Nancy is looking for a doctor.  She decides to use an online health reporting site.  She finds Dr. A, who is near her job and has a five star rating, and enthusiastically makes an appointment.  However, when she gets there, she finds Dr. A’s office closed due to a federal raid for drug fraud.  On the other hand, Dr. Z has a poor review on the ratings site, but Mary makes an appointment and finds Dr. Z thorough, informative, and extremely helpful.  Incidences like these happen frequently because health care reporting sites are not conducive to providing accurate, pertinent health care information and function as little more than commercial space.  Here’s why:

Lack of Objectivity.  Patient experience is not an objective, quantifiable event, nor is it relatable to whether or not the provider did what was appropriate to provide beneficial health care.  Neither do they take into account intangibles i.e. the wait time was long due to the physician dealing with an emergency in the next room or telling a patient bad news or comforting a patient when a loved one has died.  They also do not take into account the tremendous emotional burden of the health care clinician.  Surveys can be valuable as tools to spur internal improvement, but unless they are validated tools that improve physician performance, they should not have high-stakes impact. 

Quality of Information/Format.  As is, these sites employ no system of verifying whether or not the information reported to the site is accurate or authentic.  
Satisfied patients seek the doctor’s care again; often, it is the disgruntled patients who review, for instance: a patient who wants narcotics but isn’t prescribed them.  These sites often represent a venting place for patients who didn’t get what they wanted. Responders are allowed to rate and comment anonymously, leaving no deterrent to bias or libel.  The ratings could as easily come from a bitter ex-spouse or competitor as an actual patient. There are no methods in place to determine if a patient was actually seen by said physician.

The questions ask patients to weigh in on issues that either they may lack the capacity to answer in meaningful ways or hold little relevance to the bottom line, which is patient care.  For instance, comments don’t read: I reported to Dr. Smith with the following symptoms and a history of upper respiratory issues, but she dismissed my concerns and treated me for…; instead, they measure satisfaction in terms of patient wait time and cordiality of staff. While these are not unimportant measures, they should not be used as standards to gauge physician competence.
Responders are allowed to leave low ratings without any further comment.
Doctors are not allowed to refute negative claims

Motives.  Although doctors are not allowed recourse in the actual comments, they are contacted to see if they would like to “advertise” in order to improve scores.  In addition, sites allow doctors after “owning” the pre-set review page the ability to hide a few negative reviews further proving the sites know the information could be inaccurate and biased. It stands to reason that a site could and would gain by planting negative reviews as this could drive traffic to their site. Healthgrades, and other review sites, contact doctors to offer them sites they created that may have incorrect information and/or negative reviews to encourage them to “own” said sites under the guise of this is way you can control your internet presence.  By not “owning” said unsolicited negative review site, the doctor’s reputation may suffer as persons may continue to check a site that they have no idea that may not only be inaccurate but also defaming and allow libel.  This could be considered extortion by some and furthermore reiterates the need for transparency in the ratings process. 

Right to Privacy.  Health care clinicians, like all, have a right to a separation of their personal and private identities.  These sites have included doctors’ personal addresses and contact information.  Not only is this practice a violation of a clinician’s privacy, it is dangerous and irresponsible, especially to those who treat patients with severe mental and behavioral disorders.   Physicians have been killed in their own homes by former patients who gained access to this information.  Physicians and other health care workers do not deserve to be put at such risk.

Usefulness.  Are these sites really useful?  There are systems in place that monitor physicians in a manner that may be more beneficial to patient care.  Insurance companies including Medicare and individual clinics and hospitals check in with patients to determine whether they feel a doctor has done his/her job properly, and these results are not for sale.  In addition, if the goal of health rating sites is to help physicians give better care, they have failed miserably.  Doctors often won’t read the reviews because of their overwhelming bias and a refusal to participate in this culture of consumerism.

Providing information about whether a doctor has been sanctioned or if he or she is board certified can be beneficial to a patient’s physician shopping; however, reducing the sum of that doctor’s care to a questionnaire that does not reflect the quality of care provided or the true patient’s experience is disrespectful, unhelpful, and sometimes downright dangerous.  Many do not know doctors have traditionally high suicide rates due to the pressure of the field; as the provider’s reputation and livelihood are at stake, these sites must be ethically responsible and held accountable for the information they publish, who they allow to publish, and how they allow the doctors to respond.  The bottom line is that, as with any information found on the internet, healthcare ratings should be taken with a grain of salt.  No online review should be the basis of your important healthcare decisions; moreover, if these sites don’t serve your health and wellness, they have no place in your health care.

Stand with us as we tell Healthgrades CEO, Roger C. Holstein and CMO, Keith Nyhouse to provide fair, unbiased and responsible surveying and reporting and to not publish Physicians', NPs' and PAs' private information. Furthermore, we ask Healthgrades to not create sites for Physicians', NPs' and PAs'  without their permission. At the least, clinicians should be given the ability to opt out of survey capability, as they have previously allowed when addressing past Better Business Bureau complaints. As stated previously, there are systems in place to give validated feedback that can help improve patients care and experience without the commercialism. Physicians, NPs and PAs strive to provide excellent patient care. Let them do their jobs without distraction and defamation.

Contact Better Business Bureau http://www.bbb.org/denver/business-reviews/health-and-medical-general/healthgrades-in-denver-co-64020102. 

Healthgrades requests that you contact Healthgrades Customer Service at 720-963-6575 (phone), 303-716-1298 (fax) or by email: cs@healthgrades.com prior to filing a complaint with the Better Business Bureau.

Top 183 Complaints About Healthgrades: http://www.consumeraffairs.com/online/healthgrades.html

 Authors: Addie Citchens, Kim Jackson