Making the Grade: How Doctor-grading Websites Can Impact Your Practice, and What You Can Do to Lessen the Blow

Should your practice have a policy for responding to negative comments about the quality of care and service delivered by you and your staff left anonymously on an online physician-grading website?

“Her MA is very rude, uncompassionate. Dr. X doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

This is an actual comment that was posted by a patient on a website that rates physicians. There are more than a dozen well-known sites where patients can leave anonymous, negative comments about you, your staff, and your practice. There are more of these sites popping up every day, and more and more patients are looking to them as reliable resources when selecting a physician. As more patients turn to the Internet and social networking tools to find information about healthcare providers, you need to know what these sites are offering and what can you do about it if you receive an unfavorable review.

Doctor grades

Rating physicians has been part of the medical business for years. In the past, formal grading was done by utilization review or hospital quality assurance committees, and mediated through lawsuits and by the various state medical boards. This information was maintained internally and for the most part accessible only by the medical community. The other, informal method of rating was via word of mouth. Although this has often been the most effective way to market a practice, it has also been equally effective at losing patients. The conventional wisdom is that one patient’s bad experience will be heard by 10 others, whereas one good experience will only be heard about by that one patient. But now, the fact that patients can use the Internet to communicate their views and share experiences with a wide audience has added a new factor to the mix, making online rating sites and what they can do for you (or to you) a phenomenon that physicians ignore at their own peril.

The Internet offers much more than “Find a Physician” sites that list your practice’s address and contact info; there are a multitude of websites that purport to rank and grade how well you are doing when it comes to taking care of your patients. Many of these sites use questionnaires and also allow patients to post comments and even assign a rank or grade to your practice (you may find yourself with stars by your name, a smiley or sad face, or a numerical score). The options for reviewing and grading physicians online are diverse and growing:

• With 7 million visitors each month (http://tinyurl.com/qmab2p), HealthGrades.com is probably the most utilized and sophisticated physician-grading site. It offers free basic reports (contact info, specialty, insurance accepted, and user ratings) about physicians, with complete reports (including a background check that lists sanctions and disciplinary actions) available for $12.95.

• AngiesList.com: This site allows users to post comments about you and rate you on your bedside manner. There is a membership fee to join, but visitors can post comments without membership on selected items. Unlike similar sites, AngiesList.com requires that patients sign their name to their comments, giving physicians an opportunity to respond or follow up.

• RateMDs.com uses patient comments and marks physician profiles with a smile, neutral, or sad face in four categories: punctuality, helpfulness, knowledge, and a five-point quality scale.

Additional sites, such as PhysicianReports.com, Vitals.com, BookofDoctors.com, MyDocHub.com, DrScore.com, HealthcareReivews.com, and DoctorScorecard.com, provide similar rating information. Patients can also find physicians’ “grades” posted on managed care-sponsored websites. The most worrisome aspect of these online resources for patients is that they do not offer sophisticated opportunities to review actual medical outcomes or quality measures. Instead, they present anecdotal evidence that measures highly subjective factors such as bedside manner, wait times, and other non-quality measures.

It is important that physicians recognize patients’ changing roles and expectations in the era of Health 2.0 and understand how patients use the information that they find online. Patients search sites like HealthGrades.com to find information about their physicians, including education, training, and in some cases, malpractice history. But they also want to be able to participate in the creation of that information by reporting on their doctor’s office visits. More often than not, these online opinions represent the extremes the patient is very happy or very unhappy with the service he or she received. Unfortunately, it seems that most of the reviews on these sites are from unhappy patients who complain about delays in being seen or unfriendly staff.

How do you deal with the Internet?

Dealing with negative online comments and reviews can require a significant amount of time and effort from you and your staff. Here is what one practice chose to post on a website in response to negative comments:

“We at [the doctor’s office] would like to make it clear that the poor reviews listed on this site over the last several weeks are written by a single woman who is logging on under "shadow" aliases which are easily obtained through Yahoo and leaving slanderous e-mails. Please note the use of capitalized letters in all e-mails and the truly disparaging remarks which are a common theme in all of the e-mails. They should not be interpreted as being legitimate in any way. We have reported her to the correct department at Yahoo and an investigation is underway. We encourage anyone to talk to a legitimate patient or family member at our clinics if one takes her comments seriously. Please feel free to call our clinic and ask for a patient or patient’s family to discuss options with. Many have volunteered after seeing these statements. They do not reflect our clinic or our clinic’s goals.”

Some practices have resorted to asking patients to pledge that they would not post any comments about the practice on a website, even going so far as to ask patients to sign a contract that bars them from commenting online (http://tinyurl.com/yz9e52k). Critics of this approach note that it is unclear whether these contracts would hold up in court and that such a preemptive action could make it appear to patients that the practice is hiding something. There are several approaches that you should consider when dealing with Internet grading or “gossiping” sites, all of which should be done in a realistic and proactive manner. An angry, poorly planned response to a negative comment on a website will be perceived as defensive and is unlikely to produce the desired outcome. Instead, we recommend that you do several things:

Be aware. Simply being aware of the existence of physician-rating sites is a key step. The best way to find out what is on the Internet about you and your practice is to search online for your name and/or the name of the practice. You may find sites with comments and rankings that you were not aware of. In some cases, it may be beneficial to pay the fee to join these sites in order to be able to monitor what is being said. This activity should be assigned to a staff member.

Understand what each site is measuring and how they are determining the rankings. At many sites, there may be only one comment about your practice posted, which results in a low grade. While this may not be statistically significant, to many readers it will not make any difference. Understanding the metrics and measurement formula used by each site is important. If you find a site that has a negative rating based upon one report, you may choose to print and post it in your reception area as an educational tool for your patients.

Take action. Once you are aware and understand what is behind the grading systems, it is time to act. Remember: it’s not a bad thing to hear negative comments if you learn from them and use them to improve the practice. If you choose a defensive response and do not recognize that what is being said may be a legitimate complaint, you are missing the boat. A thoughtful and truthful analysis of your practice will yield positive results for your patients and for you.

Develop a practice website, or update your current one. If patients are searching for you online, your website should be one of the first page options they see. That way you can control the information and can send positive messages about who you really are, what services you offer, and key policies that affect the patient. And, you can offer secure logins for appointment and patient registration, links to other key websites, and more.

At your next practice board or management meeting, you should review your options for responding to the Internet grading and gossip system and create an action plan and set of procedures. We believe that a positive, thoughtful plan will be more beneficial for you and your patients than a defensive, negative response.

Mr. Dahl is the founder of Owen Dahl Consulting (www.owendahlconsulting.com), The Woodlands, TX. Mr. Rahman is an assistant administrator and pharmacoeconomic specialist for Oncology Consultants, PA, in Houston, TX.

What Do MDNG Readers Have to Say about Online Physician-grading sites?

In a January 25, 2010 post titled “Poll: What Should Doctors Do if Patients Give a Negative Online Review?”, HCPLive.com blogger KevinMD wrote that “Patient reviews can be manipulated. It’s easy for a doctor or his staff to counter negative reviews by posting numerous positive ones. And how can one be sure that the reviewer is even actually a patient? Or just someone with an ax to grind against the physician? Doctors are bound by patient privacy laws that prevent them from issuing specific rebuttals. Also, a physician typically has only a handful of reviews — hardly a representative sample. So patients should be cautioned against making judgments based on such little data. But online physician ratings can have value. We don’t have our own system for getting feedback from our patients. These unfiltered patient voices provide a window into what patients look for in a medical provider and can help doctors constructively improve their practice. Doctors who dismiss online reviews do so at their peril. Reviews are indexed by search engines, and patients will find them when they type your name into Google. Physician review websites aren’t going away any time soon. It makes sense to find a way to work with these sites. The medical profession can help improve the reliability of online ratings by ensuring they’re written by actual patients, and are based on real encounters.” [Results of the poll show that 56% of physicians have searched for patient ratings of themselves online]

In a comment to the online version of this article, Rodney Ritchie, MD, wrote that he “found a single critical posting on Yahoo from several years back. This complaint had been thoroughly investigated by the Texas Medical Board, with the finding that none of the allegations were true.” He requested Yahoo to “remove the posting based on the Texas Medical Board's finding. They answered back that it was their policy NOT to ‘interfere’ and the posting would stand as written indefinitely.”

Also in the comments to this article, Bradley H. Kline, DO, wrote that physicians “should not be evaluated by sophomoric tools whose metrics are pushed by individuals with less medical expertise and experience than a freshman, medical student. This is unfair to us and will have devastating effects for patients.” He thinks that the ratings sites should be held liable “since they do not provide adequate due diligence and since they are potentially damaging. The sites [listed in this article] should themselves receive poor grades in this arena. Tort law is specifically designed to protect individuals from damaging negligence.” Kline proposes that physicians should “organize class action suits against sites when it can be shown that they have functioned in a way which is negligent due to their lack of due diligence, and where such negligence has damaged our practices.”

What do you think about these sites? Have you discovered anonymous negative comments about your practice online? How did you respond? Visit the online version of this article and share your thoughts and opinions.