Online Doctor Reviews Need to Go

I suppose I understand why online patient reviews of physicians exist.

Patients have told me they provide helpful information when searching for a new physician. Physicians have told me they provide insight into what patients are thinking. They can give patients a sense of agency in a medical system that so often strips it from them.

A few years ago, my colleagues and I were told that selected patients would be rating us from one to five stars and would be allowed to leave comments about their experiences. Some ratings and comments would be made public on our website. I have good relationships with the families I see, so I figured all would be fine. I was wrong.

These reviews have unintended consequences, and they are representative of a mindset that will continue to drive physicians away from the practice of medicine over time.

Perverse Incentives

The existence of online patient reviews provides a clear incentive to keep patients and their families happy. Happy patients write good reviews. Unhappy patients write bad ones. On its face, this seems reasonable.

Of course, it’s not that simple. As a pediatrician, I frequently find myself in situations where families feel specific interventions are needed, even if they are not medically indicated. Some angle for antibiotics for their child’s viral upper respiratory infection. Some push for acid-reducing medication for their infant with mild reflux. Some demand specific labs or imaging. I always make an effort to listen to their concerns, and I always discuss why I think certain interventions would or wouldn’t help. But in my experience, this isn’t enough for certain families. There are some who want what they want, and believe me, they can get upset when they don’t get it. Some leave reviews.

This gives me a clear incentive to give in, to give these families whatever they want, and to provide unnecessary treatments. I’m supposed to keep them happy, right?

Feedback Without Value

I can appreciate that negative feedback, as painful as it may be, can be valuable.

I learned this early in my training. We were expected to present overnight patient admissions at our daily gathering of supervising and training pediatricians. I’d done a good amount of public speaking by then, and I thought I presented well. One day, a supervising physician pulled me aside and, quite directly, told me my presentations were subpar, too meandering, and that she expected more. It stung. It still stings to think about it now. But I used that feedback to practice, to improve, and I became a better communicator. I wouldn’t have gotten to where I am now without her feedback.

Online patient reviews, in my experience, are rarely helpful in this way. They often lack specificity. A score of one to five stars typically isn’t instructive, and the comments are often generalized and vague. I have yet to find a consistent way to improve my practice because of them.

Oversimplification

Something about the star ratings has always bothered me. They oversimplify.

As physicians, we must wade through the complexities of the human body and mind to reach a diagnosis. We must wade through the complexities of the modern world to implement treatment plans. We must form and maintain relationships over time. To ask patients to reduce it all to a number of stars and a sentence or two feels reductive and wrong.

The Emotional Toll

When customers leave a review for a restaurant or online retailer, they are reviewing a business. When my patients leave a review, they are reviewing me. I’ve heard some say that we should look at the reviews objectively and not take them personally. But when a patient leaves a nasty comment about me and my role as a physician — a core part of my life, into which I’ve invested so much time and energy — how can I not take it personally? When the comments are made public on the internet, for all the world to see, like graffiti on a middle school bathroom stall, how can it not hurt?

Am I being overly sensitive? Probably. Are there bigger problems facing the healthcare workforce? Of course. Should we, as physicians, be more focused on the problems of our patients than our own? Absolutely.

But I still think this is worthy of discussion.

I’ve loved this job and had always thought I’d do it forever, but some days I’m not so sure. Online reviews are problematic for all these reasons, but perhaps more than anything, they are sending a message. They are a message from administrators and patients that I am seen as an interchangeable cog in a machine, whose value can be calculated on a scale of one to five, and put on public display.

I don’t think this is right. This outlook may one day drive me out of this profession. And, unfortunately, I don’t think I’m alone.

Let’s get rid of online patient reviews for good.

Samuel Cross, MD, is a pediatrician in Virginia.

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