Prepared Patient, is created by the Health Behavior News Service (HBNS), part of the Center for Advancing Health. This monthly series helps Americans participate more fully in their health and health care. For more issues of the Prepared Patient series, visit the archives.
Written By: Becky Ham, Science Writer and Kelly Malcom, HBNS Editor
'We're Listed With the Plumbers Now'
Angie's List can help you locate a reputable handyman. Yelp can push you in the direction of' the perfect ' restaurant for your anniversary dinner. Amazon's consumer reviews can even help you choose the TV that will fit in the corner of your den. So why wouldn't you turn to the Internet to find your next doctor?
39-year-old Jennifer Stevens did just that when she needed an obstetrician for her first child. Not wanting to reveal her pregnancy too soon by asking friends for suggestions for a good OB, she turned to the Web for more information on potential physicians. She soon found that a lot of the information she needed to make this important decision was missing. 'A lot of sites gave stars, but I didn't really know what those stars meant. I just wasn't comfortable picking an OB based on that kind of vague information,' she said.
Lindsay Luthe, a 30-year old Washington, D.C. resident, consulted the popular ratings website Yelp after asking her friends to recommend a physician. 'I perused the reviews for this particular doctor and saw how positive they were. Those reviews, combined with my friend's personal recommendation, led me to make an appointment with the doctor. I think I even used the contact info on the Yelp page to call the office,' she said.
The success of physician ratings websites'such as HealthGrades, or RateMyMD, among many others'has been mixed. It's easier than ever to find at least a little more information about your next partner in health. But patients are still frustrated with the dearth of details online and remain confused about how to evaluate the facts they find there. Some experts have suggested that these sites are still not as useful as they could be'in some cases, misleading potential patients with incorrect or out-of-date information.
'We're listed with the plumbers now,' joked Zucel Solc, M.D. The Pinellas County, Fla., radiation oncologist, like many doctors and patients, has reservations about online rating sites. But the sites won't be disappearing any time soon, and patients may have a chance to contribute to the next generation of ratings.
What You'll Find Online
A 2008 Wall Street Journal.com/Harris poll found that 91 percent of those surveyed would refer to online information about doctors provided by their health plan(s) and 87 percent expressed interest in providing feedback to health plan sites for physician rating. And there are plenty of reasons to want to know more about a doctor before you choose one. Doctors aren't equal in many respects. Studies show that the care you receive can vary depending on their experience, their familiarity with the latest medical advances or whether they use electronic medical records.
Unfortunately, most physician rating sites include little information on these topics. Most sites allow you to search by a doctor's name or by a geographical area. Click on an individual doctor, and you'll usually find out more about where she practices, where she went to school, whether she's been certified to practice a certain specialty within medicine and perhaps whether there are any disciplinary actions taken against her by a state licensing board. Visitors to the sites can usually rate the doctor's skills in a short survey and sometimes leave specific comments.
The sites vary considerably in how much information they provide, whether that information is up-to-date and how easy they are to navigate. PhysicianCompare, a U.S. government directory of health care providers who accept Medicare beneficiaries, was widely criticized on these points. After it was launched in December 2010, health care consultant Michael Millenson, president of Health Quality Advisors LLC, called the site 'confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable.'
|Evaluating Doctor Ratings Sites|
|They may not have all the information you're looking for, but online doctor rating sites can aid your search for a new doctor if you click carefully. Here are a few questions to ask and answer when evaluating a ratings site. This information isn't always clearly listed on a website, so you may need to dig deep.|
Tara Lagu, M.D., an assistant professor at Tufts University School of Medicine who has studied several ratings sites, agrees that many lack essential details. 'Things that we think a patient might really like to look for, such as a doctor's gender or the language he or she speaks,' she says.
Lagu and others also say these sites offer little information on a physician's area of focus, other than specialty certification. 'When a doctor specializes in different aspects of care, maybe that he sees mostly older patients or young women, he has no way of telling potential patients coming to these sites that this is what he really works on.'
Without knowing more about a provider's specialty, says patient advocate Trisha Torrey, 'it's not fair to lump all doctors into one site and rate them with the same rating system. It's like comparing a taxi cab to a jet.'
Many rating sites are silent on another point: Which doctors offer quality care? At PhysicianCompare, among other sites, said Maribeth Shannon, director of the market and policy monitor program at the California Healthcare Foundation, 'there isn't really any clinical quality information available'how good are they at actually treating the condition you have?'
Shannon said these clinical performance measures are 'particularly important for conditions where there are alternative treatments and there is 'time to shop,'' such as in the case of an elective knee surgery. 'Before I decide where to have this done, I'd like to know what the long-term outcomes have been,' she said. 'Do similar patients report a quick recovery? How often was follow-up care needed? What has been the surgical infection rate for the doctor and hospital?'
Both Lagu and Shannon noted that patients want different information from physician rating sites depending on whether they're looking for a doctor to treat a serious condition or for routine office visits.
For more routine care, patients seek out'but often don't find'information on 'the patient-doctor relationship, on parking and wait times and politeness of the reception staff,' Lagu says. 'And we just didn't find that these sites were all that patient-centered. Patients say one of their number-one concerns is to find a doctor who practices shared decision making'but only one of the sites we reviewed asked about that.'
Shared decision-making was one of the most important qualities for Stevens in her potential obstetrician. 'I wanted to find a doctor who would let me control the flow of labor. The ratings sites didn't tell me that,' she said.
Perhaps most importantly, most doctor rating sites lack enough ratings-whether on a lot of doctors or a lot of ratings for any one doctor. Unlike the extensive reviews on other consumer websites, most physicians have very few ratings to help patients in their evaluations. 'There just isn't any momentum on these sites yet,' said Torrey. 'We need ten more years, and thousands of ratings.'
Are Online Ratings Trustworthy?
Despite its considerable shortcomings, PhysicianCompare hopes to someday provide a non-profit alternative to physician rating sites that charge for their information. For-profit ratings sites may purchase their information from a large database, and in some cases will charge the doctors themselves to include their information. Some sites even offer 'enhanced profiles' to doctors'listing their best reviews first, or putting them first in a search'for a fee, Lagu said, 'focusing more on their profit motive than providing real information to patients.'
'A couple years ago, there was one website that was rating doctors and going to doctors who had a handful of negative reviews and offering to pull down those reviews for a certain amount of money,' Torrey said. There are also cases, she said, where physicians will give their current patients a discount off their next services if the patient posts a favorable review of the doctor online.
While patients may worry that doctors are paying for better ratings, doctors are worried that a handful of bad reviews may ruin their professional reputation. Most ratings sites allow people to leave reviews anonymously, without any way to confirm that a reviewer was treated by the doctor in question. Medical privacy laws prevent doctors from responding to poor reviews, since the response might reveal details about a patient's care.
Some doctors ask their new patients to sign a 'mutual privacy agreement' that prohibits them from posting comments or reviews to ratings sites, usually in exchange for privacy considerations such as not selling the patient's anonymous information to a third party, who may then market it as part of a larger database.
Lagu's studies suggest that the majority of reviews on the sites are positive.
But with so few ratings available online for each doctor, one bad review can stand out, Solc says. He compared the effect to a drawing of a tiny black dot on a white piece of paper. 'We always look at the dot in the sea of white.'
The Best Ratings? Face to Face
The proliferation of social media such as Facebook and Twitter has made it easier for people to share information about doctors without using a dedicated ratings site. Physicians' personal sites may show off their personalities in a way that can help patients decide if they would be comfortable and compatible with their care, Torrey said. 'You could follow a doctor on Twitter, read their blog posts, or look at their videos."
'I think we will see an increase in health care as a topic for discussion on social media sites,' Shannon said. 'People have always asked their friends and neighbors for advice on hospitals and doctors, this is just a high-tech alternative to a conversation on the phone or over the fence.'
Even the best ratings sites can't compare to a face-to-face meeting when you're looking for a new physician, experts say. 'There's only so much research you can do,' Solc says. 'What's going to make or break it is your first interview with the doctor.'
'To the extent that you can, get the best information ahead of time,' Torrey agrees. 'But then at your appointment, do your best to find out if you can establish an upfront, candid, and communicative relationship with the doctor.'