YAHANDA: The doctor wars

Websites that post anonymous reviews of physicians do not help individuals make better healthcare decisions

You have no doubt looked to Internet reviews when buying a product. I certainly have. But have you used similar reviews to help you choose your doctor? A recent study suggests that an increasing number of Americans are doing just that.

The study, performed by the University of Michigan and published in the most recent Journal of the American Medical Association, reports that 23 percent of patients utilize physician online rating sites. This is up 20 percent from usage rates reported in 2008. While the people comprising that 23 percent do not necessarily base their physician choices on the reviews they read, this trend indicates that more people may be using the Internet to inform their healthcare decisions. These reviews, however, should be taken very skeptically.

Online product reviews are ubiquitous. There is someone willing to review almost everything imaginable, it seems. Such a wealth of information is helpful for goods like clothes or electronics, as it enables consumers to make more well-reasoned choices and brings to light product defects. Of course, all product reviews will not be useful or made by people with similar mindsets. Overall, though, it seems as if online reviews are fairly efficient at separating quality products from inferior ones. Yet while that may work for traditional businesses, online reviews do not translate in the same way to healthcare and physicians.

Medicine cannot be evaluated online in the same way as food, cars, movies or most other items. This is because medical care cannot be so easily condensed down into a neat and simple review. As an example, the doctor-patient relationship is usually a very personal one. Even if patients show up with similar ailments, the individuals can still differ in ways that alter the connection they make with a physician. They have different backgrounds, future plans, ethical beliefs or other characteristics that make their medical care unique to them. Thus, one patient’s experience with a physician can only loosely be used to extrapolate how another patient will interact with that same doctor.

Moreover, and perhaps most importantly, the average person is under-informed about medical procedures and treatments. So, these reviews could be written by people who do not know what constitutes good medical care. Healthcare is something with which nobody wants to gamble, and online reviews of doctors should ideally be illuminating. That being said, it is hard to write a well-informed review of a doctor unless you are somewhat familiar with medicine. Medicine is a complex and ever-evolving discipline. New findings are constantly being published, and it can be hard to discern between good and bad information — especially when looking online.

To that end, a patient’s expectations before going to a physician may not be met through that visit. For instance, a person who comes to the doctor with back pain could expect to receive painkillers. If the doctor evaluates the patient and determines that heat and rest — not Vicodin — are the best remedies, then the patient may leave angry because he did not receive what he wanted (pills, a prescription, a treatment or any tangible reflection of the visit at all). This may not be a common interaction between doctors and patients, yet it outlines how a disgruntled online review may reflect incomplete information, which is probable given the average person’s knowledge of medicine.

Additionally, doctors with very charismatic personalities, but no clinical skills, may come across as fantastic caregivers to patients who are not aware of what good medical practice is. Conversely, doctors who are outstanding clinicians may not have great bedside manners, thereby unjustly earning themselves poor online reviews. Think of Dr. House from the popular medical show House, MD. He is abrasive and often disrespectful to patients. He is also an exceptionally talented physician. This is a fictional example, but it illustrates another point: online reviews are given by people whose evaluations are sometimes based on only one facet of what makes an effective doctor. People can be selective in what they choose to post and could overshadow many of their physician’s positive attributes with a lesser negative one. A positive treatment outcome is the goal. If patients reach that goal, then their physicians, even if they were not perfect, should be given reviews that nevertheless acknowledge their diagnostic or procedural prowess. Unfortunately, one bad experience with an otherwise qualified physician can tarnish that doctor’s entire repertoire of skills.

Medical care is simply too important to be heavily influenced by online reviews. It is not like any other consumer good. If one reads contradictory reviews of a restaurant, he can just go to that restaurant and experience its food for himself. People will not — nor should they be expected to — take such liberties when choosing healthcare. They want to choose the right physicians from the beginning of their treatment. It is admirable, then, that some people want to help others with respect to healthcare choices, but online forums are as often a place to vent as they are a place to educate. One should remember that online physician reviews — which, like any reviews, can be totally anonymous — are very likely to suffer from selection bias: those who post reviews probably had either very positive or very negative experiences.

The Michigan study reported that 43 percent of people who viewed online physician reviews did not trust that information. I am tempted to hope that such a number increases — or at least that 100 percent of people using online physician reviews view such reports with much skepticism. Obviously, other online resources about doctors are helpful. You can see where a doctor trained, what his specialties are or if he has won awards for his skill, for example. But when looking for a doctor, more trustworthy sources — relatives, friends or other physicians, to name a few — should be used. Anonymous online reviews should carry little weight.

Alex Yahanda is an Opinion columnist for The Cavalier Daily. His columns run Mondays.

Published February 24, 2014 in Opinion

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