Doctors feel scorched by online reviews
LOS ANGELES – Distraught over the results of cosmetic surgery on her nose, Katherine Chen did what many people do when they’re unhappy with a doctor. She consulted a malpractice lawyer and filed a complaint with the Medical Board of California.
But the 22-year-old college student from West Covina didn’t stop there. Chen logged onto her home computer and wrote a tearful review about her experience, posting it to a Web site that encourages consumers to rate their health care providers.
“I wasn’t nasty about it,” Chen says. “But I posted a comment about what I went through. These Web sites are useful. Doctors still have a lot of power.”
Chen and other consumers are trying to rein in that power. They’re saying what they think about the current state of health care and, more specifically, the doctors who provide it. Dozens of Web sites that permit people to rate, review, spin or flame their doctors have sprung up in the past year, operating in much the same way as online services that help people find hotels or plumbers.
Patients and site operators say the trend is good for consumers and good for health care. Thoughtful doctors, they say, will provide better customer service because of the feedback, and the bad ones will no longer be able to hide. And, they add, why should doctors be immune from the trend toward better customer service?
Many physicians say the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are unfair, pushing some doctors to near-ruin after a single post.
“These sites don’t yield enough power yet to get bad doctors to change. And in the meantime, they may hurt good doctors,” says Dr. Phyllis Hollenbeck, a Washington family physician and author of “Sacred Trust: The Ten Rules of Life, Death and Medicine,” a new book promoting patient empowerment. “It only takes one or two scathing comments and a doctor is put in a terrible position.”
The sites, more than two dozen of them, vary in their scope of information and efforts to be fair. But the trend is toward free, anonymous, no-holds-barred forums.
Some sites have grown out of existing ratings services. Five years after he started the hugely popular RateMyProfessors.com, John Swapceinski and his business partner launched RateMDs in 2004.
“You can find ratings on cars and flat-screen TVs, but it’s hard to rate professional services,” he says. “I think that’s overlooked.”
Angie’s List, a membership-based service that allows consumers to rate service providers, added health care services in March.
The operators of Vitals.com, which launched in January, say their goal is to provide people with free, fair and balanced information to help them select a doctor.
“We think of it as something closer to Match.com, in which we want to match up patients with doctors who are right for them,” says Mitchel Rothschild, chief executive of the Lyndhurst, N.J., company.
The restaurant survey company Zagat has even teamed up with the health benefits company Wellpoint Inc., parent company of Anthem Blue Cross, to provide Blue Cross members with an online tool to evaluate doctors. The service allows members to issue scores based on trust, communication, availability and environment.
“Consumers can pretty much go on the Web and get information on anything, from what is a better shampoo to what is a better airline,” says Dr. Zeinab Dabbah, chief medical officer of Anthem Blue Cross. “We’re offering this to meet all of the expectations that consumers have about the marketplace.”
Sharing information via the Web has given consumers a powerful tool.
But viewing a doctor the same way as a product represents a dramatic shift. Once reverential of doctors, many U.S. consumers are more comfortable criticizing physicians, says Dr. Kevin Weiss, president of the American Board of Medical Specialties, an organization that sets performance standards and certifies doctors.
“There is a lot of pent-up frustration,” Weiss says. “Costs are going up, and people are paying more out of pocket. Plus, there is a lot of data now on how the health care system needs to do better in terms of quality and safety.”
The tradition of doctors monitoring their own conduct through state medical boards and peer organizations is failing, Swapceinski says.
“There is a lot of protection for doctors,” he says. “Even with the state medical boards there is recognition that doctors policing doctors is not the best way to handle things. Most complaints about doctors are never made public.”
Chen says she did her homework – checking the doctor’s credentials and history of malpractice lawsuits and studying his Web site – before the surgery last year to shorten her long nose.
“It was minor,” she says. “I actually shouldn’t have done anything, but I wanted to be perfect.”
She found no red flags in the surgeon’s background. The results of the operation, however, horrified her.
“I started crying. I didn’t recognize myself ... I spent the next nine months at home. I was embarrassed to go out. I quit my job and dropped out of school.”
Chen says her nose was crooked and much too short, and that she was left with breathing problems and nosebleeds. She filed a complaint with the Medical Board of California, a process she later abandoned, and consulted a lawyer who discouraged her from filing a lawsuit because of the cost. She was also facing surgery to correct her nose. Ultimately, Chen says, she felt exposing the doctor on the Internet was her only recourse.
Later, pleased with her revision surgery, Chen also used a ratings Web site to write favorably about the doctor who performed it.
“I wanted people to know about my experience with him because he didn’t really have any feedback on the site,” she says.
Some state medical boards provide consumers with limited information on doctors, such as any disciplinary actions recorded and whether their licenses are current. Moreover, state governments, insurance companies and private organizations have attempted in recent years to gather data on physician performance that can be compiled into “report cards” to help consumers choose doctors wisely. Such measures have been shown to improve health care quality, according to the Agency for Healthcare Research and Quality. But those tools are in their early stages and are rarely consumer-friendly or easy to locate.
Dr. Richard Fischel, a thoracic surgeon in Orange, says his life was turned upside-down after a patient began posting vicious remarks online regarding a surgery Fischel performed.
The surgery was an elective procedure, Fischel and the patient discussed the pros and cons, and the patient signed a consent form acknowledging that discussion.
The operation went well, Fischel says. But after the surgery, the patient complained about a previously discussed side effect that can sometimes occur as a result of the surgery.
“He decided his life was ruined and destroyed,” says Fischel, who graduated from the University of California, Los Angeles, medical school in 1984 and is director of thoracic oncology at Hoag Hospital in Newport Beach.
Online, Fischel says, the patient posted “slanderous rants and raves.”
Fischel, who can’t reveal details because of a legal agreement he has since reached with the patient, soon discovered the pervasive power of the Internet. His business was affected and he suffered monetary and emotional costs because of the patient’s postings. Fischel hired a lawyer and became so depressed he considered leaving medicine.
“Doctors, in general, are sitting ducks,” Fischel says. “It’s impossible to fight back. The courts make it so you have almost no options.”
Federal laws protect patient privacy and prohibit doctors from discussing an individual’s health care in public. But the right of patients to criticize their doctors online has been established. Federal law asserts that the hosts of Web sites on which consumers post anonymous opinions are immune from charges of defamation.
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