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.
“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.
Meanwhile, physicians and medical associations should promote the credible information that already exists online, Dr. Chaudhry suggests. The FSMB provides links to the websites of all of the nation’s medical and osteopathic licensing boards, which allow free access to information on physicians’ license and sanction histories.
Over the next few years, as state licensing boards adopt more comprehensive requirements for maintenance of licensure, better information on physicians’ ongoing clinical competence may become available, Dr. Chaudhry says.
Another resource recommended by some physicians, the NCQA’s Recognition Directory enables the public to search by state for physicians and practices that participate in the organization’s voluntary quality-measurement and certification programs. The NCQA’s quality assurance programs range from back pain and diabetes mellitus management to three levels of certification for patient-centered medical homes.
But until one authoritative, go-to website for physician ratings is established, DOs and MDs must cope with scattered, anonymous ratings on multiple sites.
Dr. Spiegel recommends that DOs google themselves regularly to monitor their online reputations. It is also easy for physicians to set up Google alerts on themselves so they are notified when their names appear in new Web content. Physicians will need to pay a membership fee to check their ratings on Angie’s List, the largest subscription service that reviews physicians.
While he has been pleased with his ratings, Dr. Spiegel has found factual errors on some of the rating websites. He notes that most sites allow physicians to correct misinformation, such as out-of-date addresses and phone numbers and errors in credentials and accepted insurance plans. Because patients may scrutinize these sites, Dr. Spiegel feels it’s important to make whatever corrections he can.
Rating sites differ, however, in the extent to which physicians can contest erroneous data or defamatory comments. The policies of each rating service can generally be accessed from its home page.
A family physician in Williamstown, N.J., Lee Ann Van Houten-Sauter notes that some rating sites do not allow reviewers to single out personnel by name. She once convinced a rating service to take down a negative review of her practice because the reviewer criticized specific staff members.
Lawyers with experience in Internet libel and slander can advise physicians who feel their reputations are being damaged by unfounded adverse reviews.
A family physician from Royal Oak, Mich., Paul R. Ehrmann, DO, advises osteopathic physicians to develop attractive, elaborate websites for their practices that will supersede rating sites in Web searches on a physician’s name. To draw visitors, Dr. Ehrmann’s website includes a blog, videos and photos, as well as detailed credentials of “Dr. Paul” and his two physician associates, links for e-mailing the physicians, patient testimonials, and health news. “When I ask new patients why they came to see me, often they’ll say, ‘I like your website. Because you put so much time and effort into your site, you probably put even more effort into your practice and patient care.’ ”
Paid a monthly fee, a professional Web developer built and continually updates Dr. Ehrmann’s site. An expert in optimizing content for search engine visibility, the developer tries to ensure that docpaul.com appears at or near the top of the links retrieved whenever someone searches for Dr. Ehrmann by name.
Dr. Van Houten-Sauter is among those DOs who conduct regular patient-satisfaction surveys that ask about wait time in the office, ease of making an appointment, and other aspects of office visits that tend to be rated online. Such surveys not only provide valuable feedback that can help physicians improve their practices, but also may help ward off any inclinations patients may have to criticize their physicians online.
Laura M. Rosch, DO, a Chicago general internist, suggests that physicians engage in more rigorous self-assessments of their practice operations using “secret reviewers” who pretend to be patients—similar to the “mystery shopper” services used by some chain stores and restaurants. The findings would be presented in private so physicians can correct any deficiencies. By engaging in this process, physicians can help ensure that patients are satisfied with all aspects of their office visits, thus averting online complaints.
Physicians should also regularly evaluate their clinical care, says Carol L. Henwood, DO, of Pottstown, Pa. “Most physicians do not do regular quality assessment,” asserts Dr. Henwood, who serves on the Board of Governors of the American College of Osteopathic Family Physicians. Dr. Henwood’s group practice conducts such assessments monthly; a quality committee with representatives from each site meets every two months to review the quality data and initiate improvements.
An opinion piece in the Jan. 7, 2010, issue of The New England Journal of Medicine observed that although online rating systems are flawed, physicians can learn much from reading reviewer comments in the aggregate. The patients who give physicians rave reviews “tell stories of feeling cared for, being heard, feeling their doctor’s compassion for them and their own faith in their physicians’s diagnostic skills and technical prowess,” wrote psychiatrist Shaili Jain, MD, of Milwaukee, Wis. “These stories,” she continued, “are so inspiring that they make me want to work harder and better for my own patients.”
As Dr. Henwood notes, a silver lining in the proliferation of online rating services is that these sites reinforce the importance of quality patient care.