Online physician reviews: Patients are the ones who will suffer

The rise of the Internet has changed many things in the world of the customer.  Now, in the age of the online consumer, a person can search for not only the exact item or service he or she wants, but read hundreds of reviews on that particular item or service.  Thanks to Yelp and a host of other online rating sites, a person can find a reputable painter or contractor or babysitter with the click of a button.

While the ability to rank and review online professionals has empowered consumers and been mostly positive, this is not the case for all professions.  Specifically, it is detrimental to physicians.   Why?  After all, there are good and bad physicians just like good and bad contractors.  If a person believes their doctor does a bad job, he should be able to warn others, right?   Not exactly.

Physicians are not like other professionals.   They do not have customers or consumers.  They have patients.  While online reviews from customers are a good idea, online reviews from patients do not make sense.

First of all, the doctor’s ethical and moral duty is to prevent or treat the patient’s illness or injury, whether or not that is what makes the patient “happy” or satisfied.  A physician is required to have the difficult conversations about weight, life expectancy, poor lifestyle choices, and other topics that tend to make people unhappy.  Contrast that with a customer.  If a customer is willing to spend $100 on a shirt that looks terrible on him, the boutique owner does not have a moral obligation to tell him he looks awful.  Physicians prevent and treat illness and injury.  They encourage the overweight man to lose weight even though it might offend him.  They refuse to prescribe the narcotic pain medication to the drug user, even though she is furious.  They tell the mother that her child with a virus does not need antibiotics.  Because physicians take an oath during medical school to do no harm, if what the patient wants is harmful, they cannot and should not comply.  Yet, doctors often receive negative online reviews for doing what is right.

Second, it is often difficult, if not impossible, for someone outside of health care to adequately review a physician.  For many professions, the layperson is able to adequately assess if a job or service was done well.  If I hire a painter for my living room, I am qualified to say if he did a good job or not.  Although I am not a painter, I can tell if the paint is even and neat or streaky and splotchy.  However, it is difficult for someone without a health care background to accurately assess doctors.  Can the lay person determine if a surgical complication was the surgeon’s fault?  Can the lay person accurately assess if he or she received the correct laboratory work up or medication?

Similarly, secondary to the personal nature of health care, many patients are upset and angry at things that are out of the physician’s control.  Bad outcomes occur, and sometimes no one is to blame.  Patients can have allergic reactions or unwanted side effects to medications that could not have been predicted.  Complications arise during surgery despite the skill of the surgeon.  People die even under physician’s care.  Just because the patient died or became ill does not mean that the physician did a poor job.  Patients are also often angry with insurance and financial issues.  Often, this is out of the doctor’s control, but she is blamed.

Finally, physicians cannot defend themselves online.  Secondary to patient privacy laws, otherwise known as the Health Insurance Portability and Accountability Act (HIPAA) as well the threat of lawsuits, a physician has to silently take the negative comments.  If a customer complains about a restaurant’s service, the restaurant owner can explain the issue or apologize.  If a patient complains that the physician did not treat her appropriately, the physician cannot explain why he chose the treatment he did without violating the patient’s privacy.  A physician cannot apologize for a bad outcome without exposing herself to legal risk.

Online reviews of physicians need to stop.  More often than not, a bad review is unwarranted. A patient is not a customer.  This is not to say doctors should be jerks.  Just like any professional, a physician should be polite, empathetic, and a good listener.  Yet, a physician’s goal is very different from any other professional.  The goal is to treat and prevent illness and injury.  If the goal changes to “customer service” and improved ratings, the consequences will be huge.  The emergency room physician will hand out more narcotics to keep his ratings high.  The surgeon will avoid high-risk patients so that her complication rate stays low.   Pediatricians will hand out antibiotics per request and contribute to the development of resistant bugs.  Patients are the ones who will suffer.

Kaci Durbin is an obstetrician-gynecologist.

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