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The internet truly is a wondrous invention.
It has truly evened the playing field with a wide swath of people now having access to information that used to be possessed in the hands of only the elite few not too long ago.
However, as with most things, there can be downsides associated with any tool of progress.
YELP:
Yelp is a powerful social tool that allows individuals to share experiences, good or bad, so that the masses can gleam useful tidbits on a particular establishment.
Great Yelp reviews, especially from the so called, “social influencers,” can drive a large amount of traffic to a restaurant for example.
Scathing Yelp reviews can conversely have owners hearing crickets when their doors are open.
I admit that I have had Yelp reviews influence my decision on where to eat many a time, especially if I am in an unfamiliar place.
However, hijacking a line from Uncle Ben in Spiderman, “With great power comes great responsibility.”
And unfortunately this unchecked power wielded by every day citizens can indeed tarnish the original noble intent.
There are instances of business owners getting extorted with the threats of false negative reviews on Yelp.
Other patrons have threatened restaurants with negative reviews if not seated promptly.
“That’s great Xrayvsn. But what does this have to do with medicine?”
That is a fair question indeed.
I only have a two word response: Press Ganey.
For the uninitiated, Press Ganey is a company that has created a survey aimed at patients so that they can rate their healthcare experience.
Much like Yelp, patients can essentially grade their physicians for each encounter they have with the medical system.
The premise behind this survey is to create transparency in a business that typically shield’s itself from a consumer’s prying eyes and holds the medical professionals accountable.
The main issue at hand is that these patient survey scores have an impact on the reimbursement formulas that the payors use to compensate physicians.
Have a low enough score for patient satisfaction and your wallet will feel the impact as you will be getting less money for a patient encounter that someone who has a higher score would.
Afraid a patient seeking pain medications would leave a scathing review if you do not cave in and prescribe them?
No worries.
Just prescribe what the patient wants and you can be assured of a 5 star rating.
And if you refuse?
Then you could suffer the wrath of an angry patient.
Doing what is right and justified in medicine may incur financial and reputation penalties for the physician if the patient feels he or she is being under-treated according to whatever online source they might have stumbled upon.
And therefore, like the Yelp examples above, this may unwittingly create medical practices that actually do more harm than good.
There is also the potential for survey bias.
What do I mean?
We have all seen vehicles in front of us with the “How’s My Driving? Call XXX-XXX-XXXX” sticker.
Question.
How many of us have actually called that number to report the driver is doing a good job?
Now if that driver flips the bird at you while cutting you off in traffic would you be more inclined to call that number?
I know I sure would.
Patients who have received bad medical care, perceived or otherwise, are more likely to vent their frustrations on the survey while patients who have exemplary or even just standard care may just forgo answering the survey altogether.
[As an aside I would like to tell of the following experience that drives home this point:
In my commute to work, after some recent construction work had been going on, I noticed that there happened to be a stretch of interstate where some pretty severe potholes had developed for a period of 2 to 3 miles.
Even worse, these potholes would line up at the border between the fast and slow lanes so an unsuspecting driver who happens to change lanes would get a rude awakening.
I called the department of transportation hotline, spoke with an actual person and voiced my concern.
The very next day I was amazed that every single pothole had been filled.
I actually called the same hotline and spoke with a representative remarking what a fantastic job they have done and how quickly the turnaround was.
Her response was, “Wow. We always get complaints. You are the first person I can remember that actually called to give praise.”]
Social Media Platforms:
In addition to patient satisfaction survey scores, today’s physicians have other issues to contend with that their older counterparts never had to deal with in the past.
As social media platforms continue to gain dominance over the internet, a side effect that modern day physicians face is more to do with the appearance of high quality of care rather than actually delivering high quality care.
Physicians who have embraced this social media movement have taken to Instagram, Facebook, or Twitter to promote themselves.
At the same time, potentially more experienced physicians who do not “play the social game” may fall by the wayside as potential patients choose their more celebrity counterparts.
Would you rather be operated on by the famous Dr. Oz or someone who is not famous in the media?
Patients automatically equating celebrity to mean the best may indeed be setting bad precedence.
It really gives a new meaning to the term, “Socialized Medicine.”
Note:
If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys and gals of finance.”
Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
-Xrayvsn
NOTE: The website XRAYVSN contains affiliate links and thus receives compensation whenever a purchase through these links is made (at no further cost to you). As an Amazon Associate I earn from qualifying purchases. Although these proceeds help keep this site going they do not have any bearing on the reviews of any products I endorse which are from my own honest experiences. Thank you- XRAYVSN
Great post doc. To me, the modern phenomenon of being able to read reviews about things on the internet is a huge win for everybody. I’ve rarely buy anything that cost more than $10 online without reading reviews, and sometimes when I’m in a store I will even get out my phone and check reviews. All that said, you make some very salient points about the need for great responsibility. There are tons of fake reviews on Amazon of course, but when you get into the realm of a patient-doctor dynamic it’s a whole different ball game. The example you… Read more »
Thanks Dave. I will share a personal example that happened recently. A patient left a very negative review on me based on the fact that her doctor ordered a follow up exam that she felt she didn’t need. In her review she said that I should have seen the order and decided that the exam was not necessary and even accused me of letting the study go through because I was in it for the money. In my defense I do not see the orders before the study is done, I just read what shows up in my screen but… Read more »
Yeah, it really is a mess,isn’t it? I deal with post-op pain a lot and get consults on IV drug users and chronic opioid patients… they want you to ratchet up their opioids, even if this is not what is best for them. We offer them other modalities to improve their pain, but they just refuse and ask for more opioids. Then, they complain we aren’t doing anything (because they’ve refused what we have offered). It can be insulting that a survey knows more about what kind of medicine we practice than just about anything else. Fortunately, where I work,… Read more »
Drug seeking patients can indeed be the worst kind as nothing matters to them accept to get their drug of choice. They can doctor shop etc until they find someone who caves in. Surveys are just another annoying thing that has little to do with good medical practice and just another metric people will use against us.
Nice perspective, my friend. There is some preliminary data that suggests, at least in the ED, that Press Ganey is not affected by decision to prescribe narcotics, although the perception that it may be is enough to unfortunately alert behavior when such metrics are given excess weight. We now occasionally hear about yelp reviews on our care (the last was, “fantastic job on Grandpa’s AAA!”) in our ED. Go figure.
Fondly,
CD
Thanks CD. That is great about narcotic prescription has no influence on survey scores. Very nice that at least some positive reviews still get written acknowledging good service.
Haha. We actually like it when my husband gets bad reviews. It vets those who really care about this popularity and woo woo stuff out.
The smart patients rely on their family doctor’s opinion about who is a competent surgeon.
The ones who want us to just “be nice” and fawn over them can get their care elsewhere. We are already too busy caring for the truly sick.
Thus these rating systems help us to sort the patients who are likely high on the “Hassle factor”.
I love that take on it DMB 🙂 I agree whenever I want to find a good doctor the best source is to ask other doctors. They are the ones that have direct input from the patients and have established referral patterns based on docs they know and trust. I was a bit disheartened when I had my first negative review ever (and of all people to find it it was my daughter who googled my name). I touched on it in my reply to Dave from Accidental Fire but essentially I was given all 1 star reviews (including bedside… Read more »
Hey XRV, When you have worked with the public as much as I have. You solidify your own internal barometer of what you want from you practice. A problem for many young, especially female family docs is they have this need to be liked/ popular. When I see that, I already know they will be burnt out and running away from their practice within 5 years. I would rather be left with patients I like working with than morphing to the flavour of the month to make people happy. As for your daughter, she will figure out how this social… Read more »
I do think she understood it after I explained it to her and how this public survey system works. I agree that if we try to model a practice with the need to be liked/popular we are doomed as this should not be the driving force of what we do. Thanks again for your insightful comments as always.
To do a real review you need to have enough real information to make an actual judgement. A restaurant may have a waitress call in sick or have 15 people seated in a conference room. I took my mom to her cardiologist and some cranky old fart got up and walked out because it was taking too long and others who came after him were heading to the back before him . The guys sees patients AND has a lab so some of those people going “before” were not seeing a Dr but getting a preop EKG or pre-op echo… Read more »
Great point on perception of patients in a doctor’s waiting room. Sometimes our MRI schedule gets thrown off because it is a patient at fault (showing up later than supposed to but we still try to accommodate, which makes others later in the day who show up on time having to wait).
My previous employer organization went to surveys about 5-6 yr prior to my retirement. The administration developed a system of pay based on the results. Some of the providers in the clinic had closed practices (no new patients). The rest of us saw both new and returning patients. As you can imagine the closed practices always received the “bonus” and praise for excellent surveys. Sort of an unfair playing field. I always thought the surveys were misleading in that the questions asked had very little to do with the provider and a lot to do with the schedulers, and support… Read more »
LOL. That last line made me chuckle. Hope it doesn’t come down to physicians constantly tweeting whatever they are thinking 🙂
That does seem like an uneven playing field regarding older closed practices and having surveys against that subset of patients. Thanks for stopping by and making me laugh at the end of a busy shift.
Oh man, this is such a double-edged sword. Online reviews can help patients find the right fit, and can also yield wayyyyyyyyy to much entitlement on their part. Kinda related: Once, I was driving in CHS and this big ol’ pickup truck was zipping in and out of lanes, and almost killed me (I know I tend to exaggerate on here, but I’m not. It was close.) Then I watched him nearly kill like 3 other drivers. It was daytime, but I was wondering if the driver was intoxicated. I wanted to call the non-emergency police line. But despite billboards… Read more »
Wild story on the highway. Glad you escaped with just a close call. Probably would not have faulted you for calling 911 in that situation.
So as a “Recovering Healthcare Administrator” I am torn on this topic. I can understand the initial idea about measuring patient satisfaction. However, the implementation of the idea is what is terribly flawed. Like most things the government does, they take a good idea and screw up the implementation. Medicare has started impacting reimbursements based on these patient satisfaction results – at least at the hospital level. I don’t think they have done this to physicians but I have been out of the industry for about a year. Healthcare is not suited for a satisfaction survey as it is currently… Read more »
Really appreciate you stopping by and giving a really great perspective from an administrator point of view.
That was a great policy you implemented of ensuring people hear positive feedback instead of only being hit with negative ones.
I’m with you on the perfidy of reviews for healthcare. They are filled with bias and imcentivize the wrong behaviors.
They want happy patient not healthy ones. Often enough those don’t go together.
Everytime I don’t give antibiotics for a cold I’m risking my online reputation.
Nevermind the rediculousness of tying reimbursement to press ganey and the statistical impossibility of everyone being in the top quartile!
Unintended consequences.
I love your comment “they want happy patients not healthy ones. Often enough they don’t go together.” Only someone on the front lines realizes that and the problem is some bureaucrat is the one running the show and has no clue.
I’m curious. As a radiologist, are you immune from Press Ganey since you have limited to no patient interaction?
And I think you’re right. Social media in healthcare is getting huge now. In fact, did you know that there is an Association for Healthcare Social Media?
I only know because I have an Instagram account and I may or may not be a part of it.
Hey DMF. I think I am immune from the direct effect of Press Ganey as a radiologist, but it is an interesting fact that after I had written this post, my daughter of all people googled my name and found a scathing review of me on a doc rating website. It was anonymous so have no idea who the patient was but she was upset at me because her doctor ordered a follow up CT exam she did not want to do and somehow I got blamed when I apparently read it as normal and she felt that it was… Read more »
Social media has its tentacles everywhere now. It works for restaurants, but I’m not sure about reviewing doctors. Currently, I don’t have a good process for choosing doctors. I don’t look at reviews. I trust my family physician and just go by her recommendations. It worked out really well so far and I’m going to stick to it. Just find a trustworthy family doctor and listen to their advice. Sometimes, the old way works just fine.
I do think that the majority of people will go on the recommendation of their trusted primary doc as it should be. The primary doc typically has interactions with every doc and can make a pretty sound judgement of who they would send their own family to in case of a medical need.