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Physician Rate Thyself .... Well not quite.

By Elizabeth Kwo, MD MBA – Senior CoverMD Contributing Editor


In this article, Dr. Kwo examines the ever growing number of physician rating websites and what role they play in determining a physician's online reputation.

Your online reputation matters more than ever

“What a HORRIBLE experience! The doctor was rude and arrogant and his staff were just as bad”
Imagine this being the number one listing that appears when you type your name into Google? What’s worse, imagine that this allegation was totally false and was posted anonymously online by a disgruntled patient. In our wired world this is now the reality of how prospective patients may have their first introduction to you and your practice. In this article I’ll take a look at physician rating websites and the impact they can have on a physician’s practice – both good and bad.
There are an evergrowing number of physician rating websites for patients to choose from
Like so many industries and professions the internet has changed the way patients search for doctors (teachers and professors were some of the first to experience online ratings). The traditional way to refer physicians by personal contacts through family and friends is becoming increasingly outdated. These days, millions of patients go online to read ratings of healthcare professionals posted on an ever growing number of physician rating websites. In fact, many patients may not realize at first that they are reading a rating site since in many cases these sites rank highly on page one of Google and people often click the top listings almost immediately.

"Ratings make a difference to a business," said Dr.Christina Pham who is an internal medicine physician in Boston. "It's good to be responsive to the needs of your patients - especially things like bedside manner and etiquette. It shouldn't, however, change your medical management, since you should be making sound clinical judgment regardless."

She also added, "I don't believe in the rating agencies because they're based on advertising principles as well as dollars, so they are not presenting things in an unbiased way. That said, I think people trust those sites, especially in an absence of anything else to base their decisions on. So, like it or not, we're subject to the effects of these agencies."

Rating websites allow patients to make informed decisions about their healthcare

Knowledge is power and patients are becoming knowledgeable consumers by reading other patients comments as well as posting their personal patient experiences. In many cases this is a good thing and the ratings can be helpful in aiding the patient make an informed decision about whether to use the services of a particular physician. The benefit to the doctor comes in the form of positive feedback from patients who posted their experiences with you and your staff. This helps build the credibility of your practice and will hopefully help you gain a new patient.

The problems arise for doctors when poor or negative ratings are posted online. These can be broken down into two separate categories:
  • Firstly, comments or ratings posted by a legitimate patient who, for whatever reason, did receive poor service or a poor care experience. This needs to be addressed by you and your staff.
  • The second issue surrounds a case where false or misleading information is posted. This needs to be addressed also and I discuss some avenues of recourse later in the article. These days with the increasing competition for patients you must be a good physician and a marketing expert for your practice so be proactive in addressing these negative comments.
Some physicians report that online ratings have changed how physicians as a group now operate. “The cost of poor online comments for physicians is significant and will affect how physicians weigh costs and benefits of the patient experience (e.g. overbooking/waiting time, staff hospitality, amenities and bed side manner),” said Siddarth Rathi, a Boston based M.D. / M.B.A. student , “Online patient comments have increased the cost of poor bedside manner for the physician. “
Dr. Rathi continued by saying: “Given the lack of transparent and balanced data on physician quality, patients are forced to rely on these online non-representative data sets. A bad comment likely weighs heavily in a prospective patient's decision making process, even though the bad comment might be in stark contrast to another positive rating. Physicians have to be particularly cognizant of negative ratings as these comments, regardless of if they are warranted or substantiated, bear so heavily in prospective patient's physician selection.”

Types of physician rating websites

The stated objective of many of these rating websites is to help patients make more informed choices about their healthcare providers. The types of rating websites out there run the gamut from ones that offer more of a physician profile (specialty, address etc) to sites that allow uncensored, anonymous posting of comments. Some sites provide patient surveys where valid email addresses are required in order to submit a completed questionnaire which provides a level of validation to the process. All of the sites are free to consumers and most make their money through advertising on the site.
Physician rating websites can allow a doctor to manage his online reputation
Many of the sites allow you to set up a physician profile for free so you can manage a certain amount of information displayed about your CV and practice. Creating a profile account on the more reputable rating sites is advisable since many of these have pages that rank highly in the search engines and thus are more likely to be read by more people. Managing your profile on these websites helps ensure your information is accurate and up to date.

Doctors are working harder than ever so who has time to manage your online profiles? While we are all busy it is important to take some time to do this yourself or have one of your staff do it on a semi-regular basis – at least once a quarter. There are also now professional agencies you can hire to manage your online reputation. First impressions count so it’s critical that, if possible, you are presented in the best light possible via your online profile.
Many rating websites are finding methods to become objective, which allows the overall rating to be more precise than anonymous ratings from clinical experiences. Some of the criteria for rating include physician credentials such as board certifications, academic appointments, hospital appointments, educational background, and awards. More thorough rating websites also include disciplinary history, community involvement, publications, and professional affiliations.
The more reputable rating websites utilize software that collects Internet data regarding physician credentials and histories. Once enough information is gathered, the collected data is analyzed and matched against each other to decipher incompatibilities and discard inaccuracies. Physician profiles are then scored with a specific algorithm that combines the doctor's overall ratings with their background report, therefore allowing patients to find the right physician through these ratings services.
The type of comments that patients report online can include:
  • Friendliness, professionalism, and competency of clinic staff and physicians
  • Characteristics of the clinic such as location, appearance, cleanliness
  • Availability of staff and physicians such as hours of operation, wait time to schedule appointments, or follow up of lab reports
  • Collaborators such as physicians or nurse practitioners who will see patients when the physician is away.
  • Additional services such as contacts within the medical community or direct admitting privileges to a hospital should a patient need to be hospitalized
  • Demographics of staff and physicians such as gender, age, ethnicity as some patients prefer similar demographics, language, or culture

To respond or not?

To the best of my knowledge, all the sites will remove comments or postings that clearly violate what is acceptable free speech. However that can still leave some nasty or negative comments out there for all to see. All the sites allow some sort of recourse in the event you wish to respond to a comment.
The decision on whether to respond to a negative comment or posting is really an individual one and each case needs to be decided on its own merits. If a patient feels they had a bad personal experience (e.g. he was kept waiting for 2 hours for a scheduled appointment) then a short response apologizing and giving a valid reason (e.g. “I was late back to my office due to an emergency with another patient”) may be a good idea. Don’t make up an excuse – be truthful! Many other consumers reading about you online will appreciate your honesty and the fact that you responded. On the other hand if a patient is complaining about the course of treatment you prescribed then it is not a good idea to get into a back and forth online about this.
The general consensus among many doctors I know is that it is important to keep a separation between patient and physician when it comes to online interaction through social media. However one of my attendings does give out his email and responds promptly to patients. In that way it gets rid of the middle person (the RN) taking the call and that can help with a lot of questions/confusion. This is something I would consider doing selectively as well.
In the cases of false or malicious information contacting the rating website in a professional manner explaining your position can be a good first step but is not always guaranteed to get results. Getting legal advice from your attorney is also recommended in cases like these. If you hire the services of the professional online reputation management company they will also be able to give you good advice on how to best proceed.

“Gag Contracts” - A Good Idea?

To protect their online reputation, some physicians now have their patients agree to keep their clinical encounters private by asking them to sign a contract of non-disclosure (“gag contracts”). These privacy contracts are ways that physicians feel they can protect their reputation from inaccurate or unjustified postings.
However it may appear to patients that the physician is unsure of his or her own clinical judgment. Patients can also find alternative ways to reveal their experience to a wider audience. In addition, I’ve seen many people post on rating sites that the doctor made them sign a non-disclosure so it doesn’t really work unless you want to legally pursue each and every patient – which will only generate even more negative publicity. Some of the rating websites will even publish the names of doctors who make their patients sign non-disclosures. These non-disclosures in most cases may not be a good idea and can often backfire on the doctor and have the opposite effect i.e. more negative comments.

Medical Malpractice Insurance – does your online reputation count?

There is no evidence whatsoever that medical malpractice insurance companies use any of the information about a physician posted online in determining the rates paid by a particular doctor. However many employers now regularly Google prospective employees to see what information is available online about them. This is something most college graduates are aware of and they take care to delete their college Facebook and other social media profiles prior to starting their job searches.
It has long been known, however unscientifically, that doctors who are perceived as “nice” by their patients are far less likely to get sued. If an informal search by a malpractice company turns up multiple negative comments about a doctor and/or his practice will this weigh in the decision of whether to provide the doctor with malpractice insurance and at what price? While this is absolutely not the case at present who knows what the future holds and it will be interesting to see what role, if any, a doctor’s online reputation will have in determining his malpractice premium.

Healthcare is another business in a competitive market

Your online reputation needs to be considered as part of a good “user experience” for your practice. “Patient feedback offers a critical perspective to providers and creates an online venue that empowers patients to speak their minds,” said Veena Thomas MD an ophthalmology resident. “Physicians can utilize these ratings constructively to improve their practices, particularly in this era of medicine, where healthcare is another business in a competitive market.”
However, Dr. Thomas believes, online patient comments may also artificially influence a physician's practice of medicine. She uses a simple example to illustrate this. A patient comments, "2 stars. Despite my cough, Dr. X would not get a chest x-ray." Based on the physician's clinical reasoning and exam, he diagnosed the patient as having a simple cold, not warranting an x-ray, nor the radiation, nor the cost to the patient of obtaining an x-ray. Such a review, however, may cause Dr. X to practice medicine more defensively in the future to avoid such reviews. It adds an element of pressure to meet individual patient's unknown expectations; although some may argue that the pressure creates added incentive to improve quality of care.

Final Thoughts

A patient who has had a bad experience is more incentivized to post negative comments than the many patients who had satisfactory experiences under your care. In general, I think most people are aware of the fact that there are always a couple of bad apples in the barrel and to disregard excessively negative comments provided these don’t make up the vast majority of comments about you or your practice.
Patients may not know that a large number of satisfied patients will not post online, and instead, one negative review can ruin someone’s reputation. Negative patient reviews can also encourage more negative reviews.
Patients today often believe that online information about physicians is correct, honest, and useful. It is true that the more reviews patients post on various physicians, the more likely these will be accurate assessments. While subjective impressions by patients are measured and reported, physicians can also utilize some of this information to improve performance. As we have discussed, physicians may respond to negative patient reviews that they believe are inaccurate, as reputations are important and worth protecting.
Overall, these rating websites can make physicians better by being more accountable, but it's not without certain short comings. Ultimately, for you as a healthcare provider in the 21st century it is important that you now have the mindset that your online professional reputation is a key component of who you are as a physician.

About the Author

Elizabeth Kwo MD MBA - Senior Contributing Editor

Dr. Kwo currently works at Cambridge Health Alliance as an Internal Medicine Resident. She holds a MD from Harvard Medical School, an MBA from Harvard Business School, and a BA from Stanford University in Human Biology.

Read Dr. Elizabeth Kwo's full bio


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