Were you voted most popular?

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Do you remember the Senior Superlatives section of the high school yearbook? Most Athletic. Most Talented. Most Likely to Succeed. Most Popular. Thinking about those categories now, they seem so ridiculous don’t they? But there really is a fascination with something that is labeled the “best”. If you could get all five of those five stars, why wouldn’t you? If you had a choice between the bronze, silver or gold, I’d guess you’d choose the gold. Why wouldn’t you?

When it comes to choosing anything these days, our measure for good, better and best is the online review. From amazon purchases to which restaurant has the best fish tacos, the value of the online review is enormous.

Since medical care has become more of a business, finding a medical provider has become as similar a process as finding a car mechanic. Medical provider reviews now play a significant role in health care — for better or for worse. Good medical reviews bring new patients in the door, that’s obvious. What you may not know is that medical reviews and patient satisfaction scores are now being tied to how physicians are being reimbursed, paid and given bonuses. This is dangerous.

I googled myself the other night. It’s not a practice I do often. I’ve done it maybe half a dozen times in the last few years. I have to say that I was pleasantly surprised to see that I had a 5 star google rating with 22 reviews. I read all of them and those 22 patients had such flattering things to say. Truly, I was so appreciative to know that they had such a positive experience… but here’s the thing…. none of the reviews really commented on how well I can take a medical history or how I heard that carotid bruit or how I recognized that the hemoglobin had dropped in three months, or how quickly I suspected that cancer diagnosis and initiated that evaluation. When listing characteristics of a good physician or surgeon, “great listener” and “nice” can’t be the only two qualities on the list.

I have had terrible reviews also. I had one very recently. This one wasn’t posted publicly online thankfully but it was posted on an internal review system that our hospital system makes available to patients. I can tell you the exact patient encounter:

Mrs. X sees me for the first time. She is not a new patient to the practice but she is new to me. As I do with every appointment, I open the door, smile, introduce myself, shake a hand and sit down asking, “what can I do for you today?” Mrs. X flatly responds, “I need you to tell me what’s wrong with me and I’m not leaving until you do.” Whoa. Ok. Let’s back up. “Can you fill me in? Remember, this is the first time I’ve met you so I don’t really know what you are talking about. How about you let me know the background?” Mrs. X: “I really just need you to order these labs.”. Mrs. X hands me a piece of paper with a list of about 11 laboratory tests she has written down in pencil, 7 of which I am completely unfamiliar. “I’m sorry, what?” Mrs. X: “Just order the labs. I’m tired of all of you doctors not being able to tell me what’s wrong with me so I’ve researched my symptoms. My sister is a nurse and she suggested all of these labs. She works at Mayo.” This exchange goes on for another ten minutes and ends with me saying that this is not how I practice medicine and that it doesn’t really work this way, for a patient to pay for a visit and order what she wants as if ordering off a menu and then leaving. She stands her ground. I stand mine. Eventually, I told her that I would order her labs, I would document very clearly in her medical chart that I did not think that any of these orders were medically indicated and that she would be financially responsible for the labs and not her insurance company. She left. She then wrote a scathing review of me and sent it to my administration.

Here’s the point— reviews don’t really work for medicine in the same way that reviews work for restaurants or coffee shops. Physicians are not providing a service and the goal isn’t 100% satisfaction. Physicians are evaluating and diagnosing and treating and “doing no harm” and prescribing and reviewing labs and reading X-rays and removing gallbladders and making sure that there are no drug-drug interactions on your medication list. These may involve disagreeing with patients, with telling patients information they don’t want to hear, with saying “no” to a patient when “no” is the appropriate thing to say.

Recently, I saw a petition circulating to have online physician reviews eliminated. It had over 43,000 signatures on it, but online physician reviews are here now and continue to provide a platform for patients to voice their thoughts, both negative and positive. I encourage everyone to be very thoughtful with these reviews. Consider that maybe these positive reviews were written by the physician him/herself. Consider that maybe a review was written by someone who wasn’t even a patient. Consider that a physician or a medical provider cannot defend him/herself against a negative review directly online because it violates the patient’s privacy so a negative review will appear to be unanswered and undefended. Maybe a better practice is to do what has worked well for us for years— ask neighbors, friends and family for their recommendations.

I don’t mean to sound ungrateful for my wonderful online reviews. I am extremely happy to know that some of my patients feel like they have a physician who makes them feel that comfortable because so many patients do not have that relationship with a physician. So when you do find a medical provider who provides you with that level of comfort and confidence and trust, please do write those positive reviews. I never said there was anything wrong with “nice” and “great listener”.

Oreo. Watercolor. He’s a great listener also. A gift for a friend.


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