Looking for a doctor? Your first instinct may be to head online to look at online reviews. Those may not be your best bet.
According to two recent studies, online reviews don’t usually align with what patients really think about their physicians.
The most recent study was published in the April issue of the Mayo Clinic Proceedings. In short, it found that online reviews are more likely to reflect things beyond a doctor’s control, such as appointment wait times and staff friendliness.
A team from the clinic looked at 113 providers with negative online reviews, and correlated them with 113 randomly chosen physicians who did not have negative reviews but had Press Ganey Patient Satisfaction Survey results.
The researchers evaluated the data over a four-month span in 2014.
They found that physicians with negative online reviews had about the same score on patient surveys as other doctors.
The doctors with negative reviews, though, typically scored lower on factors beyond their control.
“Our study highlights the disconnection between industry-vetted patient satisfaction scores and online review comments,” Dr. Sandhya Pruthi, an internal medicine physician at the Mayo Clinic and a study author, said in a statement.
Views differ among sites
A similar study by Hospital for Special Surgery (HSS) reported discrepancies on reviews at HealthGrades.com, Vitals.com, and RateMDs.com.
“Although it is debatable whether these websites in their current form truly capture patient satisfaction and objectively evaluate the delivery of care, they represent a potential tool for both payors and healthcare systems to gauge how surgeons are assessed by their patients,” Dr. Anil Ranawat, a senior investigator and sports medicine surgeon at HSS, said in a statement. “Historically, three key qualities — affability, availability, and ability, known as the ‘three A’s’ — have been suggested to promote a successful surgical career and favorable interactions with patients.”
Dr. Benedict Nwachukwu, who presented the findings, said that surgeons with the highest and lowest ratings were significantly more likely to receive comments about their competence or affability.
“As such, it appears that even in the modern era, and with the adoption of online rating mechanisms, the traditional three A’s of ‘availability, affability and ability’ still hold sway,” Nwachukwu said.
The three online review websites mentioned in the HSS study did not respond to requests from Healthline for an interview for this article.
Integrity issues vs. free speech
Dr. Dana Corriel, an internist from New York, said that review sites do not vet the comments posted on their pages.
“Anyone can post their comments — positive or negative — without having to prove legitimacy. This creates a dangerous environment, in which anyone who wishes to ‘bad mouth’ a physician can do so,” she told Healthline.
Corriel added that the reviews empower patients but can be troublesome because the comments can taint a doctor’s reputation, not because the doctor isn’t competent but because a patient didn’t like the plan of care or the office environment.
“Third-party independent physician review websites do virtually nothing to ensure that reviews are from the people who have actually seen the doctor,” noted Laura Mikulski, the vice president of business development & physician relations at Physician Referral Marketing.
Some sites have the means to verify reviews but not actual doctor visits, Mikulski told Healthline.
She said doctors’ offices should be asking patients to take surveys and then listen to that feedback before frustrated patients take to the web.
Patients want to be heard and often doctors do not make the time to welcome their feedback.
That can make it more appealing to hop online and evaluate a doctor there — especially if a patient is already upset that their feedback wasn’t solicited, she said.
Others, however, argue that patients have a right to post reviews online.
A spokesperson from ZocDoc said that patients are asked for feedback after booking appointments with their physicians through the sites.
The reviews are moderated but can be positive or negative. Reviews cannot contain profanity, pricing information, details on accuracy of treatment/diagnosis, promotional content, or personal information, the spokesperson noted.
Patients are asked to share an overall rating as well as rating on bedside manner and wait time.
What sets the site apart, the spokesperson noted, is that reviews are collected through a closed-loop system to ensure reviews come from actual patients who have gone through with an appointment.
“We solicit reviews after each and every appointment, which generates a higher volume of reviews and means not only the extremely happy or unhappy outliers proactively leave reviews,” the spokesperson said. “This results in a more representative sample of patient feedback.”
The site also uses partner reviews for some physicians, which incorporate independent patient satisfaction surveys.
A representative from Yelp told Healthline about a 2013 study which found that Yelp ratings correlate with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
A 2016 study found that Yelp reviews could be helpful in helping patients choose hospitals.
Dr. Tara Lagu, an academic hospitalist in the Center for Quality of Care Research and Department of Medicine at Baystate Medical Center in Massachusetts, pointed out that there are positive and negative bias issues.
Some doctors may get their most satisfied patients and friends to post glowing reviews, while some sites may only see reviews from outraged patients.
“The main issue… is that the sample of patients [seeking out sites to write reviews] is not representative,” Lagu told Healthline. “Patient-experience surveys are generally drawn from a random sample of patients seen by a physician, while online reviews are people who have gone out of their way to write something.”
Lagu said that doctors may not be able to change every part of a patient’s experience, especially those in hospital settings.
“Emergency medicine doctors cannot make their waiting rooms less crowded. Hospitalists and surgeons find it frustrating that it is nearly impossible to change the workings of any large organization such as a hospital,” Lagu said. “This can be discouraging because an interaction that we feel like we can’t control — a rude parking attendant or nasty receptionist — can ruin the whole visit for a patient.”
Pruthi agreed that there is “certainly a selection bias” that occurs when patients only look at some online reviews instead of the physician’s patient satisfaction surveys.
“The online review likely only catches the extremes while the formal reviews are more measured and balanced,” Pruthi said.
Doctors on the line
Despite efforts by those two websites to ensure quality, Corriel still says the existing review system is generally broken.
“Doctors are also seeing an increase in threats, as bad reviews are turning into patients’ weapon of choice,” Corriel said. “They can be used to leverage antibiotics, and even controlled substances, and a physician who practices in today’s day and age must think twice before telling a patient ‘no.’”
One of the biggest barriers to the fairness of the review situation is that doctors can’t post a rebuttal to reviews, Corriel said.
“Due to HIPPA laws and a level of integrity we are trying to still maintain, our profession is holding on by a thread. Our reputation is on the line, especially when a one-sided review pops up, making false claims,” she said. “It can literally mar our name and we cannot fight back.”
Mary Hall, the chief executive officer at iHealthSpot, which aids doctors in reputation management, said the various review sites cannot guarantee a patient has seen a doctor.
“Most sites have removed the ability to answer reviews anonymously, so this helps ensure the integrity of the reviewer. It doesn’t stop some patients from simply getting confused and reviewing the wrong physician, however,” she noted.
When doctors can monitor their reviews, and are able to respond to them, that may help.
Some can note when a patient isn’t in their records to alert other users to the fact that the review may not be legitimate. They can also be proactive and appeal the review with the review site and in some cases, they can be removed, she noted.
“However, most of the review sites want compelling evidence that a review is not legitimate before they will consider removal,” Hall added. “Ultimately, the burden falls on the shoulder of the practice.”
Spotting the best docs
Pruthi, the lead author of the study, said consumers should be leery about fully trusting online reviews.
“Consumers should be wary of online reviews for physicians, as these platforms are not moderated or validated,” she noted.
When searching for a doctor, look for recurring themes when reading reviews, Mikulski advised.
If you find words like “arrogant,” “doesn’t listen,” or “billing errors” regularly, that may be a sign that a doctor doesn’t get good reviews on any website or patient survey.