Explore This IssueJuly 2023
It may seem reasonable to assume that a five-star physician provides better care than a four-star physician, but that’s not necessarily the case. A 2019 systematic review found a high degree of correlation between patient online reviews of physicians and patient experience, but a low level of correlation between patient reviews and clinical outcomes (J Med Internet Res. 2019;21:e12521). Patient ratings of medical interactions can vary wildly as well, with one patient giving a five-star review for an “excellent doctor” and another patient leaving a three-star review for a physician they describe as “the most responsive doctor that we’ve ever seen.”
Yet increasing numbers of hospitals and healthcare organizations are now publicly sharing information from patient satisfaction surveys, in the name of being more transparent about the quality of patient care. Massachusetts General Hospital has collected, monitored, and shared patient feedback internally for years, said Benjamin Bleier, MD, associate professor of otolaryngology–head and neck surgery at Harvard Medical School and the Claire and John Bertucci Chair in Otolaryngology–Head and Neck Surgery at Massachusetts Eye and Ear in Boston. Later this year, the institution plans to publish patient reviews and commentary on their websites.
At first, the majority physician opinion was apprehension. I think physicians’ general concern is being judged and rated by patients when they don’t have control over many aspects of patients’ care or their response to treatment. —Benjamin Bleier, MD
“At first, the majority physician opinion was apprehension,” Dr. Bleier said. “I think physicians’ general concern is being judged and rated by patients when they don’t have control over many aspects of patients’ care or their response to treatment.”
Although research has found that patient satisfaction scores and physician reviews are generally positive—a 2021 national review of academic otolaryngology practices found that the mean patient satisfaction score was 4.74 of 5, with limited variability between scores—public disclosures can be unnerving (Laryngoscope. 2021;131:2204–2210). Publication of patient feedback also raises interesting questions about how institutions collect, filter, and share data, as well as how physicians and patients are affected by public-facing reviews.
All Patient Surveys and Review Sites Aren’t Equal
Some websites allow anyone to post a review of a physician, without verifying whether the reviewer has actually seen that provider. Some allow physicians or healthcare institutions to pay to promote their practice and remove negative content for a fee. “I think that is an awful, nefarious practice,” said Eric Gantwerker, MD, MSc, MS, a pediatric otolaryngologist with Northwell Health in New Hyde Park, N.Y.
While most physicians likely agree with him, there are other, less direct ways that doctors can use to influence content on third-party rating sites such as Healthgrades and Yelp. “Some physicians will try to steer patients to particular review sites,” said Martin J. Citardi, MD, professor and chair of the department otorhinolaryngology–head and neck surgery at McGovern Medical School at The University of Texas Health Science Center in Houston. “It’s a little bit manipulative because most people don’t realize that the sorting isn’t happening randomly, but preferentially based on the strategy of the physician.”
In contrast, most hospitals and healthcare organizations that share patient data send surveys to all patients who receive care, which means that providers can’t selectively ask patients for reviews and patients can’t rate physicians they haven’t seen. Patient review data may still be skewed by human nature, however.
“I think there’s a selection bias,” Dr. Bleier said. “An unhappy patient is probably much more likely to leave a negative review than a happy patient is to leave a good review.”
Hospitals and healthcare organizations are trying to boost transparency (and build trust) by sharing patient satisfaction scores and feedback, so many institutions now have a webpage that describes their ratings and data publication process. The Northwell Health website (www.northwell.edu), for instance, states, “Both positive and negative comments will appear in their entirety on doctor’s profiles. However, we do not post comments that are libelous, slanderous, and profane or those that risk the privacy of our patients.” Northwell Health also discloses the criteria and scale used to assess physician performance.