Do online reviews diminish physician authority?

by on March 26, 2017 at 12:34 am in Data Source, Medicine, Web/Tech | Permalink

Mostly yes, that is a result for cosmetic surgeons, and that may be one reason why online evaluation of medical services has been relatively slow to evolve in an effective manner.  Here is part of the abstract of a new paper:

I argue that surgeons see reviews overwhelmingly as a threat to their reputation, even as actual review content often positively reinforces physician expertise and enhances physician reputation. I show that most online reviews linked to interview participants are positive, according considerable deference to surgeons. Reviews add patients’ embodied and consumer expertise as a circumscribed supplement to surgeons’ technical expertise. Moreover, reviews change the doctor-patient relationship by putting it on display for a larger audience of prospective patients, enabling patients and review platforms to affect physician reputation. Surgeons report changing how they practice to establish and maintain their reputations. This research demonstrates how physician authority in medical consumerist contexts is a product of reputation as well as expertise. Consumerism changes the doctor-patient relationship and makes surgeons feel diminished authority by dint of their reputational vulnerability to online reviews.

Here is the paper, by Alka V. Menon, and the pointer is from the excellent Kevin Lewis.

1 Jonathan S March 26, 2017 at 12:50 am

“cosmic surgery”

Is that what its called now when someone changes their astrological sign?

2 Mark Thorson March 26, 2017 at 1:27 am

“The operation was a success! You are now a Libra!”

Hey, I could do that job.

3 Michael March 27, 2017 at 6:11 am

How???

4 JK March 28, 2017 at 3:10 pm

easy, rebirthing therapy. schedule for your desired day.

5 Pshrnk March 26, 2017 at 5:20 am

Press Gainey and other raters, as well as Joint Commission are major drivers of the American “Opioid Crisis”. When docs are afraid they will lose rating points and possibly jobs or bonuses as a result, they sometimes give in to inappropriate consumer demands for drugs that cause much long term harm. Just one of the reasons American health care is screwed up. One of the reasons we will have trouble keeping up with other surging economies this century.

6 B Hansen March 26, 2017 at 7:57 am

My father practices pain management in a rural area and my fiancé is an ER physician. I can attest to the structural incentives of physicians to give in to patients demanding opioids. My father’s practice has received multiple poor online reviews from drug seeking patients, and my fiancé’s bonuses are tied to her Press Gaineys. Both have strong type A personalities and don’t give in to unreasonable demands, but there are many who do unfortunately. I’d be interested in seeing similar studies done for physician practices whose cases are mostly not elective.

7 Jasy March 26, 2017 at 4:33 pm

Exactly right. On the flip side, studies show that physicians who are merely kind to their patients receive high scores of patient satisfaction, even if patients outcomes are mediocre. Patient satisfaction should be a component of how physicians and hospitals are rated, but they should just be a component, and not a metric that is overweighted.

8 rayward March 26, 2017 at 7:41 am

Cosmetic surgeons aren’t like the rest: almost all of their patients are cash-pay and the surgery is almost always elective. And are patients who elect to have cosmetic surgery ever happy with the result? Since cosmetic surgeons don’t usually have to answer to a third party (such as an insurer), they tend to make their own rules, which can create conflict between them and other providers. I wouldn’t assume that the online experience of cosmetic surgeons would apply to all surgeons.

9 William Bromberg March 26, 2017 at 7:45 am

My wife is a cosmetic surgeon and has had to deal with these ratings on different websites including yelp. The real problem is that there is no way to engage with the reviews either good or bad because of medical privacy laws. It doesn’t matter what the patient says whether it is true, wildly distorted, or out right lie, or just a clear misunderstanding . Unlike any other business that can respond in public and clear up any misunderstandings, or even offer recompense publicly which builds reputation a physician cannot. Furthermore a physician cannot even deal with completely fake evaluations from people who are not patients. Neither my wife nor I ever thought of the rating system as “reducing physician authority” it’s more of a matter of complete inability to adequately respond and take care of the patient’s complaints in a public way which would improve reputation because even if the patient become satisfied that review remains and cannot be changed, certainly by the physician.

10 Alain March 26, 2017 at 11:59 am

Sounds like HIPPA strikes again. Oh government, is there anything you can’t mess up?

11 Troll me March 26, 2017 at 12:13 pm

“The real problem is that there is no way to engage with the reviews either good or bad because of medical privacy laws”

Thanks. That seems critical to understanding options in moving forward on the matter.

12 mk118 March 26, 2017 at 8:18 am

“…surgeons see reviews overwhelmingly as a threat to their reputation…”

Duh

Sellers in a monopolistic market (licensed physicians) have little incentive to improve their services to buyers… or seek feedback from buyers. With a semi-captive consumer base, feedback is disruptive and annoying to established sellers.

Cosmetic Surgery is a bit more competitive than most U.S. medical practice because insurance does not cover most of it… and buyers pay directly. but all physicians operate within a government enforced racket.

Non-anonymous, public reviews of physicians are risky because physicians have deep pockets for lawyers and are prone to file defamation lawsuits. Online reviews and such are a fallback option for patients because doctors refuse to engage their patients directly concerning the quality of physician services.

Doctors usually ask their patients how that patient is doing after treatment, but never ever ask patients to rate that doctor’s services. And of course doctors literally bury their serious mistakes.

13 B Hansen March 26, 2017 at 8:59 am

You are correct in saying cosmetic surgery is generally more competitive, but you paint with far too broad of a brush regarding physicians as a whole. Specialists in Medicaid heavy rural areas really don’t need to focus on patient satisfaction as much- but that’s largely because other physicians (and/or their spouses) don’t want to live there. Physicians in metro areas face much more competition, and absolutely do care about patient satisfaction. I think that there should be more competition, say by allowing more independence of mid level practioners in certain specialties, but to pretend doctors don’t currently face any competition from one another is incorrect.

Your assertion that physicians are prone to sue for defamation is flat out laughable. Physicians hardly have any time to get deeply involved in malpractice suits directed against them.

Finally, you are right to say most doctors don’t ask patients to rate their service – that’s what hospital administrators do.

14 Robin March 26, 2017 at 11:52 am

Do you think that hospitals use the same reasons criteria as patients? And if not, perhaps doctors could learn something if they asked for patient ratings.

15 Troll me March 26, 2017 at 12:22 pm

Medical services should be evaluated based on medical outcomes, not patient feel-good points.

I think patient feedback of some sort would be excellent as an input to be used for quality assurance so far as to improvements at the systetmic level. But if patient feel-good points come to be a main source of “quality assurance” inputs, then the incentives will be very poorly aligned.

Very possibly, this itself could be a major source of misallocation and over-expenditure in the American system itself.

I certainly recognize consumer satisfaction as something of inherent value. But when you drop 50 grand on a surgery, I’d like to think that the main evaluation is influenced by the medical outcome, with very limited consideration for things like whether the food was good (and, say, limited opportunities for nurse breast size to excessively influence the evaluation of medical service quality).

16 Fergus March 26, 2017 at 12:54 pm

Measuring outcomes is not as straight forward as you claim. See here the connudrum of the measurement problem in any n+1 variable system when assessing outcomes.

17 Troll me March 26, 2017 at 2:18 pm

I stated the ideal. I never suggested it would be easy.

For the 50 grand surgery, obvious indicators include “is alive in 5 years” or “redo on the surgery not required”.

18 Troll me March 26, 2017 at 2:20 pm

For something like heart surgery, it might be more complicated because free people do not behave as perfect experimental subjects.

19 Bill March 26, 2017 at 9:07 am

This is an interesting problem (physician reviews) because it may alter the ways that physicians speak to their patients, and whether the consequent modified speaking styles REDUCES adherence to physician recommendations.

There is very good literature developing in the area of behavioral economics and healthcare, and its overlap with marketing. One of the subjects is how to speak to a patient effectively.

Consider two scenarios to the situation of a teenager discussing his smoking habit with the family physician.

Scenario I (Physician conscious of his review by the patient): Well, Bill, I see you have taken up smoking. Let me tell you why this is not a good habit….

Scenario II (Physician doesn’t give a damn about the review): Holy Shit Bill, Do you realize you are going to kill yourself with this habit. I like you and You are going to kill yourself with this habit….Followed by loud continued shouting by the doctor, patient getting nervous, etc.

In studies, Scenario II is much more effective, because it raises anxiety, fear, is memorable, but no doctor will do it.

Patient reviews.

For the same reason no professor yells at a misbehaving student in the classroom without considering performance reviews by the student.

20 Art Deco March 26, 2017 at 10:00 am

In studies, Scenario II is much more effective, because it raises anxiety, fear, is memorable, but no doctor will do it.

Somehow I doubt more than a scatter of doctors are at home with rude confrontations with patients. Of the two I’ve been acquainted with, one was (I was told) sued at least twice by the families of patients he’d killed (he was a dermatologist, btw). Another abruptly closed his practice and decamped to a little town in Arkansas where he remained for a few years ‘ere decamping to an exurb of Louisville, where he practiced for a few years ‘ere abruptly retiring (or perhaps being fired). He had, once upon a time, been on the faculty of the local University hospital. The story peddled by his friends in the medical profession was that he’d departed and taken to office practice out of his house because he disliked the ‘bureaucracy’ at the University. A more cynical sort might wonder if his warm and wonderful personality was the source of his late career moving about. He received a number of reviews during his time outside Louisville from quondam patients complaining he was a rude prick. Curiously, his son-in-law is a doctor in a completely different specialty. He gets wretched reviews for being obnoxious to patients. He also practices solo, with his wife functioning as his office manager. Her mother had done the same.

21 Bill March 26, 2017 at 10:10 am

I didn’t say rude. I said: doctor raises anxiety level and fear to motivate client, listen, and act.

Ask yourself what sticks in your mind: A warm friendly low key discussion of risks, or an anxious, fearful, discussion with pictures of diseased lungs and a story of a funeral of a good friend who died of lung cancer.

22 Robin March 26, 2017 at 11:54 am

Do you have teenagers?

23 Bill March 26, 2017 at 12:35 pm

Do you mean: Did I scare them so much that they would not do drugs or led them to believe college would be much harder than it was to spur them to study in high school?

Yes.

24 Art Deco March 26, 2017 at 7:57 pm

Neither. I’m gonna die someday, and if I’m not too ruined to give a rip, it certainly feels that way most of the time.

25 Bill March 26, 2017 at 8:05 pm

Good example of hyperbolic discounting.

26 Troll me March 26, 2017 at 12:24 pm

Doctors must present professionalism. Finger wagging, if any, should be delivered with professional credibility.

27 Ricardo March 27, 2017 at 3:03 am

I wonder how effective scenario ii is in the long run. Patients often lie to their doctors about bad habits and it seems likely that a doctor who is rude and judgmental may encourage even more lying. Not to mention that grown-up patients can simply take their business elsewhere.

28 VD March 26, 2017 at 10:46 pm

Online physician reviews have been around years. Outside of cash pay, at the hospital center where I work none of my peers or I spend two seconds thinking about patient review; it doesn’t matter if we work for the VA, blue cross/kaiser, academic, or medicaid. There is only one patient review that we care care/worry/talk about: the chance of getting sued.

29 Axa March 27, 2017 at 7:22 am

Medical care is a commodity. Commodities are fine as long as they comply with a standard. A review system is good because bad doctors get filtered. However, a review system could also reinforce the banal quest for the “best doctor”. I think we all have a family member that is proud of only consulting the best, when medical care becomes luxury consumption :/

30 William Dorrington Fisher April 5, 2017 at 1:05 pm

I for one have never thought of this as being a reality until I read this post. I am very amazed that I had not considered this possibility before because it only makes sense that a doctor would feel his reputation would be vulnerable to online reviews. Though there is a doctor patient confidentiality privilege, nothing is stopping the patients from going online and sharing their experience and level of satisfaction with a specific doctor. Though doctors are very professional, most times, and do their job well their whole livelihood could be jeopardized by a single negative review.
Often when people have good experiences they share it with one or two people, whereas when they have a negative experience they are more likely to share it with an average of five people. With the internet being how it is, a single bad review on a social media or online source could be viewed by countless people which could cost that specific doctor a lot of business. So I understand how doctors would feel pressured to change how they operate to satisfy the public. This is a very different world we live in now, where professionals must worry about keeping the public happy and appeasing the masses while also trying to do their job efficiently and correctly. I for one do not like how professionals need to do this, because this could lead to an unhealthy balance and affect how they operate and may even cause them to do their job incorrectly just to save their reputation.

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