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

Medica Research Institute is a non-profit, research organization determined to improve health outcomes for all, especially the most vulnerable through advancing knowledge that informs value-based healthcare and accountable communities for health. We are committed to contributing to evidence through independent, data-driven health services research that is placed in the public domain.
This article was written by Jon Christianson, PhD, Medica Research Institute senior fellow, and James A. Hamilton chair in health policy and management at the School of Public Health at the University of Minnesota.
The amount of publicly available information about physician performance is exploding, and it is taking 2 forms1: formal reports and patient-initiated ratings. Formal reports, constructed using claims and medical records data, are pushed out to the public on the internet. For instance, Medicare maintains websites that provide basic information on physician characteristics and disclose payments to physicians by pharmaceutical manufacturers. Health plans offer information to their members on quality of care and, less often, on average physician costs for treating specific conditions.2,3 Voluntary community stakeholder coalitions host public websites that contain quality measures on physicians, clinics, or medical groups.4
This information is an important part of the burgeoning “transparency movement,” but surveys find relatively low awareness among consumers that these reports exist. Among those who are aware, only a minority state that they find the information useful.5 They say that the measures in the reports are too technical, are not presented in a way that is understandable, and do not address issues that they truly care about. Consequently, consumers continue to seek information about physicians from family, friends, and other sources.6,7 And, it is increasingly common for them to search for internet sites with patient-initiated ratings.
Patient Report Websites
For a relatively new development, there are now many (upwards of 408) “dedicated” internet sites that invite consumers to provide feedback on their experiences in physician offices. The most popular—as measured by number of visitors—are Healthgrades, Ratemds, Ucomparehealthcare, Vitals, and Zocdoc.9 More general sites, such as Angie’s List, also offer opportunities to comment on or rate physicians. Visitors to these sites can express their opinions regarding individual physicians using their own words. On some sites, users are asked to answer a relatively small number of pre-formatted questions in order to generate physician rating scores.9
The lure of these sites for consumers is that they can see what others are saying about specific physicians. These unscientific evaluations seem to fill a gap for consumers.
Perhaps information on these sites augments, or even replaces, the traditional “over the back fence” conversations with neighbors about who is a good doctor and who should be avoided. The online process is familiar to consumers who use similar sites when choosing movies, restaurants, automobiles, home remodelers, and the like.9 In fact, many consumers turn to these sorts of sites when making purchases, suggesting the value they place on the reported experiences of others. One survey reports that 34% of consumers select physicians based on patient reviews, compared to 9% that use more formal quality ratings.10  
Not surprisingly, patient report websites typically are not held in high regard by the medical profession. For instance, one former president of the American Medical Association recommends that “anonymous online opinions of physicians should be taken with a grain of salt.”3 Physicians react more negatively to patient report websites than to the scientifically based, externally vetted performance measures disseminated by third parties in part because “its personal.”11 Patient comments certainly strike closer to home than, for instance, a measure of the percent of patients seen in the physician’s medical group receiving a recommended vaccination. And, as well as affecting their reputations, negative patient reports might reduce the demand for their services.
Studies on Patient Report Websites
Beyond the fact that they can be disconcerting to physicians, what do we know about patient-report websites? Actually, more than one might suppose. While there is a growing body of research that addresses the limitations, usefulness, and effectiveness of formal reports of physician performance, a similar literature is emerging that focuses on patient report websites.12,13 These studies have received less attention than they deserve, possibly because most have appeared in physician specialty journals (eg, Ellimoottil et al, 2013)14 or in the Journal of Medical Internet Research, where readership is limited. However, their findings shed light on the people who use patient report sites, site content, and the validity of physician concerns. The study results are sometimes surprising. 

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