Internet ratings of physicians have an impact on your hospital’s reputation.

Michael L. Millenson

You may well have gotten into the habit of occasionally Googling your hospital in order to keep tabs on your community reputation. But what are patients saying about your doctors?

The “electronic medical grapevine,” to coin a term, is growing in importance. In 2001, the American Medical Association issued a press release suggesting that patients make a New Year’s resolution to “trust your physician, not a chat room.” As with much other New Year’s advice, this proffered piece of wisdom went unheeded. Today, online doctor ratings have become an integral part of an effort to intensify the interactivity of health care sites and thereby make them more attractive to users.

For example, physician ratings are part of the packages offered by WebMD and HealthGrades, publicly traded companies with two of the most popular medical information sites. At the other extreme is Angie’s List. The site, which calls itself “the homeowner’s grapevine,” just added doctors to the list of service providers (plumbers, handymen, painters and more) that its 600,000 users can rate. Others racing to divulge doctor details include Revolution Health, begun by AOL co-founder Steve Case; health insurers, such as WellPoint’s pairing with Zagat; and small start-ups, such as Vitals.com. The growing number of sites that explicitly invite users to share the experience of their illness with others, such as Trusera and the Health Central network, inevitably include many comments on physician performance.

Meanwhile, a site called Careseek features nurses rating doctors, a feature it hopes will set it apart from what the company estimates is more than 30 other sites offering doctor rating and reviews.

Many doctors, not surprisingly, remain suspicious. After all, these are typically anonymous anecdotes posted by a very small subset of patients. They appear on too many sites for an individual clinician to monitor, and the physician’s response is solicited only rarely. As one family practitioner told USA Today, “Imagine there was a dating site where every time you went on a date, someone could rate you. That would really change the way you saw dating.” (Doc, have you ever heard of Facebook?)

Of course, caveat emptor also applies to positive comments. After all, that anonymous rave review about the doctor’s bedside manner may have been written by his wife.

Meanwhile, the federal Agency for Healthcare Research and Quality is working to adapt the hospital patient satisfaction criteria recently made public via Hospital CAHPS (Consumer Assessment of Healthcare Providers and Systems) to physicians. The CAHPS Clinician and Group Survey is already being tested out in the field in order to bring “transparency and standardization to the medical community.”

If you think this is only the doctor’s problem, think again. Although a hospital’s reputation is woven from many threads, it all unravels without good physicians. Scattered positive or negative comments won’t have much impact, but a pattern of “best doctors” ratings or, conversely, ratings showing the “worst attitude toward patients” can be much more important in a competitive marketplace. To protect themselves, hospitals at the very least should check up on big admitters and prominent leaders of the medical staff. Like it or not, the first thing many “singles” do before a first date is search the Web for information on that potential partner. In that same spirit, keeping track of your physician partners is just common sense.

Incomplete Picture

There’s also a more weighty issue involving impaired or incompetent physicians: Patients can’t rely on the Internet for the whole truth. Surfing through a state Web site recently, I discovered a psychiatrist—I’ll call her Dr. Smith—whose license was suspended in January 2008 after a series of publicly documented problems with substance abuse that dated back nearly two years.

What, I wondered, would physician search portals tell me about Dr. Smith if I were a patient turning to them before turning to her?

The answer: Not much. In fact, there were only two sites that made any allusion at all to Dr. Smith’s difficulties. Xoova, a site aimed at helping patients “learn what to expect in advance of a care encounter” offered little more than the physician’s address and phone number. Just below those stark facts, however, a patient had signed his name to a poignant post:

“Dr. [Smith] saved my life. Since she has been on leave I have seen 10 doctors and they all have cracker jack degrees. They do not have any natural abilities either. Dr. [Smith] was wronged and so was I.”

Wronged? Perhaps, but a $29.95 report from HealthGrades (Disclosure: the company provided a complimentary copy for this article) was the only Web information that told potential patients about this doctor’s serious problems. That’s because HealthGrades collects and organizes state disciplinary information that competitors don’t.

Information on the Internet may “want to be free,” but sometimes you get what you pay for.

Dr. Smith is still listed on the Web site of her medical group, by the way. Maybe it’s an oversight, or maybe it’s an expression of hope that a colleague struggling with alcohol and pills will win the struggle. However, when I performed a “physician search” on the sites of the two local hospitals, she was nowhere to be found.

We all know that in the real world, the importance of regulatory authorities isn’t going away. But in the virtual world, the electronic medical grapevine is growing in importance in a way that may someday rival the stamp of approval of regulators. These days, it pays to pay attention to the impact of both.

Michael L. Millenson is the president of Health Quality Advisors, Highland Park, Ill., a visiting scholar at the Kellogg School of Management and the author of Demanding Medical Excellence: Doctors and Accountability in the Information Age. He is also a regular contributor to Most Wired OnLine.

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This article first appeared on May 14, 2008 in HHN's Magazine online site.

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