sites

in Physician | 12 responses

Stuff the ballot box.

The value of these sites, previously exposed as pretty useless in this Slate piece, is mainly due to the anonymous nature of the comments.

Indeed, even if a doctor wanted to genuinely improve from this form of patient feedback, “posting anonymously on the Web (on sites a doctor does not regularly monitor) is probably the least effective way to accomplish that goal.”

So, physicians are fighting back by skewing the reviews (via Dr. RW) in their favor. A couple of good ideas: i ) Have patients fill out comment cards in the office that can later be posted on physician-ratings Websites; and, ii) Direct satisfied patients to these sites and encourage them to comment.

A doctor utilizing these techniques can skew their positive to negative comment ratio 50-to-1, so that, “The bad ones are totally ignored since they look so petty.”

The lack of regulation works both ways.

Comments

http://www.scienceandsensibility.org Amy Romano
I agree that most of the provider rating sites are ineffective, but there is one that I support. The Birth Survey. It allows consumer feedback on maternity care providers and facilities, and is much more robust than most of the commercial provider rating sites I’ve seen. I do ask all of my clients to complete the survey at their postpartum office visits. Almost half of all of the women I took care of last year did in fact take the survey, even though it takes at least 20 minutes to complete (and these are busy, sleep-deprived new mothers!). I wrote about why consumers may be more likely to rate maternity care providers than other specialties – and why the feedback may be more likely to make a difference – on my own blog.
AnnR
It’s not a bit unusual at big retailers to have the clerk circle the web site at the bottom of the receipt and suggest you visit and leave your opinion.
David Block MD
The problem with “stuffing the ballot box” is that it enlists patients as co-conspirators instead of transforming them into shareholders in a doctor-patient relationship. In a crazed enough legal environment, one might see it as inducing false advertising. Isn’t our issue with pseudoscientific surveys per se that do nothing except provide advertising space for those “fine young men and women (God knows, you got to love them”) – as we say in the south – who turn a dollar based on the ignorance and ill will?
So I’m guessing that instead of “stuffing”, you’re really telling us to find ways to educate our patients about helping us be successful by letting everybody know that our clinical care is forever personal and never anonymous. You’re asking us to teach them a bit about statistics so that they understand not only why these ratings are downright evil, but also why some of the gross marketing of drug companies and attorneys is equally perfidious. Perhaps we should, quite easily, start free blogs for each medical practice on blogspot.com, or form individual practice social networks on ning.com after all becoming “business associates”. We might at least having somebody purge protected information before going on-line just to be safe.
Perhaps some of our more visible physicians – a Sanjay Gupta or an Andy Weill – could try to stop a bullet aimed at the profession by coming out and, without dropping any names of these rating services, just pointing out in public that these sites are…well… garbage. Let everybody know that our profession is devoted to changing the direction of medical practice to being about people and their homes and their relationships, and that “doctors and patients know what quality is, not MBAs.”
Don’t stuff the ballot box. You may win the battle. But you know damn well you are doing this out of cynicism and impending despair. You will lose the war because you think it is just a matter of time.
Change the context of the argument. Redefine the goals. Stop trying to manage what is no longer ours – if it ever was. Doctors are leaders. Aren’t we?
http://drgrumpyinthehouse.blogspot.com Dr. Grumpy
I try to ignore these sites. They are unscientific crap.
I’ve had my practice posted a few times that I’m aware of, suprisingly all in a positive light, but I still think this practice is wrong. Most comments will be negative, because a satisfied patient will not often take the time to post.
An angry patient will track down every site they can, and post on it, and then post more under different names. Especially those seeking pain meds or angry that you refused to fill out disability papers.
I don’t think the ballot box should be stuffed by either side.
http://www.unnecesarean.com Jill–Unnecesarean
I was going to give a thumbs up to The Birth Survey, but I see someone already has. It takes a long time to fill out.
I subscribed to Angie’s List to see what all of the ruckus was about and found very few ratings. The ones I saw were mostly positive.
Anecdotes are unscientific, but are they really crap? Not to the patient. Looking for someone to perform a simple in-office procedure and you read a review that someone thinks that they are not nice? Probably not a big deal. Looking for a respectful OB that practices evidence-based medicine and doesn’t section 75% of his or her patients and you read a lot of pissed off reviews? I’d take that into account before I met with that person.
David Block MD
Well, Jill makes a good point: such informal survey websites may be pseudoscientific garbage, but they are not necessarily crap for information. If a physician or her staff is not considered “nice” or “available” or “on time” by at least one patient, then she may have a personality conflict or marketing problem or office inefficiency that she needs to know about. For sure, she’s got a communication problem with at least some folks at the moment and point of delivery of service that demands attention, and she doesn’t know if these are sentinel events. We’re not taught many of these skills or rewarded for such people-oriented performance in medical school or residency, so why would we be successful here? You get the behavior you reward, HR folks tell us, rather than not getting the behavior you punish.
So then every physician ought to beat these pseudo surveys to the punch but not discount the information. First, communicate honestly, genuinely, authentically. We need to show emotional intelligence in addition to our other smarts – although, again, we were rarely rewarded for this in training. “Yes, I’m late because the ER is stacked up and I got caught there because we don’t have enough PCPs in town, and I’m as angry as you are about it. What can we do about this? We’re all in this together, aren’t we?” “Yes, I’m angry today because MY people are getting turned down by BCBS for the care they need. What can we do about this?” Make patients shareholders, give them a stake in our mutual care, our mutual efficiency, and shift the focus of discourse from YOU to the root cause. Of course, if the patient says “I don’t care about you, Doc,” then maybe you don’t want that patient. Empathy goes both ways; screw fake Aequanimitas. And if we are inflexible and can NOT do these things, then – yes, maybe we really are the problem. Second, involve patients in our own blog or social network so it becomes their own blog or network. You build compliance, you build market share, you build forbearance and forgiveness if you DO mess up, you build friends. Not just PCPs but even the wisest among us – the neurologists – were people before they were doctors.
Me being a neurologist, I know this stuff….
http://brucesmallsurveys.typepad.com/ Bruce Small
I am familiar with five of the physicians listed on one of the rating sites. Three, absolutely some of the finest physicians in the area, had stellar ratings from multiple patients. One, whom I’ve considered incompetent for years, had a horrible rating. The last, while competent, is know for her arrogance, and that was reflected in her horrible rating.
Anecdotal no doubt, but my experience is the ratings are quite accurate.
Lizzie
If patients had access to the insider knowledge that physicians and other healthcare providers have about the “bad” doctors and the “good” doctors there wouldn’t be a need for the, admittedly, bogus rating sites. I suspect it’s really more about being consistently good – not just rising to the occasion when the doc’s in the mood and having a good day.
If physicians had a credible way of policing themselves and patients could trust that they aren’t all covering for each other there wouldn’t be a the need for the sites. And perhaps, less malpractice.
There are lots of small ways in which a physician cuts corners or doesn’t do his/her best (all in the name of efficiency) that don’t harm a patient in ways for which the patient cannot compensate (e.g. not taking the time to carefully dissect breast tissue away from ALL the chest muscle during mastectomy, taking a “minimal amount” – patient can compensate, but is permanently weakened), but do cause damage.
Think about the possibility of keeping detailed accounts of outcomes that must be open to the public. The patient can choose the surgeon that does take the time to carefully dissect ALL MUSCLE and the result will be that ALL SURGEONS will do it, taking muscle only when there is no other way to safely complete the procedure. None of them wants that reputation.
That’s just one example. I’m sure there are many, many ways to create scoring of outcomes for procedures and care. In his book “Better,” Atul Gawande wrote about the creation of the Apgar score and its effect on infant mortality. Suddenly doctors did better work, took the time to save babies’ lives that previously had been considered hopeless. He talks about creating similar scores for surgical outcomes. There must be ways to apply this idea to create a system that rates quality of care. And, I’m not just talking about the high drama, live or die type of care – but the small stuff that really impacts a patient’s experience and long-term relationships (read TRUST) with the healthcare system.
The patient that is experiencing small weakness due to “minimal muscle loss” from mastectomy can carry on, but has a daily reminder of the loss. It actually does matter, even though no one in healthcare accepts the patient experience as valid. No one’s watching. No one’s measuring – so none of the doctors believe it has any impact.
Patients complained for years of “chemo brain,” and were ignored until finally, someone, decided to see if there really was something to it (I’m guessing it was done to prove the patients wrong). Wow, the stupid, complaining patients were actually right – there is such a thing as chemo brain. It began with anecdote. It ended with scientific methodology and continues with research to both explain it and treat it.
Step up. Find a credible system to measure quality of care and quality of experience. Provide the light of day to the insider knowledge you already have. It matters.
GG Freeman
Maybe what the AMA and AOA need to do is come up with a guideline that says that -IF- a doctor rating site is to be considered valid and somewhat reliable, it must rate the physician and his/her office on the following criteria: and come up with a list of, say 20 things. Make it like ebay in that the physician, once the site is claimed, can respond to individual negatives if desired.
Make sure it requires a short written blurb about what the patient did or didn’t like about the office. This should be required that they write it out. Sometimes whole arguments are invalidated when they look like this: “My doctor wuz terrible n didt take tiem to help me wun bit.”
You realize too, that IP addresses can be tracked when someone posts to any website or fills out an online form. Multiple complaints from similar ip’s can be exposed or removed (sorry, this makes ballot box stuffing harder too)
It also exposes proxies because if you start getting a lot of complaints from Russia, Latvia or a town you don’t work in… you can be sure they aren’t valid.
paul
as an ER doc… if you can decide whether or not to come in and see me based on my ratings on these sites… you probably have no business coming into my workplace to begin with
http://www.yorkyates.com Dr York Yates
Good advice
I recently started giving patients a list of these sites so that they could comment. I actually am not against these sites and think that it can be valuable for the consumer (patient). Hopefully some of the bad apples will be exposed and those providing good care will be promoted.
Doc Lawrence
It seems like while most of the doctor rating sites tend to be a sounding board for patient dissatisfaction, patients often use things like how long they were in the waiting room and other factors that are not directly attributed to the physician’s knowledge and skill set to judge the physician. This is really not a fair way to assess a physician’s abilities. Recently a bad review was posted about me on MyDocHub.com, and though it did not list the patients name, I knew the patient since what he described in the review was already brought to my attention.