Mixed reviews: Online physician ratings stoke DOs’ concerns, ideas
This article is the first installment in a series on Web-based physician rating services. The second installment will address the legal issues surrounding online ratings.
Notified in early January of having received the Patients’ Choice award for his unanimously high ratings on Vitals.com, Neil Spiegel, DO, at first felt honored, even elated. Eight people had given him an average composite score of 3.7 out of 4 on variables ranging from promptness to bedside manner to accuracy of diagnosis.
But a sense of perspective soon tempered his pride. “I asked myself, ‘What does this really mean?’ ” reflects Dr. Spiegel, who practices rehabilitation medicine in Rockville, Md. Although more than the one or two reviews many physicians have on various rating sites, eight reviews in no way represent the more than 1,000 patients he treats each year, he observes.
“Because of the small sample sizes, online physician ratings aren’t valid,” Dr. Spiegel says, noting that he is lucky that he hasn’t received a poor rating from a disgruntled patient. Someone could easily tarnish a physician’s reputation for refusing to do something unethical that a patient requests, he proposes. And some patients may be disinclined to rate their physicians highly because they have unremitting pain or other chronic or life-threatening ailments that are not responding to treatment.
John T. Pham, DO, a family physician in Portland, Ore., sees “both good and bad” in online rating services. “I’m delighted that I’ve gotten great reviews from my patients,” says Dr. Pham, who has the maximum five-star rating on HealthGrades.com. The high ratings reinforce Dr. Pham’s confidence that he is providing top-quality care and help attract new patients to his practice, he says.
But Dr. Pham worries about the lack of a “watchdog” to ensure the authenticity of the reviews. On many of the websites, anyone can rate a physician, he points out. Thus, physicians could potentially give themselves stellar reviews and slam their competitors, says Dr. Pham, who was the AOA’s 2007 Mentor of the Year (PDF).
“What gives these rating services the right to determine the ranking criteria for physicians?” asks AOA Trustee Norman E. Vinn, DO. “These websites are coming out of nowhere. The whole phenomenon is unregulated.”
Among osteopathic physicians, Drs. Spiegel, Pham and Vinn are far from alone in their concerns about the validity, fairness and accuracy of the more than 40 websites that post consumer ratings of physicians, as well as information on physicians’ education, board certifications, hospital affiliations and sanction history.
Nevertheless, some physicians value the insights into patients’ expectations that online ratings provide. A number of DOs, moreover, have developed techniques for monitoring their ratings and strengthening their reputations on the Web.
Room for improvement
An osteopathic manipulative medicine specialist, Al Turner, DO, of Portland expresses dismay at the sheer silliness of some of the online reviews of physicians, as well as the lack of accountability for the postings. He notes that one review encouraged people to visit his practice to see the goatee, bow tie and footwear of an associate. “I’m not putting on a circus act,” Dr. Turner says. “I’m committed to improving patients’ health.”
Quoted last November in a Chicago Tribune article on physician Web ratings, family physician Robert Francis Boll, DO, of Orland Park, Ill., disparaged the ratings physicians receive online as not only statistically insignificant but also frequently frivolous and irrelevant. “I get rated on everyone from the girls who open the window to the nurse who gives the shot,” Dr. Boll, who has excellent reviews on several sites, is quoted as saying. “I understand there has to be something. I just don’t have to agree to like it all.”
While many physicians do not like them, “the medical community in general has accepted online physician rating sites as a reality,” says Humayun Chaudhry, DO, the president and chief executive officer of the Federation of State Medical Boards of the United States (FSMB). Dr. Chaudhry notes that he understands the public’s desire to learn more about physicians. “With the vast amount of information on the Internet, health care consumers feel increasingly empowered and want to make informed decisions,” he says. In his view, the challenge is to direct the public to the best currently available information and to develop better databases on physician performance for future use.
“It’s good to have better-informed patients,” asserts James R. Freeman, DO, a family physician in Eau Claire, Wis. Dr. Freeman encourages patients seeking medical information to visit MedlinePlus, a service of the National Library of Medicine and the National Institutes of Health. “Unfortunately, there isn’t a comparable, reliable, comprehensive resource for information on physicians,” he notes.
In the Chicago Tribune article, Dr. Boll acknowledged the need for “objective, verifiable and uniform ratings” of physicians.
In conjunction with a quality improvement organization, such as the National Committee for Quality Assurance (NCQA) or the National Quality Forum, perhaps the AOA and other medical associations could consider developing a comprehensive rating system that would take into account patient outcomes, clinical competence and performance, practice management characteristics, and patient satisfaction with their office visits, Dr. Vinn proposes. Such a system could tap data from existing initiatives, such as the AOA’s Clinical Assessment Program for Physicians and osteopathic continuous certification. But an undertaking of this magnitude would take a long time to complete.