For the fictional Dr. Y., whose story was told at the beginning of this article, this is the best possible answer to her dilemma: Leave the review alone. It’s an opinion, and while hurtful, it isn’t slander and is unlikely to meet the requirements for removal. However, it might be wise to follow up with the bullet-point recommendations I’ve made, above.
Can you muzzle your patient population? One company, Medical Justice, Greensboro, N.C., provides practices with a patient contract that allows the physician to retain copyright to patients’ online comments. The contract doesn’t preclude posting, but the physician is free to remove negative comments. The company’s product was described by its founder and chief executive officer in an article in the December 2009 issue of OBG Management (“Should you worry that patients will use the Web to grade you?,” at www.obgmanagement.com).
Even if—and that’s a big “if”—patients are willing to sign on the dotted line, it’s unclear how such a contract could stop anonymous posting. And, by analogy, would you eat at a restaurant where you were required to turn over copyright to your online comments before you saw the menu?
Here’s what I do
I’m a believer in physician ratings: If I’m doing a good job for my patients, I like to know that. And, if there’s room for improvement, I can change or fix something I do only if I know about it.
My physician group has had a patient survey in place for several years. It’s similar to the CHECKBOOK/CSS program, although it is accomplished by mail.
I’m proud that I receive high scores from my patients. Whenever I find that some facet of my ratings is slipping, I redouble my efforts. Online, 70% to 90% of my reviews are positive, which is in line with physicians’ experiences reported in the literature that I cited for this article.
Most negative opinions in medicine stem from communication difficulties
As a parent of two medically fragile children who has spent a greater part of 7 years at the other end of the stethoscope, I understand this only too well. So I strive to provide the kind of service that I would want from my providers. I ask my patients if:
- they understand my recommendations
- they agree with the management plan
- there is anything else I have not addressed (and not while I have my hand on the doorknob!).
If I sense that my patient is unhappy, I ask her what’s wrong, and I do my best to allay her fears or mitigate her problems that are under my control. last, I’m not afraid of online reviews—although my preference is for a scientifically valid questionnaire with a focus on achieving adequate numbers.
I believe that, when patients search for health information, they deserve accurate content not only about their health condition but about their physician, too.—Jennifer Gunter, MD
Other models that are worth considering
The United Kingdom’s National Health Service (NHS) operates a health-care rating site (NHS Choices; http://www.nhs.uk), where, among many other services, patients can provide feedback about both physicians and hospitals (anonymous if desired, although an e-mail address is required for validation).1 What’s unique about NHS Choices is that it is moderated; there are specific ground rules for providing ratings; and physicians are encouraged to respond to individual ratings.
In several geographic markets in the United States, Consumer’s CHECKBOOK/ Center for the Study of Services (CHECKBOOK/CSS), a not-for-profit consumer education organization, has piloted an online survey of physicians. Patients are sampled randomly from the enrollment of a list of insurers and invited to participate. The system verifies that the patient being surveyed has made a visit to the physician in question during the past year.
CHECKBOOK/CSS uses questions developed by the US Agency for Healthcare Research and Quality. The reports generated by the system are based on a statistically valid number of surveys (on average, 49 completed surveys for one physician). They are available without charge to the public at the organization’s Web site (http://www.checkbook.org/patientcentral).
A recent perusal of CHECKBOOK/CSS in one market easily found an “above average” rating for a member of the OBG Management Board of Editors….
Let’s make this a useful thing
Here is what we can say with reasonable certainty, based on observation:
- Most online reviews are positive
- Most physicians have far too few ratings on any one Web site to approach a meaningful degree of scientific validity
- Lack of accountability on many ratings Web sites raises the specter of sham negative or positive reviews. The CHECKBOOK/CSS model that I described appears to address many of these concerns.