Managing Your Practice

For better or, maybe, worse, patients are judging your care online

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When patients rate you on Internet sites, it’s not necessarily the end of the world. It is an opportunity to apply your most valued clinical skill: listening.


 

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CASE: Unfairly labeled and now unnerved

Dr. Y, your colleague, calls you; she’s distraught. She performed a Google search of her name and found what she describes as a hateful review on a physician-rating Web site from someone claiming to be her patient. The reviewer declared that Dr. Y. was “rude” and interested only in “pushing one drug.”

“She must be a shill for a drug company….”

You’ve referred many patients to Dr. Y, and you’ve always heard wonderful things about her care. You know that she has never accepted pharma money for lectures or research.

“What should I do?” Dr. Y pleads with you.

We physicians probably don’t think twice about looking up reviews and ratings of hotels and restaurants. But many of us balk at the thought of our professional services being reviewed in such a manner. We’re aware that patients discuss their care, of course, but the Internet— well, that provides a megaphone of global reach for what was once mere water-cooler chat.

And reading angry words in print hurts more than hearing them secondhand.

With the Internet hosting more than 30 sites that rate health-care providers and hospitals, most of us can expect to be reviewed at some point. Only about 15% of people report consulting online physician reviews, however, and fewer than 5% have posted an online review themselves.1,2

What do you need to know about these sites and their potential to have an impact on your practice? Here are some important observations and pearls from the literature and from my experience at the receiving end of ratings.

Types of physician online rating

The first step in navigating the morass of Internet review and rating sites is to understand the types of sites that you’ll encounter.

Angie’s List. This site rates all kinds of services, including physicians. Membership requires registration and a fee. A member can post a review of a given physician every 6 months. Although the names of reviewers are not posted, they are available to the physicians being reviewed—if they ask.

Free Web sites that require registration of some kind. These are general review sites, such as www.yelp.com or specific sites for physicians, such as www.DoctorScorecard.com, which states that a reviewer is allowed to rate a given physician only once.

Free Web sites that don’t require registration. One simply finds the physician’s name and either clicks on the number of stars or writes a review, or both. Two examples: www.vitals.com and www.drscore.com. These sites claim to limit the number of reviews: vitals.com, one review a month; drscore.com, one a quarter. A spokesperson for drscore.com, claiming that such information is proprietary, declined to tell me how, without the controls offered by registration, the site prevents a physician or an angry patient from stuffing the ballot box.


How valid are online reviews?

You might think that the patients most likely to rate a physician or post a comment about her (or his) care are ones who are unhappy with their medical care. You would be wrong: 70% to 90% of online ratings of physicians are positive.3,4 It’s unclear if the positive-negative division of ratings varies between Web sites that require registration (and therefore have a greater degree of accountability) and those that do not. A recent informal sampling of sites reveals that most physicians have five or fewer reviews on any one site—a sample far too small for the rating to be considered valid or to offer meaningful feedback to a physician.

What can I do to protect my reputation?”

Good question. The answer is multifaceted.

  • Give your patients an opportunity to provide feedback after an appointment. If they can off-load to you at, or immediately after, their visit, they may be less inclined to post damaging comments elsewhere. And you might actually learn valuable information about your practice and your staff— and how convenient parking is.
  • Consider an anonymous survey for the patient to complete before leaving the office or to mail back in a stamped envelope.
  • Does the idea of a third-party Internet ranking site appeal to you? Find one that allows you to create a profile and have your staff direct patients to that site.
  • Develop a robust Internet presence. Web content that is under your control is more likely to appear at the top of the first search-engine response page (SERP)—thereby pushing potentially negative reviews out of this prime real estate (links that appear on the bottom half of the first page of search results, and beyond, are far less likely to be viewed or clicked). If your Web site isn’t listed first, consult with a search engine optimization specialist about trying to change that. Other ways to generate positive hits on the first SERP? Use Twitter (as long as you are using a version of your name as the username); start a blog; and write guest posts on other Web sites.
  • It’s possible to register with all the physician rating sites and receive alerts when you are mentioned, but that could be time-consuming. This strategy is also unlikely to be productive: First, not all sites allow rebuttal or other feedback from physicians. Second, even if you were able to respond, what you can say is limited by HIPAA. Last, although you can flag malicious content for removal, what you consider malicious and what the site administrator considers malicious could differ.

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