How Do You Rank?

Online physician-rating websites have been around for more than a decade, but many physicians and patients still have questions about how to use them.

The way people access information has changed substantially in the last 15 to 20 years, and that is no different for how consumers find physicians. Gone are the days when a family, or even a town, sees the same doctor. In the information age, people can pick a doctor based on reviews, ratings, and rankings posted by other patients on online physician-rating websites.

Just as they might search for a reputable contractor on AngiesList.com, patients can search for a physician on a variety of online rating websites – including Vitals.com, RateMDs.com, and even Yelp.com – and use the information they find to decide whether or not to see that physician for care, without ever having met him or her face to face.

A study published in JAMA in 2014 by David A. Hanauer, MD, and colleagues found that consumers are basing their decisions on these types of rating websites more and more. Among a group of 2,137 survey respondents, 59 percent believed that physician ratings sites were “somewhat important” or “very important” when it came to selecting a physician.1 More than one-third of respondents reported selecting a physician based on a positive rating, and 37 percent avoided a physician because of a negative rating.

“The online rating websites seem to be filling a big void,” Dr. Hanauer, clinical associate professor of pediatrics at C.S. Mott Children’s Hospital in the University of Michigan Health System in Ann Arbor, Michigan, told ASH Clinical News. “Before these websites, patients had no easily accessible place to go to find information about physicians. These sites provide a platform that did not exist before, and allow patients to comment in a way that is familiar to them because it exists on so many other consumer websites.”

When patients are dealing with one of the many challenging conditions treated by hematologists and oncologists, the stakes for finding a good physician are even higher, he said. Therefore, it is important that patients, as well as physicians, are informed and educated about these websites and the type of information they provide.

Emergence of Ratings Websites

Before the internet entered every corner of our lives, word of mouth or referrals were probably the most influential sources of good-quality information about which physicians to visit, according to Ritu Agarwal, PhD, Robert H. Smith Dean’s Chair of Information Systems and senior associate dean for Faculty and Research at the University of Maryland in College Park, Maryland.

“We all trusted our doctors, and if our doctors recommended a pulmonologist or a cardiologist, we were more than likely to believe them and go to that specialist,” Dr. Agarwal said.

A little more than a decade ago there was some basic information about physicians online, mostly in the form of insurance companies’ databases, she explained. Many companies maintained demographic information about physicians, as well as information about their level of experience, their educational background, and their board certification status.

That all changed in 2005 when, seemingly all of a sudden, physician-rating websites started popping up. RateMDs.com was first, appearing on the scene with physician reviews, recalled Tara Lagu, MD, MPH, assistant professor of medicine at the Tufts University School of Medicine and academic hospitalist in the Center for Quality of Care Research and Department of Medicine at Baystate Medical, in Springfield, Massachusetts.

“Within just a few years, a number of new websites were launched and this rating and ranking concept caused great concern among physicians,” Dr. Lagu said. Specifically, she remembers seeing articles in periodicals interviewing physicians who had bad experiences with these online ratings websites.

“One of the early concerns was that patients – or anyone really – would be able to go online and write reviews of doctors. They could say whatever they wanted, and doctors would not be able to respond because of issues with confidentiality,” Dr. Lagu said.

In reality, most physician-rating websites allow doctors to respond to negative reviews – to acknowledge the criticism, to address what they perceive as a misrepresentation of the facts, or to explain why the patient-reviewer had such a negative experience – as long as they comply with HIPAA regulations. Per patient-privacy laws, doctors cannot disclose any protected health information in the response because the (often anonymous) reviewer has not given his or her consent to do so; the fact that the patient may have disclosed private information in the initial review does not give a doctor permission to do the same in response.

The integrity of the information on these websites has always been called into question. As a result, in 2010, Dr. Lagu and colleagues investigated the quality of physician-rating sites.

They searched reviews on 33 physician-rating websites between March 1 and June 30, 2009 to establish a random sample of 300 Boston physicians. More than 70 percent of the physicians did not have a review published online at the time; among those with a review, 88 percent were positive.2

“Although this online rating system was a new thing, we found that, early on, there were not a lot of reviews online,” Dr. Lagu said.

But, Dr. Lagu noted, that didn’t mean that consumers weren’t looking for information about physicians. Shortly after the study’s completion, Dr. Lagu was contacted by a friend for a referral to a good dermatologist. “She said she had been looking and could not find this doctor anywhere, meaning she had looked online for reviews but there weren’t any out there,” Dr. Lagu said. “So, even back as far as 2009, patients were adjusting the way they looked for physicians.”

What Are Consumers Looking For?

Since that 2010 study, Dr. Lagu said that the number of physician-rating websites has decreased from more than 30 to about 17 or so, with a few clear leaders emerging. Among the most visible websites are Vitals.com, Healthgrades.com, RateMDs.com, and Yelp.com (see the SIDEBAR for more on these sites). These four websites all provide basic demographic information about physicians or physician practices and allow patients to give a physician or practice up to a five-star overall rating. Ratings are based on individual categories related to the physician (such as communication abilities and knowledge) as well as the practice (such as the office location, the staff, and wait times).

“Some of the early concerns about commenting on clinical topics have turned out not to be true,” Dr. Lagu told ASH Clinical News. “Patients are not talking about individual medical problems or issues with a physician, but are commenting more often on things like parking or wait times.”

According to Dr. Hanauer, some physicians are still concerned that these online reviews can have a negative effect on their reputation or practice because they are based on factors that they have little control over. A common example is when a physician needs to spend more time with a patient than is scheduled, meaning that the following patients will experience longer-than-desirable wait times. This can happen often, Dr. Hanauer said, but it’s hard to predict.

The People’s Voice

One of the biggest benefits of online physician ratings is that they provide patients with a voice, said Dr. Hanauer.

“Before these websites, it was not quite clear where people might go if they did have an issue or a complaint about a physician,” Dr. Hanauer said. “These sites are filling a void that nobody else has done a good job of filling.”

Dr. Lagu agreed, adding, “Sometimes health care can be disempowering for patients and this gives an opportunity for patients to voice and share thoughts about a physician.”

Another benefit is that the information on these websites is available 24 hours a day, seven days a week, according to Guodong (Gordon) Gao, MD, co-director of the Center for Health Information and Decision Systems at the Robert H. Smith School of Business at the University of Maryland. “You can easily search and get information from multiple patients – not just friends and family,” Dr. Gao said.

Physician-rating websites also help patients address issues where privacy might be a concern, Dr. Gao added. For example, if a patient has a disease that carries some kind of social stigma, like HIV, he or she can search anonymously online instead of asking friends or family for a recommendation.

However, for every benefit to these sites, there can also be some drawbacks.

For example, the anonymity that might make these sites appealing to some patients may undermine the integrity of the information. Many of these websites are open to the public and anyone can go online and write a review about a physician without any sort of verification that the person was, in fact, a patient.

“A consumer going to a website has to try to figure out what is real and genuine, or if the reviews have been faked or influenced to some degree,” said Dr. Hanauer.

In January 2016, Dr. Hanauer and colleagues at the University of Michigan Health System’s C.S. Mott Children’s Hospital asked a national sample of parents about their views of doctor-rating websites.3 The results of the survey showed that 30 percent of parents had consulted online doctors ratings for themselves or a family member in the past year. Of those, about two-thirds of parents thought some of the ratings might be fake. Eleven percent of survey respondents had left an online rating for a doctor, and 30 percent reported having done so because the physician or office staff had asked them to – demonstrating that health-care providers are starting to recognize the importance of these ratings, as well.

Although some of these websites have been around for as long as 10 years, the number of reviews on any given site is still relatively low, Dr. Lagu noted, leaving a too-small sample size to gauge the true effect of the sites.

It’s a problem of extremes, she explained. “Only the happiest or most upset patients will go to [a] ratings website to post reviews. If a patient searches for a physician and there are only two reviews and one of them is negative, that can really color a patient’s opinion of a physician.”

Physicians also criticize these websites because they feel that sometimes patients may not be in a position to judge whether or not they have received appropriate medical care. For example, in the primary-care setting, Dr. Hanauer said, physicians are discouraged from writing unnecessary prescriptions for antibiotics, but when a patient comes into the office and feels as though he needs a prescription for antibiotics and does not receive it, he may be upset and leave a negative review.

Finally, even though many studies show that positive ratings far outnumber negative ratings – as shown in a 2012 study by Dr. Gao and colleagues that showed no evidence of these sites being dominated by disgruntled patients5 – the ratings available on a website may not be a true proportion of the positive and negative experiences at that physician office.

New Movement Toward Transparency

The topic of online reviews strikes a chord with many physicians, according to Dr. Hanauer. Nevertheless, there is an upside to these reviews in their approach to patient engagement and involvement.

“We have to find a way to liberate more information and not be so opaque about differences between physicians or health systems,” Dr. Hanauer said. “One of the challenges going forward will be figuring out how to get everybody on board and find a happy medium that we can all agree with.”

One example of the increasing movement toward transparency is the use of OpenNotes, an initiative in which patients are given the opportunity to read the notes written by their physician during or after their appointment, he explained. It was started by physicians at Beth Israel Deaconess Medical Center and Harvard Medical School, and now includes several major health systems such as the University of Texas MD Anderson Cancer Center, Geisinger Health System, Billings Clinic, and DukeHealth. Health systems such as Cleveland Clinic have made physician notes available to patients through the EPIC Mychart system.

“Patients have a right to see their notes anyway, but the health-care system makes it difficult,” Dr. Hanauer said. “Physicians are often initially resistant to the idea of sharing their notes with patients because they think it is going to cause problems.”

However, a study published in 2012 showed that a year-long experiment using OpenNotes among a group of 104 primary-care physicians and more than 13,000 of their patients was successful.5 Among patients who chose to view their notes, between 77 and 87 percent reported feeling more “in control of their care” and 60 to 78 percent of patients taking medication reported increased adherence. After the experiment, 99 percent of patients wanted OpenNotes to continue, and no physicians elected to stop.

As an alternative to online physician-rating sites, some health-care systems are beginning the process of taking patient reviews and comments from surveys and putting them on physician biography pages within the health system’s website, according to Dr. Lagu.

“This is a new approach to providing patients with the kind of information that they want, which is patient feedback and narrative comments,” Dr. Lagu said. “It also overcomes the sample-size issues because it allows for more reviews by systematically collecting patient experience surveys.”

As opposed to seeing four to five reviews on a review site, patients can see 30 to 40 reviews collected from a random sample. There is still some concern about the content of the reviews being controlled by the health system, though, she noted.

Embracing Reviews

Online physician-rating sites can’t completely be written off, Drs. Hanauer and Lagu agreed, because they can provide important feedback. Doctors should take the information they find there and use it to their advantage – viewing these websites as a possible tool to find out more about how people perceive their practice.

In a study published in 2013, Dr. Lagu and colleagues looked at reviews left by patients in the United Kingdom through its quality-reporting website, NHS Choices.6 Looking at 20 randomly selected hospitals, they found that the domains of feedback were similar to those seen on patient experience surveys, and the majority of reviews were positive. However, the reviews also captured the experiences of patients who were not typically represented in the surveys because of special needs or issues. For example, one of the surveys included information from a wheelchair-bound patient who arrived at a hospital but left because there was no accessible parking.

“There can be a small subset of reviews that are extremely useful for improving quality on items related to communication, staff, billing, parking, receptionists, or other areas,” Dr. Lagu said.

Although it may be difficult, online reviews can also offer physicians important insights into how they communicate with patients.

“A physician could look at the reviews and patient comments and say, ‘Maybe I’m not explaining things well enough because multiple people say I explain things too fast,’” Dr. Hanauer said. “It can be a valuable source of feedback if physicians can embrace it and take the criticism. It could help them with self-reflection.”

One thing is for sure, Dr. Gao said, online ratings are going to be around for a long time.

“In the past, for anything new that comes up, physicians are often not sure what to do so they sometimes ignore it,” Dr. Gao said. “We can be very sure that online ratings are here to stay. Physicians cannot just ignore this phenomenon but should leverage this source of information to improve their services.”—By Leah Lawrence 


References

  1. Hanauer DA, Zheng K, Singer DC, et al. Public awareness, perception, and use of online physician ratings sites. JAMA. 2014;311:734-5.
  2. Lagu T, Hannon NS, Rothberg MB, et al. Patients’ evaluations of health care providers in the era of social networking: an analysis of physician-rating websites. J Gen Intern Med. 2010;25:942-6.
  3. National Poll of Children’s Health. Many parents wary of online ratings for doctors. http://mottnpch.org/sites/default/files/documents/032116_doctorratings_1.pdf. Accessed April 30, 2016.
  4. Gao G, McCullough JS, Agarwal R, et al. A changing landscape of physician quality reporting: analysis of patients’ online ratings of their physicians over a 5-year period. J Med Internet Res. 2012;14:e38.
  5. Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors’ notes: A quasi-experimental study and a look ahead. Ann Intern Med. 2012;157:461-70.
  6. Lagu T, Goff SL, Hannon NS, et al. A mixed-methods analysis of patient reviews of hospital care in England: implications for public reporting of health care quality data in the United States. J Comm J Qual Patient Saf. 2013;39:7-15.


Check Your Score

In the last decade, a multitude of websites have launched providing consumers with a place to post and view ratings about physicians. Among the most prominent websites are:

Vitals.com

Founded in 2008, the website lets patients find information about a physician’s specialty area and years of experience. Physicians are given up to a five-star overall rating and are rated on individual areas like ease of appointment-making, accurate diagnosis, and follow-up after visit. Patients can also leave narrative comments. In addition, physicians can be awarded badges like the Vitals On-Time Doctor Award or the Compassionate Doctor Recognition.

HealthGrades.com

This site includes specialty and location information about physicians, as well as up to a five-star overall rating. Patients can also rate physicians on areas specific to a doctor’s office or staff and their own experiences with the physician.

RateMDs.com

Claiming to be the “original doctor ratings site,” this website provides office location and specialty information for physicians. Physicians are given up to a five-star overall rating and rated on individual areas like staff, punctuality, helpfulness, and knowledge. Patients can also leave narrative comments.

Yelp.com

Yelp was launched in 2004 and, until recently, was used mainly to find information about local businesses, like restaurants or hairstylists. Now, the site has been gaining attention for its reviews of health-care providers, including anyone from oncologists to cannabis clinics (although “hematologists” is not a listed category). The site provides location information, up to a five-star rating, and patient narrative reviews.

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