Can we trust online physicians’ ratings?

That is a new paper by Susan F. Lu & Huaxia Rui, here is the abstract:

Despite heated debate about the pros and cons of online physician ratings, very little systematic work examines the correlation between physicians’ online ratings and their actual medical performance. Using patients’ ratings of physicians at RateMDs website and the Florida Hospital Discharge data, we investigate whether online ratings reflect physicians’ medical skill by means of a two-stage model that takes into account patients’ ratings-based selection of cardiac surgeons. Estimation results suggest that five-star surgeons perform significantly better and are more likely to be selected by sicker patients than lower-rated surgeons. Our findings suggest that we can trust online physician reviews, at least of cardiac surgeons.

The pointer is from Andres Marroquin.


The oncologist (now dean of a major medical school) who saved my life in the 1990s always got my nerves. His bedside manner seemed arrogant. I'm not sure what rating I would have given him.

But, then again, here I am to kvetch about him.

There should be a time element in these ratings. Your rating shortly after surgery probably would have been lower than today. Of course, this would also introduce a selection bias, if some patients did not live long enough provide a rating -- but that bias should favor increased accuracy, at least for positive reviews.

Yeah, need public reporting of detailed cost data and validated quality measures collected in a systematic way. Minnesota is starting to do this. Minnesota is moving down this path.

While we're at this, can we also trust online professor ratings?

Education is all about signalling anyway, so it doesn't matter.

Maybe not. The whole area of consumer ratings of medical care is fraught with problems. We often find large discrepancies between competence and outcomes and patient satisfaction. Patients prioritize niceness and environment over most other attributes. So, to answer your question, a high rating probably means that the physician will have a modern, nice facility with flat screens and fountains with friendly staff. The physician will likely be friendly and relatively prompt. The physician may or may not actually be competent based upon the ratings. (Cardiac surgeons are a poor choice for this study for a number of reasons, not the least of which being that cardiologists actually make most of the choices, especially for sicker patients.)


It depends on what you want from the ratings. Maybe many patients' desire for a pleasant experience outweighs their desire for competence.

Compare how restaurant ratings may complain about the atmosphere or service, which is of less interest to those diners who care more about the food.

It makes me remember the story of Van Halen and the M&Ms. Being friendly to a patient is not the main goal for a surgeon, but if he's caring enough to be friendly even after lots of work that means commitment to the job and attention to small details. In other words less prone to forget scissors in your chest, more attention to hygiene, etc.

So far this article shows correlation between patient ratings and surgeon performance. It would be great to have some data showing what Sailer and the steve suggest, that they can be good surgeons despite not being caring to patient's emotions.

Just an anecdote, but still....

My dad, an infectious disease doctor, seems to get high praise from every other doctor he's worked with. He has a CV twenty pages long and a stack of thank-you letters 3 inches high, many of which say things like "thank God for sending you into my life." He was once president of his hospital. He has written articles in standard reference books used in medical school. Out of no need but professionalism, he routinely works 12--14 hour days. He was on a shortlist of candidates to get a teaching position at Harvard Medical School. He was once on the front page of the New York Times. He chooses not to collect about 25%+ of potential income rather than employ a collection agency. Etc. etc. Point is, he seems to be about as good at his job as any other doctor.

But when you type his name into Google, you find only a handful of ratings where he scores in the middle. The only review I found was negative. If you didn't know any better, you wouldn't want to see this doctor. I think doctor review websites need more users before they are reliable.

I've had two very bad physicians for one kid, wrong diagnosis and dangerous medication error. I've checked back periodically on their reviews, out of curiosity, wondering if I'd have saved her trouble if I'd Googled these guys before taking her to see them. Every once in awhile a bad review will turn up (usually the same kind of trouble that I had) but then it's gone. They have more stars by their names than the many excellent physicians I've dealt with. I'm guessing the good doctors get more like four stars because they don't hire some firm to buff up their online profiles. Maybe a physician with a five star rating and no bad reviews should be the red flag.

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