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"They Said What?": Patient-Initiated Internet Reviews of Physicians

There are upwards of 408 “dedicated” internet sites that invite consumers to provide feedback on their experiences in physician offices. The lure of these sites for consumers is that they can see what others are saying about specific physicians.
Who Uses Patient Report Websites?
Use of patient report websites is substantial, with over 7 million people a month visiting Healthgrades alone.15 In general, studies report that users of these websites are disproportionately female, middle aged (45 to 64 years), and college educated. As one might expect, they also are relatively high users of health care.9,13,16 However, there is some conflicting evidence about age, with one study reporting that middle-aged people are more likely to use the sites,9 and another suggesting that younger people are more likely to use them.6
These findings, while somewhat sketchy, do not support the notion that patient report websites are principally the domain of young internet-savvy consumers, although people who have a higher opinion of their own internet skills are more likely to be users.16
Different website characteristics appear to attract different age groups. For example, Zocdoc is more popular with younger consumers. Interestingly, frequency of daily internet use does not seem to be associated with use of patient report websites.16 Female visitors to rating sites frequently have children, so at least some may be searching for information to use in making decisions about their child’s health care. Thirty percent or more of the visitors to some sites are international, for reasons that are not clear.9
How Often Are Physicians Reviewed on Patient Report Websites?
Physicians are unlikely to be rated even once on any given site.3 When a physician is rated, the median number of individual ratings is about 4,17 and it is very common for physicians to have a single rating.13 At first glance, physicians may view this as reassuring—the number of negative reviews must, by definition, be small. However, because of the small number of reviews per physician, a single bad review by a disgruntled patient could receive more attention than is warranted or than it would receive if there were a larger number of ratings.
What Do Patients Typically Say About Physicians?
Understandably, physicians fear that their unhappiest patients will post comments on patient report websites (most sites permit anonymous reviews). They fear that these negative reviews will create a false impression for prospective patients and among the physician’s colleagues as well. But this doesn’t seem to be the case.
Physicians should be reassured by the fact that multiple studies report comments on patient report websites to be mainly positive.12,9,14 For example, a study of parents who visited these sites seeking information about child health care found positive comments outnumbered negative comments by 3 to 1.18 This may reflect consumer concerns that their comments are not truly anonymous and that a negative review could result in physicians taking some action against them.19
When negative reviews do exist, results from one study suggest that consumers are relatively sophisticated in interpreting them. For example, when only a few reviews are posted, and there is a negative review, consumers place more credence on fact-based reviews and tend to discount emotional reviews.20 As one site visitor reported, most reviews “are pretty sober, boring, and don’t sway me one way or the other.”21
Is There a Relationship Between Patient Evaluations and Traditional Quality Measures?
Patient reports regarding physicians provide a different perspective than clinical performance measures in formal reports. Postings on patient report sites also differ from measures of consumer experience based on surveys that ask patients to respond to a validated battery of questions. This raises the question of how well patient reports and rankings might correlate with the other 2 types of physician performance measures.12
Researchers have found no statistically significant correlation between patient reports and technical measures of quality. For instance, in a recently published study in JAMA Internal Medicine, Gray and colleagues (2015) found “no evidence that physician website ratings were associated with clinical QMs [quality measures].”22 But they did find a small statistically significant association with survey-based patient experience measures. In their work, they did not examine the content of written comments posted by patients. They point out that the lack of association with clinical quality measures is not unexpected or bad. It may simply reflect fundamental differences in the dimensions of physician performance being measured. Some of the same researchers found a positive correlation between patient reports and structural quality measures, such as board certification and malpractices claims.23

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