Pulse
Consumer Reports
Several websites now allow patients to post comments about their physicians. But do these online reviews really provide insight into who is a good doctor?
Three years ago, health care quality improvement expert MaryAnn Stump noticed that patients wanted more than outcomes data and performance rankings to help them choose a doctor. As president of Eagan-based Consumer Aware, an affiliate of Blue Cross and Blue Shield of Minnesota that strives to provide user-friendly health information, she learned from focus groups that patients really wanted to hear from other patients. “References,” she says. Patients wanted to be able to say to their doctor, “If you’re going to take out my gall bladder, can I talk with three other people whose gall bladders you’ve taken out?”
With that in mind, Stump and her group began working on an idea—creating an online forum, where people could post accounts of their interactions with physicians. “I was intrigued by the idea of looking at ways we could capture stories of the experiences patients had,” she explains, adding that the forum also fit nicely with an Institute of Medicine challenge to address health care improvement from the consumer’s point of view.
At the time, no websites offered patients the opportunity to review physicians, so when her group developed the Health Care Scoop (www.thehealthcarescoop.com), a site with what Stump calls “a blank page” for consumers to write about anything health-related, it was the first of its kind. When the site went live in October 2007, she had no idea whether it would catch anyone’s attention.
It became clear right away that the Health Care Scoop met a need. In the last year, the site has received more than 800,000 hits, and more than 1,000 people have used it to recount their experiences with physicians and medical groups; many other users have commented on their stories. Although it was promoted only within the Twin Cities metro area, people from more than 40 states have dropped in to read or comment on the posts. What’s more, Stump’s concept seems to have caught on, as a plethora of consumer-oriented health care-rating sites have popped up on the Internet in the past year.
From Plumbers to Physicians
One of the new sites is Angie’s List Health, which was launched in March of 2008. Angie’s List (www.angieslist.com) has long been known for offering paying members the opportunity to review and grade service providers such as plumbers and electricians. Expanding into health care was a natural extension, says Mike Rutz, vice president of Angie’s List Health in Indianapolis. “Our members were asking for it,” he says. Initially, consumers could review providers in 40 categories—from primary care to dentistry. In the first month and a half, more than 10,000 members posted their personal accounts, answering stock questions and giving grades for the service they received. Since then, nearly 52,000 people have weighed in, and the 40 categories have been further divided into 120 subcategories. (There are six variants listed under orthopedics, for instance, focusing on individual parts of the body, and the medical spectrum ranges from acupuncture to vascular surgery.) The reviews are largely positive: 94 percent of posters give their physicians an A or a B. What it shows, says Rutz, is “that consumers are starting to think a little bit more about health care and medicine and the choices that are presented to them.”
But physician reaction to online reviews has been mixed. “Some physicians have been vehemently against it,” acknowledges Rutz, “and then there are some who are cheerleaders.” One complaint he’s received from health care providers is that individual accounts do not truly convey who is a good doctor. In fact, he received a letter from the Ohio State Medical Association expressing concern that the reviews offer limited information for readers.
Rutz’s response is that patients’ experience is important to determining whether a doctor is doing a good job. He says they’re revising the site so members can offer feedback about intangibles such as bedside manner and communication skills. At the same time, he notes, Angie’s List has taken steps to act more as “a conduit of information” between patients and their health care providers. For instance, physicians have the opportunity to contact a poster and respond to his or her review. In addition, physicians receive an email within 24 hours of the moment they are mentioned on the site.
Rutz acknowledges that Angie’s List Health will continue to evolve. He’s communicated closely with the Ohio State Medical Association about its concerns and is eager to work with doctors to make the site as helpful as possible and include more clinical outcomes data on it. Rutz is also interested in establishing an advisory board that includes physicians as well as representatives from hospitals and insurance companies.
A Value to Physicians?
But even some physicians who’ve received stellar reviews online question the merits of the websites. One is James Dufort, M.D., a pediatrician in private practice in Apple Valley, who got raves on the Health Care Scoop (“Great doctor’s office for kids and parents,” the review is titled. The personal account goes on to say, “I selected Eagan Valley Pediatrics Clinic with doctor Dufort and I am sooo happy that I did.”) Although he was grateful for the positive comments, he’s aware that the pendulum can swing the other way. At his office, he’s long relied on a suggestion box to solicit patients’ comments and ideas. “I do know we do a good job in a lot of ways,” he says. “I also know that you can’t make everybody happy every day.” A negative review on a website could harm morale and hurt business, he points out, as readers may remember a negative review longer than they do a positive one.
Other physicians are taking advantage of the popularity of the new websites. Joseph Wegner, M.D., was pleased when the six-site practice he helped found in the Twin Cities suburbs, Physicians Neck and Back Clinic, received several positive comments on the Health Care Scoop. Such sites can be particularly helpful for patients with chronic pain, he says, “where there’s a lot of controversy about treatment and patients are looking for information.” What surprised him was that one of those posts was viewed more than a thousand times. His group has since purchased a “profile” on the site, which offers more information about the clinic and a link to its home page.
Ultimately, many physicians believe the online reviews will improve caregiving. At Mayo Clinic, which doesn’t advertise and has long relied on word of mouth for new patients, the public affairs office is embracing the opportunity to make use of patients’ postings. Websites like Angie’s List and the Health Care Scoop are “a 21st century implementation of something that’s been going on forever,” says Lee Aase, manager for syndication and social media. His office monitors sites and relays both positive and negative information back to physicians. One poster on the Health Care Scoop described a Mayo family physician as “a godsend … caring, compassionate, and genuine.” Another poster described a harrowing experience with an unnamed doctor following a hysterectomy. The public affairs office let the obstetrics department know about the angry post.
Opinion Matters
What’s become clear is that patient opinion about the care a doctor provides is now considered an important enough factor to chart. MN Community Measurement, which develops quality measures of physician performance, got the same message from patient focus groups that Stump did: People longed to hear from others like themselves. President Jim Chase says they considered establishing a website to gather such information, but they wanted to produce data that could be compared among clinics and physicians and that would be more useful for the improvement of a group. Instead of a website, the organization is conducting a standardized survey to chart patient experience. It allows patients to rate how well a physician communicated and express how strongly they would recommend the provider to others. The benefit, Chase notes, is that the information has been gathered consistently “so you can compare across time and medical groups and locations. And that helps groups figure out what they need to do to improve their results.” The survey is being tested at 124 sites across the state.
Although the MN Community Measurement survey will generate more standardized patient satisfaction data, websites such as Angie’s List and the Health Care Scoop allow patients to speak their minds and share their stories, providing insights that can’t easily be quantified. For Stump, who’s adamant about the open-ended possibilities of “a blank page,” the medium offers a close look at the art of medicine, as opposed to the science, as patients’ own stories express best “the richness of what we’re doing well and what we could be doing better.”—Kate Ledger