From: MedScape

Review Sites Proliferate Like Bacterial Spores

When Anatole Broyard, a former editor of the New York Times Book Review, was diagnosed with prostate cancer, he wrote about how disappointed he was in his doctor. From the moment Broyard met his doctor, he didn’t like him[1]:

I had a negative feeling about this doctor. He didn’t seem intense enough or determined enough to prevail over something powerful and demonic like illness. He had a pink, soft face and blue eyes, and his manner was hearty and vague at the same time… He reminded me of a salesman with nothing to sell but his inoffensiveness…

The difference between Broyard’s account in 1990 and today’s online patient reviews of doctors is vast. To begin, Broyard was a professional editor and writer, and his words were reviewed by editors before they went out into the world for readers and for posterity.

Today’s Yelpification of doctors and healthcare is here to stay. Websites are proliferating like bacterial spores, enabling anyone—whether you’re a patient or not—to review doctors. Experts agree that the three most common types of negative online physician reviews are as follows:

  1.  “Crazy person”: The review is overly sensitive, overreactive, and unrealistic, but could influence people.
  2.  “Medical competence”: The reviewer complains about a misdiagnosis or medical error, casts doubt on the physician’s medical competence, or believes that he or she did not get the right tests or medication.
  3.  “Nuts and bolts”: The review runs the gamut from office dйcor, staff attentiveness, doctor lateness, bad coffee, loud music, lack of WiFi, outdated magazines, cleanliness of the bathrooms, and more.

This 2015 Yelp review of Dr Charles Saha, a Manhattan-based internist and gastroenterologist, illustrates all three of the above categories. “This is verbatim,” says Saha.[2]

First of all the practice itself is strange. It looks like a country doctor’s office. You have to walk up many flights of stairs to get there. Then there’s Fox News on the TV (the first I’ve ever encountered!) Dr Saha appeared with a white MD coat covered with political buttons and an American flag. I asked if he was Republican and he said yes. It was very unprofessional. (I have MDs that are Republican but this is just weird.) I was there for synthroid med and after several tries, we got the correct dosage. But I don’t feel the practice suits me. And I didn’t want Dr Saba [sic] to examine me. So we just agreed to deal with medication issue. Receptionists behind the desk were efficient. Patients there looked staid. Just not my kind of folks.

According to a 2014 JAMA survey, the use of online physician reviews and testimonials is growing and increasing in importance for consumers.[3] JAMA’s survey revealed that 40% of patients think that physician ratings on websites are “somewhat important.” Of those who used the Web to find a physician, 35% selected a doctor on the basis of good ratings, and 27% avoided a provider because of bad ratings.

Although a recent study from the Center for Health Information and Decision Systems reports that physician ratings are overall positive (a mean of 3.93 on a scale of 1 to 5),[4] what’s a physician to do if he or she receives a review that falls into one of the three particularly brutal negative categories? Let’s take a look.

The ‘Crazy Person’ or Rant

Allan Strongwater, MD, a New York/New Jersey-based pediatric orthopedic surgeon, says he’s had his share of negative reviews in all three categories. “I had a patient who did not have an appointment walk into the office, and although my staff informed them of the “no walk-ins” office policy, the patient refused to leave,” recalls Dr Strongwater. “Ultimately, my staff called the police. The woman got into a physical altercation with the police and was removed in handcuffs. Generally, those individuals who fall into the ‘crazy person’ category defy logic and cannot be reasoned with. They will do and say as they wish despite the facts and truth.”

Medical Competence

“It’s rare to get ranting reviews or reviews about doctor incompetence,” according to Ron King, CEO of Vanguard Communications, a “reputation management” company whose expertise is growing medical practices and increasing positive reviews and online ratings. “A national Internet survey of 35,000 reviews—across all specialties, including hospitals and all healthcare providers—showed that only 1 in 25 cases fell into the “crazy person” or “medical competence” categories.”[5]

Still, a swipe at a doctor’s competence stings the most, as would be expected.

“Competence reviews are disturbing, in part because they indicate that I failed in my communication with the patient to get them to understand the various risk factors and potential complications associated with medical treatment,” says Dr Saha. “I cannot tell you how much time I have spent with patients explaining informed consent, only to find that the following day when I ask the patient what we are going to do, he or she has little or no recollection of the informed consent.”

When Dr Saha has received negative complaints, he’s tried to address them personally with the individual. “I do my best to resolve complaints with the patient directly until I can fully resolve them to the best of my ability,” he says.

But sometimes the patient is anonymous, can’t be reached, or doesn’t want to talk. Furthermore, experts say, removing a negative review is not easy—owing to legal protections provided to the sites and patients themselves.

Dr Marianne Styler, a New York-based gynecologist in private practice, says she’s received negative reviews in all three categories. “I’ve gotten combo reviews that fall into the ‘crazy person’ and ‘medical competence’ categories,” she says. “One person used an alias to post. The complaints came about because the patient had an abnormal result and it was suggested that she come in to discuss, but she called wanting her ‘abnormal result’ discussed over the phone. When I declined to do that, stating that I only discuss abnormal results face-to-face, the patient hung up irate and in a huff.”

At the time of the above incident, Dr Styler was subscribing to a service that alerted her to the Yelp post. Yelp refused to do anything about it. “I tried to remedy the negative review [posts] by asking the next couple of patients to post positive reviews.”

Currently, the law is on the side of websites—each of which maintains individual policies for posting and removal. For instance, RateMDs and Healthgrades prohibit defamatory reviews but then retain sole discretion to remove the reviews. RateMDs’ policy is that it “generally does not remove ratings.” Wellness, a site featuring provider locator and comments, maintains a policy that if you report a review for removal, it “may investigate the allegation and determine in our sole discretion to remove or request the removal of the material.”

Wellness further states in is FAQ for businesses[6]:

How can I have my information removed from your website?

Wellness.com does not remove listings for active doctors or health practices because we provide an objective third party rating and review system for consumers. Consumers have a right to rate and read reviews about all businesses and health practitioners regardless of whether they are accepting new patients or not. Since the name and contact info for licensed health practitioners are public information, Wellness.com is protected by law from any attempt to remove a listing.

Eric Goldman, a professor at Santa Clara University School of Law, has studied medical review sites extensively. He advises against suing to try and get negative reviews removed, because doctors rarely, if ever, win.

Also, it’s not a good idea to engage in a defensive online argument, which often just fuels the reviewer’s initial complaint. Addressing the situation directly and compassionately, according to Goldman, can work favorably for the doctor and practice. Plus, patients are more likely to soften or retract a negative review if they know they’ve been heard.

Critiques That Really Sting

‘Nuts and Bolts’

This “fluff” category, as Goldman calls it, is an area that historically, doctors have thought they don’t need to pay attention to. But it’s the category that receives the most negative reviews. “If your patients are saying that you’re not meeting their needs, this is valuable customer feedback that should be taken seriously,” says Goldman.

“The majority of complaints fall into the ‘nuts and bolts’ category,” says King. “Patients are not happy when people don’t answer the phone or the billing department can’t explain a bill. Ninety-six percent of complaints fall into ‘customer service.'”

According to a recent Vanguard survey that was based on 34,748 reviews nationwide[5]:

  •  53% of complaints are related to communication;
  • 35% are related to long wait times/waiting rooms;
  • 12% are related to practice staff;
  • 4% are healthcare (delivery)-related; and
  • 2% are related to billing.

As a surgeon, Dr Strongwater has been unavoidably delayed to office hours, leaving some patients to wait. After some complaints, he started a policy that if a patient waited more than 10 minutes beyond their scheduled visit time, they were not billed for the visit. However, with the proliferation of HMOs, he was forced to do away with that policy.

Besides lateness, Dr Strongwater says that complaints about the office or waiting area were probably second most common — for instance, poor magazine selection, seats being too high or too low, and room temperature being too hot or too cold. “Some patients wanted weekend or evening office hours, but I needed some time off,” he said.

According to DocSpot, an analysis of a quarter million reviews found that the majority of online patient reviews are favorable toward doctors.[7]Sixty-five percent of the reviews analyzed gave healthcare professional the highest rating possible, and 3 out of 4 reviews rated the doctor positively (either a 4 or 5 on a 5-point scale). The survey corroborated what experts say: It’s not all about the competence, diagnosis, and medical outcomes, but rather heavily weighted on the physician’s staff.

Goldman says that once you get a negative review in any category, it can be advantageous to turn a griper into one of your fans. He suggests that doctors reflect on the situation from the patient’s perspective: for example, “I got a parking ticket because the doctor was late.” The clinician needs to realize and accept: I screwed up their day and should be accountable.

In a recent New England Journal of Medicine article, Vivian Lee, MBA, MD, PhD,[8] wrote that patient reviews offer clinicians valuable performance feedback for learning and improving. And receptivity to performance feedback, which depends heavily on physicians’ acceptance of the data’s validity, facilitates a culture of learning and patient-centeredness. Patient reviews offer the opportunity to improve healthcare delivery while strengthening the provider/patient relationship.”

The Wrong and Right Ways to Go About It

A 2017 New York Times piece raised the question: Is it ethical for clinicians to solicit reviews from patients? The columnist’s advice was that as soon as you ask, you’re influencing the patient’s rating.[9]

Goldman believes that once you solicit feedback—for instance, by placing an iPad in the office for patients to do so—you’re influencing patients, because they will believe that they are being tracked and feel obliged to write good reviews for fear of retaliation.

However, those in the business of growing medical practices and improving ratings would disagree that encouraging or soliciting comments from patients is unethical. Rather, it’s business. It’s a competitive market out there, and doctors need to acknowledge the rapidly changing tide and accept that their reputation, and possibly livelihood, is increasingly influenced by online reviews.

King explains that if you have 20 happy patients, then the few negative reviews look less credible. However, he notes, if you, your practice, or your hospital show a trend of negative complaints, it’s important to assess and retool your practice. He, like other experts in the field, agree that although it’s not fun getting negative reviews, it’s good that clinicians are feeling that they must be better communicators, put themselves in their patients’ shoes, and be accountable to their patients.

Mark Lange, CMO of Reputation.com, recalls one case with a large hospital system that received many complaints about parking. “Once we drilled into complaints, we discovered all parking complaints were due to signage—and we could fix the problem,” says Lange. “If you have good analytics, you can get clear information about online reviews. For instance, if a doctor, practice, or hospital says, ‘We have a problem with cleanliness/friendliness,’ we can get specific granular feedback to help make improvements systematic.”

Dr Strongwater says he works with his staff to avoid unpleasant patient experiences. “Every negative comment over the years in practice has significantly impacted me personally and pushed me to improve sensitivity to patients’ needs,” says Dr Strongwater. “Many are satisfied that you agree there was a problem and acknowledge that a remedy will be sought. I take every complaint seriously— even those in the ‘crazy person’ category are evaluated.”

“People need to be heard; they need to know you’re listening,” says Goldman, who maintains that 70%-90% of doctor reviews are positive. Still, if you do receive a negative review, “Turn it into a win. Find out the problem, listen, and fix it.”

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