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A discussion about the content and methods of physician-rating sites

A growing number of adults in the United States are turning to the Internet for information about health conditions, physicians and hospitals. Research (.pdf) conducted by the Pew Internet & American Life Project shows an estimated 15 percent of health-care consumers compare hospitals before making a selection and 30 percent compare doctors online before making an appointment. In searching for medical information online, a significant number of patients are engaging on physician-rating websites and a contingent of them are leaving feedback about their health-care experiences, according a recent survey (.pdf) conducted by Deloitte.

Few large-scale studies have been conducted to assess the content and rating methods of these physician-rating sites. And so, to better understand information provided on such websites, Stanford researchers and colleagues used Google Trends to identify the most commonly visited physician-ratings websites that have user-generated content, evaluated the content characteristics of each site to rate physicians and analyzed 4,999 individual online ratings of physicians.

The researchers, whose findings were recently published in the Journal of Medical Internet Research, found that overall most patients give physicians a favorable rating on online physician-rating sites but that the optimal content, structure and rating methods of these sites deserve further study.

Interested to know more about the study, I contacted Bassam Kadry, MD, an instructor of anesthesia at the School of Medicine and senior author of the study. Below he discusses the motivation for studying these websites and the potential role of such sites in advancing the conversation about quality of care for patients.

What was the catalyst for launching this study?

Even as a physician it is hard to know who is a good doctor. This is especially true if someone is "shopping" for a surgeon to do a specific procedure. Sadly, we know more about what TV to buy or which athlete is better than we know about what physician to go to for our specific needs. Ultimately, what drove me was curiosity. I know it is an important topic and I just didn't know the answer to the questions asked.

If consumer driven health-care is to become a reality, patients need to have access to information that includes more than just satisfaction but also quality and cost. Patient satisfaction is important but to improve quality and decrease cost we have to at the very least start measuring these metrics accurately. Ultimately if we can't measure it, we can't manage it.

Why is the issue of physician-rating websites becoming more important in the overall discussion of quality for care for hospitals and doctors?

Currently, I would be cautious about using the current paradigm of physician-rating websites for any meaningful decisions. They don't offer enough information to allow people to make choices relevant to their specific needs. There would be much more value if patients had access to more meaningful data such as volume of care for a specific surgery, relevant clinical outcomes and actual costs.

To improve we need to learn. To learn we need to understand. To understand we need to have access to information that is accurate, valid, and relevant. Physician-rating sites offer a window into some data that at the very least is easy to understand. Some resources may use insurance claims data to help measure outcomes but there is a significant limitation to this to the point that I would question its utility in making decisions about a specific provider or hospital. Ultimately, what is needed is direct access to clinical data that sits in the electronic health record. Having the ability to compare apples with apples requires this level of granularity. Until then organizations will use what data is available, such as claims data, because people are hungry for information.

In the study, you and your colleagues note, "physician-rating websites depend on subjective data input and offer limited quantitative information about quality and cost of care." Given this limitation, why do patients like engaging on these websites?

Patients, including myself, are hungry for information - especially when it comes to something as important as their health. I definitely think satisfaction information is important and at the very least provides some meaningful information about the doctor. The reality, however, is that satisfaction cannot serve as a proxy for quality. Moreover, it doesn't convey anything about cost.

I think having the ability to choose doctors is empowering. Why would we choose someone we don't like? I know I appreciate making my own choices. However, making a good decision depends on having access to relevant information. Even more challenging is that sometimes patients don't know what they don't know and consequently don't even know what to look for when making a decision. Since subjective information is easy to measure and is relevant to patients I think there is value. However, it is not the only, nor should it be the only component for an important decision.

What further research is needed to assess the content and rating methods of physician-rating sites?

I learned a great deal from doing this study and recognize its limitations. For one, I think validating the quantitative information using any qualitative information from the comments would help determine the validity of the quantified rating.

It would be interesting to see how survey methodology influences satisfaction scores. Currently, most physician-ratings websites depend on motivated patients to take the time to write a review online. It is quite possible that the results would be drastically different if patients filled out a quick survey at the time of the clinic appointment or during their hospital admission. In other words, the solution to data pollution may simply be dilution. Maybe providing an incentive to patients to give feedback and making it easier to do so would provide more useful information. Doing a study to evaluate the impact of survey methodology on results is worth exploring.

Previously: Physicians launch study on oversights in the physical exam and Foundation launches app challenge to develop tools for selecting doctors, hospitals

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