How Does my Doctor Rate?

In 2011, the UK Health Minister said: I wouldn’t think of going on holiday without cross referencing two guide books and using TripAdvisor. We need to do something similar for the modern generation of health care. Do we? This article discusses the nature and use of these doctor rating websites, and provides some strategies on what to do if you are the subject of an adverse rating.

There are a number of websites that allow users to anonymously post ratings and commentary about doctors. These rating websites have been described as “the 21st century’s answer to word of mouth or over-the-garden-fence chit chat”,¹ and “chaotic and unregulated activity which brings to mind the notorious witch trials of Salem”.²

The most common website that our Members seek advice on is RateMDs which is hosted overseas. Recently there has been some discussion about Whitecoat, an Australian website that has been dubbed the “TripAdvisor for Australian health care”.³ The site provides an online healthcare provider directory and over 250,000 “customer” reviews of Australian healthcare practitioners.

What are patients saying?

The vast majority of online reviews about doctors are positive. A review of 33 doctor rating websites found 88% of comments were positive, 6% were negative and another 6% neutral.⁴ However, the small proportion of negative online reviews can be a source of great distress to the doctors who are the subject of these reviews.

Most medical practitioners find doctor rating websites fundamentally flawed

• How can a handful of ratings properly represent an appropriate assessment of a doctor who may see several hundred patients each month, and many thousands over a career?
• The anonymity means there is generally no ability to identify the person who has posted the rating. Is it a patient, a person with a grudge, or even a colleague in “competition” with them?
• Is this an appropriate method of assessing a practitioner’s skills as a doctor? There is very little evidence about the association between quality of medical care and online ratings. At best, there may be an association with other measures of patient experience and a weak association with clinical quality.⁵ However, a study published in the Journal of the American Medical Association (JAMA) in 2015 found no evidence that doctor rating websites were associated with clinical quality measures.⁶

Who is using doctor rating websites?

• A 2012 survey conducted in the US found that 42% of respondents had used social media to access health-related consumer reviews, including 11% who reviewed doctor rating sites.⁷
• A 2015 survey of patients at the Mayo Clinic revealed that 16% had visited a doctor rating website.⁸
• It appears these sites are used less frequently in the UK where only 14.5% of respondents surveyed in 2012 were aware of the sites, and only 3% had actually used them.⁹
• The proportion of Australian patients accessing doctor rating websites is not known.
• It has been suggested that people who use doctor rating websites may be more extreme (positive or negative) in their views, be younger than the general population, and may vary in their health status.
• More importantly, “gaming” may occur – competitors may post adverse comments and practitioners (or their representatives) may provide favourable ratings.¹⁰

Case study

The doctor was “Googling” his name when he came across the following review: The worst doctor I have ever seen. I took my daughter to see him when she was very sick. He missed the diagnosis and was deliberately rough with her because he was hassled. It was like we were imposing on his time. I’d ask a taxi driver for medical advice before seeing this animal of a doctor. Never see him if you are ill – or well.

The doctor was very distressed. He did not know who had made this comment about him. He wanted to know what he could do to have the online comment deleted.

What are your potential options if you are the subject of an adverse website rating?

• Do nothing.
• If you can identify the patient, consider contacting the patient directly to discuss their concerns and see if they will remove the post.
• Respond online (see below).
• Utilise the website policy for removal of posts.
• Send a letter to the patient and/or website proprietor seeking removal of the post.
• Threaten or commence defamation proceedings.

In order to seek a legal remedy against the person who posted the comment, the poster must be able to be identified. If their identity cannot be adequately proven, there is likely very little a medical practitioner can do.

A letter sent to the website proprietor requesting removal of the post may result in its removal. However, on occasion, this step may result in more attention being drawn to the existing adverse rating, and that letter may be then included on that website and others. There are specific websites that post these types of letters to try to embarrass and further criticise medical practitioners.

Can and should you respond online to a patient review?

Most negative comments are not worth responding to online. If you feel you must provide an online response:

• be very careful not to breach patient confidentiality and privacy
• make sure you do not respond when angry
• ensure your reply is caring and demonstrates a willingness to take on feedback and continually improve
• seek advice from a colleague and/or MDA National about your proposed response
• keep any response simple, for example: Thank you for your feedback. I am committed to improving my practice and have taken your comments into consideration.

It is worth identifying if there is any constructive criticism in the negative rating:

• Is there anything you could do differently to improve your practice?
• Should the concerns raised in the review be considered at a practice meeting? A number of complaints on these sites are about waiting times, parking and other practice management matters.¹¹

If you can identify the patient who has posted the comment, consider whether it is appropriate to contact the patient to discuss and address their concerns. Again, it is worth discussing the comments and circumstances with a colleague and/or MDA National.

Doctor rating websites appear to have less impact on patient choices than other factors. A 2014 US survey found that 59% of respondents reported doctor rating sites were “somewhat important” or “very important” when choosing a doctor, although the sites were endorsed less frequently than other factors, such as word of mouth from family and friends.¹²

Beware advertising testimonials

Consumer and patient information sharing websites that invite public feedback/reviews about their experience of a health practitioner are not considered “advertising of a regulated health service” under the Medical Board of Australia guidelines.¹³

However, it is important to be aware that it is not acceptable to use testimonials in your own advertising, such as on your website or Facebook site. This means you cannot use or quote testimonials on a site or in social media that is advertising a regulated health service, including patients posting comments about a practitioner on the practitioner’s business website.

Doctors should therefore not encourage patients to leave testimonials on websites they control, and should remove any testimonials or positive reviews that are posted there.

Conclusion

Whether or not there is any association between online ratings and the quality of care provided by doctors is not known. Some commentators recommend that there is value in monitoring your online presence and reading patient stories, suggesting these stories are “nuggets of qualitative data on patients’ attitudes regarding the quality of care and their needs and preferences in their relationships with their doctors”.¹⁴

However, most doctors find adverse postings on these websites immensely distressing, upsetting and anxiety provoking, especially since there is little that can be done to remove, or even respond to, these negative posts.

As another commentator has concluded:
The hard truth is that there probably isn’t a lot doctors can do to protect themselves from this kind of cyber-attack, apart from doing their best to ensure any criticism is undeserved.¹⁵

Summary points