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Patient Reviews: Putting Doctors on the Examining Table

Why do we seek out the reviews of our consuming brethren? Because such reviews are a form of "word of mouth." We like to know what others -- especially groups of others -- think about prospective products and services.
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Every month in the U.S., we engage in 100 million searches for health-related information online. [1] Of that number, roughly 15 percent focus on doctors and their backgrounds -- e.g., work and education history, insurance accepted, care philosophy and, increasingly, patient reviews. [2] While just the utterance of "patient reviews" makes most doctors break into hives, thinking through why these reviews exist may be the calming saltwater bath doctors need to start fostering such reviews rather than fearing them.

To begin, it's important to recognize patient reviews exist because we want them to. Recent Nielsen data shows consumers trust online reviews second only to recommendations from people they know. This may be surprising, but think of your own purchasing behavior: Let's say you are researching a big-ticket purchase -- maybe the high-end MB360 mountain bike. Google sends you to a website for the MB360, with videos of professional riders hopping over Paul-Bunyan-size logs. There are all sorts of glitzy quotes from top riders and high-resolution photos offering detail all the way down to the whatchamacallits on the thingamajigs. While all of this is interesting, does your research stop there? No. Your next Google search looks something like, "User reviews for MB360."

Why do we seek out the reviews of our consuming brethren? Because such reviews are a form of "word of mouth." We like to know what others -- especially groups of others -- think about prospective products and services. It is why review websites like Yelp, TripAdvisor and Avvo have boomed in the last decade. It is why YouTube is replacing TV, Wikipedia is replacing Encyclopedia Britannica and Facebook has unleashed its torrent of "likes."

Notwithstanding this freight train of Web 2.0 consumer demand, many doctors (or their consultants) are operating from a fearful place and attempting to silence patient reviews. They argue that patient reviews are subject to fraud, there are too few of them to be useful and patients cannot evaluate service quality. They have even filed a couple dozen lawsuits just to prove their point.

But these fearful arguments don't hold water for me.

Review "fraud" is the most-offered criticism of patient reviews -- the idea that these reviews are simply the product of crazy patients, jealous competitors and jilted lovers. The underlying message is that all patient reviews are negative and will only hurt doctors. This could not be further from the truth. A recent American Medical Association study found 90 percent of all online doctor reviews are positive. Moreover, while no system can completely avoid fraud (take the SEC or IRS as two well-funded examples), the leading review websites have invested in sophisticated and responsible systems that are successfully weeding out fraudulent reviews. Speaking for Avvo, we reject 35 percent of the reviews we receive because they fail our screening requirements and community guidelines.

Next, the argument that there are too few reviews available on any one site to be valuable makes no sense. This is akin to criticizing the person who brings a can of food to the holiday food drive. Critics of patient reviews would probably scream "don't bring it!" as such a small amount could not possibly help. But there are a lot of very hungry people out there -- both for a can of food and for a review of a doctor who might remove their gall bladder.

Finally, the idea that patients cannot evaluate quality of care is where irrationality meets hubris. Yes, patients may be less educated in technical health issues, but they are well-educated in their body pain, doctor office smells and poor bedside manner.

To put it another way, it is their opinion, and it is my opinion that when the opinions of your customers are involved, they are always right. In testimony before Congress relating to the health care bill, Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, could not have put it any better. He said, "In my view, we doctors are not our patients' partners; we are guests in our patients' lives. We are not hosts ... An overarching aim for an ideal [physician] practice [is] that its patients would say of it, 'They give me exactly the help I need and want exactly when I need and want it.'"

In the end, it is not a question of whether these reviews should exist because the consuming masses have already spoken. Yes, we need to remain vigilant in weeding out fraudulent reviews. Yes, we need more patient reviews in general. And yes, patients' opinions will not always be 100 percent technically accurate. There will always be room for improvement. But I believe that silencing consumer opinion through lawsuits and fear-mongering should never be the path to such improvement.

I believe that the real question is whether doctors are ready to embrace this new era of transparency not only made available by the Internet but also developed by their very own patients. Early signs are that some doctors will embrace patient reviews and also use them to their marketing advantage. Some will be indifferent. And those with the most to hide will always squirm on the patient-review examining table.

[1] [2] Based on 2010 Google AdWords search data

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