Life at the Crossroads of Medical Practice, Public Opinion, and Reputation: Physicians Under the Magnifying Glass

Consumerism and technology have created a daunting intersection, generating savants on diagnostic, treatment, and pharmaceutical information.In addition, consumers' choices are relying more and more on opinions generated by crowdsourcing. Area physicians weigh in on how how they view and are navigating this challenging time.

For decades, our society encouraged doctors—through education, experience, and patient expectations— to develop a sense of competence and the importance of being beyond reproach.

In the 1950s, nurses still gave up their seats for doctors and opened doors for them.1 Those days are long gone. Today, physicians engage in partnerships with other health-care practitioners and support staff, and often bring patients and families into the treatment and decision-making huddle.

The pressure on physicians to transition from elitism to collaboration is public, influential, and coming from all sides. There are articles on how not to be intimated by a doctor and how to maximize communication, patient satisfaction surveys, and Top Doc lists. Doctors face glowing reviews or the chopping block on numerous portals of opinion sharing—chats, blogs, Facebook, Twitter, and other social media.

A survey from the Pew Research Center found that 72 percent of Internet users (87 percent of people surveyed) looked online for health information.There, consumerism and technology have created a daunting intersection, generating savants on diagnostic, treatment, and pharmaceutical information. In addition, consumers’ choices are relying more and more on opinions generated by crowdsourcing.You can find ratings and reviews on products and services from running shoes to blenders, hotels, physicians, and medical facilities.Yelp and Healthgrades are popular sites, with extraordinary traffic.

You can find surgeon and gynecologist reviews on the same site as recommendations for the best Thai food in your neighborhood. As of Q3 2015, the site had 90 million reviews and a monthly average of 89 million unique visitors via their mobile device. In the mix of approximately 1.3 million health reviews are raves and five-star ratings, as well as comments like “Learn from my experience and stay far, far away,“ “It’s like the seventh level of hell,” and “I disliked your officious personality and your brusque office staff.” Ouch.

Tod Baker, CEO of MDValuate, says in a recent Physician’s Practice article on online patient reviews that 90 percent of the issues on those sites come down to better interpersonal skills. Baker also thinks physicians would prefer being rated on quality outcomes, rather than something that could be construed as arbitrary. Examples of the latter would include staff friendliness and time spent waiting. To improve its rating criteria, Yelp has teamed up with ProPublica, an independent, nonprofit newsroom practicing investigative journalism in the public interest. This will allow Yelp to provide statistics-based care information, compiled through CMS databases, on a care facility’s website.

Unlike Yelp’s historically limited response options, Healthgrades asks consumers to rate individual measurements, such as ease of scheduling an appointment, office atmosphere, wait times, how well the doctor listened and answered questions, time the doctor spent with them, and their level of trust in the doctor. Healthgrades also has robust tools to help doctors deal with the issues of reputation and making use of online feedback. (See related article, “The Increasing Importance of Online Physician Rating to Drive Patient Engagement.”)

One approach to online rating sites is to ignore them. A highly innovative, accomplished physician, with a yearly spot on Seattle’s Top Docs, declined being interviewed for this article because he pays “no mind” to online physician ratings. He doesn’t care what these sites say about him; he never looks at them. He feels his reputation is based on his expertise and work, not on how somebody grades him on a website.

On the other hand, Neal Futran, MD, also on the Top Docs list and chair of the Department of Otolaryngology-Head and Neck Surgery at UW Medicine, acknowledges that the online sites are here, whether we like it or not. He knows there is no way to tell how trustworthy they are; they could be helpful or destructive without quality control. “However, it is important to pay attention,” Futran says. “Sixty to 70 percent of my patients have checked me out.”

Another Top Docs physician—who prefers to remain anonymous because she does not want to appear to be speaking for the health-care organization she works for—says, “Younger doctors are more into social media and online searching regarding more parts of their lives. There will only be more of this, and from a business perspective, it’s not realistic to assume it doesn’t matter.” 

According to an article in the BC Medical Journal, doctors are typically independent, competitive, and high achieving. So, seeing an anonymous, poor, and out-of-context assessment could really sting. Our anonymous doctor says, “I looked at my ratings: three stars from three people in over 10 years. I don’t look like anything special. I wouldn’t pick me!” She understands that professional pride can make getting a bad review humiliating and embarrassing to admit you care. “But ignoring it might be dangerous,” she says. Those ratings can influence prospective patients, with no warning to you. And overlooking ratings and comments could be missed opportunities to improve your medical practice, including your approach with patients.

Doctors and Patients See Reviews Differently In addition to being rated with what some doctors consider to be insubstantial criteria, there’s the risk of being judged by whether or not a patient got what he or she asked for, not by whether the physician’s decision was medically appropriate. A patient with an addiction problem shopping for painkillers may rate her doctor poorly if she leaves the office without a prescription. “Someone might be angry that I did not prescribe them an antibiotic because I deemed it was not the best thing to do,” says Edward Earl Leonard, MD, an infectious disease specialist in private practice in Bellevue, Washington. “People can say whatever they want and hide behind it on their computer screen.”

A Five-Star Rating Might Not Be a Five- Star Rating
A physician shopper might decide on a doctor with a five-out-of-five-star rating, seeing this review as a recommendation, even if it is based on a slim number of responses. “Think about Consumer Reports—you might buy the car rated the safest, but hate it because you find it uncomfortable,” cautions Dr. Leonard. A specialist might be rated poorly, but her community lacks an alternative in that field. In addition, Dr. Leonard fears there is a disconnect between online reviews and actual care, in part because the metrics used to evaluate doctors on these sites are limited, as noted above. “Sites need to use tools that assess outcomes and quality of care.” For example, reviews like CMS’s Physician Quality Reporting System use benchmarks to “ensure patients get the right care at the right time.” (See related article, “Physician Compare: Changing How Health Care Choices Are Made.”)

Peer Opinion Surveys Are Important to Patients Doctors recommended by other healthcare practitioners carry a lot of weight with patients. In the Puget Sound area, they look to Seattle Met’s “Top Doctors and Nurses” and Seattle Magazine’s “Top Doctors.” Portland Monthly has a similar yearly list called “Top Doctors and Nurses,” and Castle Connolly Medical Ltd. creates Idaho and Wyoming’s lists.The process and criteria differ somewhat, but in brief, include years of experience, competency, specialty, patient rapport and satisfaction, compliance with care recommendations, number of nominations received, education, and ability to work effectively with colleagues across specialties to deliver the best patient care.

Professional Referrals Are a Vote of Confidence
Another reflection of reputation is referrals—particularly repeat referrals— from other professionals. Physician referrals “are critical to our success, especially with specialists,” says Dr. Futran. To retain goodwill, it is essential to be thoughtful of referring doctors. A call or text to reassure them that their patient will be well cared for goes a long way. Dr. Leonard cautions that bad attitudes, disrespect, arrogance, and lack of follow-through make a colleague hesitant to refer again.

Word-of-Mouth Recommendations
Patients often judge a medical practitioner or hospital by the opinion of someone they know. The “Yelpification” of heath care shows that consumers are increasingly relying on the experience of their peers in choosing a doctor or hospital. Friends and relatives express their thoughts on social media, like Twitter, Facebook, and online chats, as well as in e-mails and during conversations over a cup of coffee. Not necessarily based on Top Doc criteria, some people choose or reject a doctor based on the opinions of office coworkers or Aunt Mable.

In this grand swirl of opinion, there are opportunities, and what helps your reputation also helps your patients. For example, patient surveys can serve as reputation boosters if used effectively. At UW Medicine, one of Dr. Futran’s roles as co-chairman of the Physician Engagement Committee is getting doctors, through the though UW Medicine’s Patients Are First quality initiative, to look at these sources of internal feedback. He believes they drive better patient outcomes and better skills, because by taking patient opinions and ideas seriously, physicians can improve their care, systems, and communication, thereby enhancing public perception of them and the organizations they work for.