August 3, 2014, MedPage Today
When a Yelp reviewer gave Justin Bazan, OD, at Park Slope Eye a one-star rating, Bazan felt it was only fair that he give his own view of the matter.
"You might be the worst Yelper on Yelp," he wrote on the site to his former patient, who had claimed he was treated unfairly after showing up without his insurance information and was charged a fee to reschedule. "Save all of us the headache from having to deal with you."
Bazan advises -- and takes -- an active approach to dealing with patient reviews on social media. "People want to see that 'somebody is home,'" he told MedPage Today in an email. "The worst thing in the world to do is to ignore it."
And ignoring reviews completely is hard to do with the proliferation of review sites like Yelp, ZocDoc, HealthGrades, Vitals, RateMDs, and UCompareHealthCare. These sites let patients -- or disgruntled co-workers, family members, ex-partners, perhaps even students who got a poor grade, all pretending to be patients -- assign a value to their experience and write about it for others to see.
Poor Credibility, But Still Important
The sites often have no verification process, but it's important that doctors know what's out there and address concerns, two healthcare consultants told MedPage Today.
"There's no credibility for any of these sites," said Steven Peltz, a certified healthcare business consultant. "All they do is give you somebody's 5-second opinion of something that went great or went terrible."
But for Judith Hutchinson, MD, an anesthesiologist in Gettysburg, Pa., there wasn't even a real patient behind one of her reviews.
"The only negative online review I had was clearly written by my ex-husband," she said. She said she contacted the site and had it removed, but it highlights the sites' unreliability.
A 2012 study in The Journal of Urology found that though most reviews on such sites are positive, composite scores are often based on a small number of reviews. Poor scores can have an exaggerated effect.
It's a problem that doesn't seem to be going away any time soon. Kathy Moghadas, RN, also a certified healthcare business consultant, recommends that all patient reviews should be viewed with a critical eye.
For negative reviews, doctors can reach out and say something like, "We appreciate your time taken to review us and have implemented steps to improve other patients' experiences," said Moghadas, who is also certified in healthcare compliance and licensed as a risk manager.
She said she had a case in which the reviewer called a doctor an arrogant jerk. When she spoke to the doctor, he dismissed the feedback out of hand -- "I soon discovered that the reviewer had pegged the guy's attitude correctly," she said.
For his part, Peltz, who runs Peltz Practice Management & Consulting Services, advises that doctors and clinics give the patient their own survey. They can ensure that the patient had a good experience and if there's a problem, can move to fix things. Those reviews can be shared internally.
And once a poor review is up, there's little a doctor can do, in Peltz's opinion. The doctor can try to address it, and sometimes the patient or site will take it down, but clinics should give great service so that it doesn't go up in the first place.
"Communication with the patient is always the most important aspect," he said. But he said it's impossible to avoid negative reviews completely.
"Ricky Nelson wrote a song, 'Garden Party,' and in it he said 'You can't please everyone,'" he said. "So you do the best you can."
Let It All Hang Out
Hospitals and clinics in the University of Utah system are taking the tack of complete transparency. They collect and publish patient reviews online for other consumers, said Chrissy Daniels, director of strategic initiative at University of Utah hospitals and clinics.
This has led to what Daniels called a "fire hose effect" -- bad reviews are far outnumbered by positive ones. "Instead of defending yourself against bad reviews why not let the other patients speak for you?" she said.
It took time to convince doctors that it was a good idea, said Daniels. Many doctors were unaware that they were being evaluated online in the first place -- some didn't know about online reviews for products or services of any kind when the hospital began talking about putting the reviews online.
They publish 99.5% of the comments unedited, taking out those they consider to be libelous, profane, or that risk the privacy of patients, according to a statement. There are far more reviews on its own site than on Yelp or other sites. And its results often place higher on Google searches than those from elsewhere.
The Cleveland Clinic uses information from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a survey designed by the Centers for Medicare and Medicaid Services to improve patient care. Results of these surveys are available online. They are one of two dozen quality measurements tied to Medicare payments.
But it doesn't contain reviews of specific doctors and is less consumer friendly than other review sites.
As for whether or not the trend of online offerings is good for healthcare, Moghadas said that, when used appropriately, results can be "great to assist in identifying problems or issues and transforming a practice."
But Peltz said that since most of the complaints are about office operation -- long wait times, being charged fees, or being treated rudely by staff -- responses to the reviews will mostly result in better office operations, but not necessarily better treatment.
"The true healthcare experience is in the examination room with the physicians," he said.