Mo Med - May June 2016

The Drawbacks of Rate-Your-Doctor Medical Transparency

Mathew S. Isaac 2016-06-10 09:40:18

Encouraging physicians to try to get glowing reviews may skew treatment in unhealthy ways. Vanderbilt University Medical Center recently announced a big change that most marketers would probably applaud. Vanderbilt plans to publicly share the results of patient surveys—including reviews and ratings of individual physicians and practices—on its website. This initiative follows similar efforts at the University of Utah Health Care, Piedmont Healthcare, Wake Forest Baptist Health, and many others. As a marketing professor, I should be thrilled about the movement to increase transparency in health care. No discipline embraces the philosophy of customer centricity more than marketing. Gaining access to a rich repository of information about providers that can be used to make more-informed decisions would certainly appeal to consumers. Maybe it could even help reduce those long wait times at the doctor’s office. Unfortunately, in an era where patient-satisfaction scores could determine funding from governmental programs and even affect health providers’ own compensation and job security, the urge or need to get positive reviews may give providers an incentive to make choices that are not always in their patients’ best interests. Providers may feel extra pressure to comply with patients who plead for a certain drug advertised on TV, or who demand a prescription for antibiotics to treat their common cold. Imagine if you knew that saying “no, you don’t need it” would result in a negative review and even negative scrutiny or attention at your workplace? A recent report by bioethicists at the Hastings Center noted that “good ratings depend more on manipulable patient perceptions than on good medicine.” This means that fancy hospital gowns and convenient parking may influence satisfaction scores more than the provision of sensible, high-quality and medically necessary care. In fact, the Hastings Center report notes that “the pressure to get good ratings can lead to bad medicine.” For instance, physicians may needlessly prescribe medications, order diagnostic tests, and perform invasive Aft er all, patient-centered medicine and patient-satisfaction-centered medicine are not the same. procedures that are not only expensive but may actually harm patients by exposing them to radiation, side effects or other complications. This may explain the surprising association that researchers from University of California Davis observed between high levels of patient satisfaction and mortality rates. Apparently, when providers perform discretionary services—such as a CT scan for an ordinary headache—to appease their patients, the risk of potential adverse effects increases. Proponents of health care systems publicly sharing ratings often argue that patients already use third-party online reviews to make health care decisions but are limited by the relatively small samples on sites such as Yelp or Their claim is that by disclosing ratings on their own websites, health systems can give their constituents better data with which to make better decisions. While I agree that having more patient ratings increases the reliability of a provider’s average rating, a large body of research in social and cognitive psychology has found evidence that negative information wields much more influence than positive information on evaluations and choices—resulting in a negativity bias. This means that a faceless consumer without just cause who spews venom online from behind a keyboard or smartphone has the power to affect the decisions of many other prospective patients. True, this could happen today on a site like Yelp, but the likelihood of encountering a vitriolic and even patently false review would spike as the sheer number of reviews increased on a provider’s own website. The negativity bias also suggests that a few glowing reviews won’t be able to offset a single scathing one. Finally, what about the potential impact that revealing every single patient review would have on health care providers? Isn’t the public disclosure of every inane comment or complaint online an easy way to demoralize and possibly humiliate a hardworking and competent health care provider? I worry what the longterm effect might be on provider motivation, job satisfaction and turnover. Assuming that the transparency train has already left the station, there are ways health care systems can make the transition smoother. • Report numerical patient-satisfaction scores only, but be more judicious when sharing qualitative comments, especially those contained in “outlier” reviews that may not reflect the views of the majority—and perhaps implement a policy not to report the top and bottom 10% of scores and accompanying reviews. • Keep close tabs on provider morale and motivation before and after shifting to a more transparent model. • Most important, recognize what patient satisfaction surveys can and cannot reveal about the health system’s overall performance. They may be great at identifying if the front desk staff is friendly or if a doctor has an impeccable bedside manner, but they can’t reveal whether patients’ health ailments are being competently treated. After all, patient-centered medicine and patient-satisfaction-centered medicine are not the same. Mathew S. Isaac, PhD, is an Assistant Professor of Marketing, Albers School of Business and Economics, Seattle University, Seattle, Washington. Contact: Reprinted with permission from The Wall Street Journal

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