Online reviews of medical providers: Take them with a grain of salt

The post here is a slightly edited version of 

Online Doctor Ratings Are Garbage

, which appeared on the usnews.com blog 

Policy Dose

Online customer reviews and ratings are now the gold standard of quality in many industries: such appraisals affect sales of books, movie ticket sales, and hotel bookings. They are, unfortunately, becoming ubiquitous in the health care sector as well. Soon you can find as many online reviews on your primary care physician as you can find on your local pizzeria on Yelp. While it makes sense to check the reviews of a restaurant before eating there, I argue that online patient reviews should not be the basis of one’s decision to choose a medical provider.

Customers are typically qualified and capable to evaluate services and products. Consider a restaurant, anybody can say if the steak is too chewy, the atmosphere is not pleasant, or the waitress is rude. While people have different tastes and thus evaluate similar qualities differently, the overall ratings provided by a large enough sample of patrons give a fairly good sense of what is going on in that restaurant. That is, the online reviews are valid measures of a restaurant’s quality.

This is not the case for online patient reviews of doctors. Patients are neither qualified nor capable of evaluating the quality of the medical services that they receive. The actual quality of the medical services and the consequences of a doctor’s medical decisions on a patient’s health are often not measureable in a short period of time. How can a patient, with no medical expertise, know that the treatment option that he or she received was the best available one? Or how can a patient’s family who lost him on a hospital bed, know that physicians had provided their loved one with the best possible medical care? If patients are not qualified to make medical decisions and should rely on physicians’ medical expertise to make such decisions, then how could they evaluate the quality of such decisions and know that their doctor’s decision was the best possible one?

A person may lack financial expertise and rely on a financial advisor to manage his or her stock portfolio but that individual can judge the quality of the financial advisors’ recommendations by considering the stocks growth and comparing it with the market. In other words, there is a basis with which one can compare the outcomes of a financial advisor’s decisions. Patients have no basis to make similar comparisons with health care: How can a patient know by how many years the treatment that he received from a physician has increased or decreased his life expectancy? Moreover, since market conditions are the same for everyone, the quality of a financial advisor’s decision is the only factor that affects one’s investments yields. On the other hand, in addition to a physician’s medical decision, a host of other factors also affect a patient’s health outcome and make it much more difficult for someone with no medical expertise to evaluate the quality of that decision.

Since patients do not have the medical expertise to judge the quality of physicians’ decisions in the short run and are neither capable to evaluate the outcomes of such decisions in the long run, their feedback would be limited to their immediate interaction with medical providers and their staff members. Instead of the quality of the medical services, patients would evaluate the bed-side manners of physicians, decor of their offices and demeanor of their staff. This is why a physician’s online star rating is not a valid measure of his medical expertise.

To avoid Dr. Hodad, one should instead rely on valid measures of quality and medical expertise that are also available online. Examples of such measures include effectiveness of care at hospitals, experience of physicians in performing a specific medical procedure and nurse to patient ratios at nursing homes.

While the interaction between patients and their medical providers is an important element of the medical care process, it is not the most important one. To choose the best medical provider, patients are encouraged to rely on measures of medical expertise and avoid invalid online reviews.