Patients' evaluations of health care providers in the era of social networking: an analysis of physician-rating websites

What Patients Say About Their Orthopaedic Hand and Wrist Surgeons: A Qualitative Analysis of Negative Reviews on Yelp

Background  Patients often turn to online reviews as a source of information to inform their decisions regarding care. Existing literature has analyzed factors associated with positive online patient ratings among hand and wrist surgeons. However, there is limited in-depth analysis of factors associated with low patient satisfaction for hand and wrist surgeons. The focus of this study is to examine and characterize extremely negative reviews of hand and wrist surgeons on Yelp.com. Methods  A search was performed using the keywords "hand surgery" on Yelp.com for eight major metropolitan areas including Washington DC, Dallas, New York, Phoenix, Los Angeles, San Francisco, Boston, and Seattle. Only single-star reviews (out of a possible 5 stars) of hand and wrist surgeons were included. The complaints in the 1-star reviews were then categorized into clinical and nonclinical categories. Result  A total of 233 single-star reviews were included for analysis, which resulted in 468 total complaints. Of these complaints, 81 (18.8%) were clinically related and 351 (81.3%) were nonclinical in nature. The most common clinical complaints were for complication (24 complaints, 6%), misdiagnosis (16 complaints, 4%), unclear treatment plan (16 complaints, 4%), and uncontrolled pain (15 complaints, 3%). The most common nonclinical complaints were for physician bedside manner (93 complaints, 22%), financially related (80 complaints, 19%), unprofessional nonclinical staff (61 complaints, 14%), and wait time (46 complaints, 11%). The difference in the number of complaints for surgical and nonsurgical patients was statistically significant ( p  < 0.05) for complication and uncontrolled pain. Clinical Relevance  Patient satisfaction is dependent on a multitude of clinical and nonclinical factors. An awareness of online physician ratings is essential for hand and wrist surgeons to maintain and improve patient care and patient satisfaction. We believe the results of our study could be used to further improve the quality of care provided by hand and wrist surgeons.

An examination of negative one-star patient reviews for foot and ankle orthopedic surgery: A retrospective analysis

BACKGROUND

Despite the questionable validity of online-based physician review websites (PRWs), negative reviews can adversely affect a provider's practice. Several investigations have explored the effect of extremely negative "one-star" reviews across subspecialties such as adult reconstruction, sports medicine, and orthopaedic traumatology; however, to date, no study has explored one-star reviews in foot and ankle surgery. The goal of this study was to characterize factors that contribute to extremely negative, one-star reviews for foot and ankle surgeons on Vitals.com.

METHODS

A retrospective analysis of negative one-star reviews with corresponding patient complaints for foot and ankle surgeons (both orthopaedic surgeons as well as podiatrists) in the United States. Physicians included were selected within a 10-mile radius of the top ten largest cities in the United States. Data was stratified by patient type (e.g., those receiving surgery and those not undergoing surgical intervention) and binned according to type of patient complaint, as previously described.

RESULTS

Of the 2645 foot and ankle surgeons identified in our initial query, 13.8% of surgeons contained one-star reviews eligible for analysis. Patient complaints related to bedside manner and patient experience are the causative factors accounting for 41.5% of the one-star reviews of foot and ankle surgeons for nonsurgical-related complaints. Surgical complications and other outcomes-related factors comprised roughly 50% of the complaints related to surgical patients.

CONCLUSION

In conclusion, complaints related to bedside manner and patient experience are the causative factors accounting for 41.5% of the one-star reviews of foot and ankle surgeons for nonsurgical-related complaints. Surgical complications and other outcomes-related factors comprised roughly half of the complaints related to surgery. This data serves to inform practicing foot and ankle surgeons as to the influences behind patients leaving extremely negative reviews on PRWs.

LEVEL OF CLINICAL EVIDENCE

IV.

Assessing reviews of academic oral and maxillofacial surgeons within the US on Healthgrades

PURPOSE

The purpose of the following study was to explore the patient feedback on academic oral and maxillofacial surgeons (OMSs) practicing in the United States (US) using the physician rating website (PRW) Healthgrades.com.

METHODS

We conducted a retrospective cohort study on academic OMSs in the US using data from Healthgrades.com. Predictor variables included OMS characteristics or rating characteristics. The primary outcome variable was overall rating. Linear regression was used to determine independent predictors of overall rating.

RESULTS

The final study sample consisted of 309 academic OMSs (mean age, 56.4 years; males, 86.4%). Age group was significantly associated with overall rating (p = 0.034). Dual-degree OMSs had a higher mean overall rating than single-degree OMSs (4.26 vs. 3.98, p = 0.012). The number of ratings was also significantly associated with overall rating (p = 0.019). Upon controlling for all other variables, merely age group was independently associated with overall rating. Specifically, OMSs aged 41-55 years were associated with a higher overall rating (+0.96, p = 0.022) relative to OMSs aged >70 years.

CONCLUSIONS

The OPRs on Healthgrades.com for academic OMSs within the US are generally positive. Age was the only independent predictor for overall rating - younger OMSs (aged 41-55 years) were independently associated with a higher overall rating relative to older OMSs (aged >70 years). The new generation of younger OMSs is likely to be aware of PRWs and their implications in the growing world of online exposure.

Social Media and Digital Footprints in Orthopaedic Trauma: An Analysis of 1465 Orthopaedic Trauma Association Members

OBJECTIVES

The purpose of this study was to quantify social media usage among Orthopaedic Trauma Association (OTA) members.

METHODS

All active OTA members were searched for involvement among common social media platforms. Surgeons were then classified as "active" on any given social media site if they posted within the past 6 months. Surgeons were also identified by the region they practiced in, sex, and their practice setting (academic vs. private). Finally, a surgeon's score and number of reviews from common physician review websites were examined.

RESULTS

A total of 1465 OTA members were included in the analysis. Most surgeons were male (89.1% [n = 1305]) and practiced in a private setting (54.5% [n = 799]). A total of 590 surgeons (40.3%) had at least one form of social media account. Social media sites most used were LinkedIn with 48.7% (n = 713) and ResearchGate with 29.2% (n = 428). Academic surgeons were more likely to have a ResearchGate, LinkedIn, and Twitter account while private surgeons were more likely to have a personal website ( P < 0.05). Finally, there was no correlation between surgeons more active on social media and average scores on Vitals.com or Healthgrade.com ( P > 0.05).

CONCLUSIONS

Most orthopaedic trauma surgeons do not have professional social media accounts. Although social media may help spread scholarship, having a professional social media account does not correlate with better online physician reviews or increased online reviews among orthopaedic trauma surgeons.

Rating of French maxillofacial surgeons on their Google® business account: Current status and reflections for equitable communication

INTRODUCTION

Online reputation is misattributed in France in academic publications. However, this phenomenon is growing. The objective of this study was to establish an inventory of the e-reputation of French maxillofacial surgeons through the opinions posted on their professional Google® account.

MATERIAL AND METHODS

A descriptive study included all the surgeons registered on the list of the French National Medical Council in "maxillofacial surgery and stomatology". Data collection was carried out from February to April 2022.

RESULTS

Among the 483 surgeons included, 61.1% had received at least one opinion, the number of per surgeon was 22.2. The average was 4.3/5. Among the 4433 written comments completing the review, 85% were positive. The average response rate of surgeons was 10% and was all the more important as the rating of the opinion was lower. Stomatology (65.3%), aesthetic surgery of the face (15.1%) and orthognathic surgery (14.5%) were the most commented maxillofacial procedures.

DISCUSSION

The online image of French maxillofacial surgeons was very positive. However, faced with a defamatory or insulting comment, the surgeon found in an unbalanced situation where he could not respond without risking betraying medical. We recall some common-sense recommendations for managing one's e-reputation and some legislative adjustments for better regulation of these platforms, also considering legal and ethical aspects.

Centricity on patients using healthcare reputation management strategies to improve dentistry image in Romania

Reputation is seen as an abstract concept that focuses on patients' perceptions of a particular medical institution. A good image of these practices among patients makes them return to them and also helps attract new patients and increase their reputation and revenue. The paper aimed to explore the respondents' perceptions of the way the image of online dental practices can influence their reputation management. For this purpose, a quantitative study was conducted on a sample of 107 respondents. Data collection was carried out using a questionnaire that was posted on an online platform. Data analysis was done by using IBM SPSS software. The results emphasized that patients think that the image of dental practices in the online environment can influence their reputation to a high extent.

What Makes a 5-Star Orthopaedic Sports Medicine Surgeon? An Analysis of Positive Online Patient Reviews

Background

The increased focus on patient satisfaction has led to growth in the use of physician rating websites.

Purpose

To analyze the factors associated with online 5-star patient reviews for orthopaedic sports medicine surgeons.

Study Design

Cross-sectional study.

Methods

A total of 70 orthopaedic sports medicine surgeons were randomly selected from the AOSSM website. A search was performed for these surgeons on Yelp.com. All reviews other than 5 stars (of a possible 5 stars) were excluded from the study. Each review was categorized as referring to a surgical or nonsurgical aspect of care, and each comment within the review was categorized as being clinically or nonclinically related. Comments were further subcategorized by specific features such as bedside manner, clinical outcomes, and patient education. Categorical variables were analyzed using the chi-square test.

Results

Overall, 400 five-star reviews were included in the study, comprising 1225 total positive comments. Of the 400 five-star reviews, 200 (50%) were from surgically treated patients, and 200 (50%) were from nonsurgically treated patients. Of the 1225 positive comments, 505 (41%) were clinically related, and 720 (59%) were nonclinical. The most common positive clinical comments were for clear treatment plans (191 reviews [48%]), good outcomes (173 reviews [43%]), and providing alternative treatment plans (55 reviews [14%]). The most common positive nonclinical comments were for good physician bedside manner (287 reviews [72%]), friendly/professional staff (194 reviews [49%]), and ease of scheduling (68 reviews [17%]).

Conclusion

The majority of 5-star patient reviews left positive comments regarding nonclinical aspects of care such as physician bedside manner and friendly staff. The most common positive comments regarding clinical aspects concerned good outcomes and clear treatment plans. The overall most common positive comment, in both surgically and nonsurgically treated patients, referred to good bedside manner.

The Credibility of Physician Rating Websites: A Systematic Literature Review

OBJECTIVES

Increasingly, the credibility of online reviews is drawing critical attention due to the lack of control mechanisms, the constant debate about fake reviews and, last but not least, current developments in the field of artificial intelligence. For this reason, the aim of this study was to examine the extent to which assessments recorded on physician rating websites (PRWs) are credible, based on a comparison to other evaluation criteria.

METHODS

Referring to the PRISMA guidelines, a comprehensive literature search was conducted across different scientific databases. Data were synthesized by comparing individual statistical outcomes, objectives and conclusions.

RESULTS

The chosen search strategy led to a database of 36,755 studies of which 28 were ultimately included in the systematic review. The literature review yielded mixed results regarding the credibility of PRWs. While seven publications supported the credibility of PRWs, six publications found no correlation between PRWs and alternative datasets. 15 studies reported mixed results.

CONCLUSIONS

This study has shown that ratings on PRWs seem to be credible when relying primarily on patients' perception. However, these portals seem inadequate to represent alternative comparative values such as the medical quality of physicians. For health policy makers our results show that decisions based on patients' perceptions may be well supported by data from PRWs. For all other decisions, however, PRWs do not seem to contain sufficiently useful data.

Exploring Customer Journeys in the Context of Dentistry: A Case Study

This case study aims to explore how customer journey concepts can apply to a hypothetical scenario, centring on a patient (customer persona) within the dentistry arena, and with a particular focus on special care dentistry. As an educational exercise, this paper may inform dental and allied professionals on how aspects of the customer journey notion may be embedded into their own practices, so that patient-centricity might be better optimised. The hypothetical scenario considers the organisational context, customer persona, contemporary customer purchase decision-making models, and marketing approaches. These components are used to create a customer journey map to help visualise and identify the varying customer–business interactions. The customer journey, focussing on the awareness, initial consideration, active evaluation, pre-purchase, purchase and post-purchase stages, is then conceptually analysed. The analyses reveal that there are areas of friction, attributable to numerous factors. The case study recommends that by introducing digitalisation and omnichannel marketing, alongside existing internally generated and multi-channel marketing approaches, considerable improvements may be achievable. As the patient technology landscape becomes more digital and dental organisations face fiercer competition, dental care providers relying on traditional marketing approaches may well need to adapt and introduce innovative, yet cost-effective digitalisation and omnichannel marketing approaches. Nevertheless, dental care providers, and dental and allied professionals must uphold an underlying duty of care, ensuring that all practises are legal, decent, honest, truthful, and above all ethical.

Gender Disparities and Differences Among Urologists Included in Top Doctor Lists

OBJECTIVE

To understand gender trends among urologists included in "Top Doctor" lists as more women practice urology, we (1) Evaluated whether Top Doctor lists reflect a contemporary distribution of urologists by gender; (2) Describe regional differences in gender composition of lists; (3) Report similarities and differences among men and women Top Doctors.

METHODS

All urologists in regional Top Doctor Castle Connolly lists published in magazines between January 1, 2020 and June 22, 2021 were included. Physician attributes were abstracted. American Urological Association (AUA) census data was used to compare the number of men and women Top Doctor urologists to the number of practicing men and women urologists within each list's zip codes. Log odds ratios (OR) and (95% confidence intervals) were used to compare likelihood of list inclusion by gender overall and by region.

RESULTS

Four hundred and ninety-four Top Doctor urologists from 25 lists were analyzed, of which 42 (8.50%) were women. Women urologists comprised 0%-27.8% of each list, with 7 lists (28.0%) including zero women urologists. Using AUA census data, OR for list inclusion of men urologists compared to women was 1.31 (1.01, 1.70) overall, with OR = 0.78 (0.36, 1.72) in the West, OR = 1.39 (1.03, 1.89) South, OR = 1.46 (0.8, 2.67) Northeast, OR = 1.90 (0.50, 7.18) Midwest. Women top urologists completed fellowship more often than men (66.7%, 55.1%) and were significantly more likely to complete female pelvic medicine and reconstructive surgery (FPMRS) fellowship (P <.001).

CONCLUSION

Men urologists were significantly more likely to be included in Top Doctor lists than women urologists. Top women urologists were significantly more likely to complete FPMRS fellowship.

Characterizing Single-star Negative Online Reviews of Orthopaedic Trauma Association Members

INTRODUCTION

The purpose of this study was to characterize factors that contribute to 1-star negative reviews regarding orthopaedic trauma surgeons.

METHODS

A search was done for Orthopaedic Trauma Association members on Yelp.com, Healthgrade.com, and Vitals.com in New York, Boston, San Francisco, Los Angeles, Dallas, Phoenix, Seattle, Baltimore, Denver, Houston, Philadelphia, and Washington, DC. All single-star reviews (out of a possible 5 stars) were included in this study. Reviews were categorized as either clinical or nonclinical and then further subcategorized. Categorical variables were analyzed using a chi-square test. The rate ratio (the ratio of the rate for nonsurgical divided by surgical reviews) was determined for each category.

RESULTS

Two hundred eighty-eight single-star reviews were included in the study, comprising 655 total complaints. Of all complaints, 274 (41.8%) were clinically related and 381 (58.2%) were nonclinical. Of the 288 single-star reviews, 96 (33.3%) were from surgically treated patients and 192 (66.7%) were from nonsurgical patients. Most complaints were in reference to nonclinical aspects of care such as physician bedside manner (173 reviews, 60%), not enough time spent with provider (58 reviews, 20%), and wait time (42 complaints, 15%). The most common clinical complaints were for complication (61 reviews, 21%), disagree with decision/plan (49 reviews, 17%), and uncontrolled pain (45 reviews, 16%). Surgical patients had a significantly higher rate of clinical complaints than nonsurgical patients (1.57 vs. 0.64 clinical complaints per review, P < 0.001). Nonsurgical patients had a significantly higher rate of nonclinical complaints than surgical patients (1.43 vs. 1.10 nonclinical complaints per review, P < 0.001).

DISCUSSION

Most 1-star reviews referenced a nonclinical aspect of care with a physician's bedside manner being the most common complaint. Surgical patients were markedly more likely to reference a clinical aspect of care, such as complications or misdiagnosis compared with nonsurgical patients, who more commonly referenced nonclinical aspects of care.

How Do Users Respond to Mass Vaccination Centers? A Cross-Sectional Study Using Natural Language Processing on Online Reviews to Explore User Experience and Satisfaction with COVID-19 Vaccination Centers

To reach large groups of vaccine recipients, several high-income countries introduced mass vaccination centers for COVID-19. Understanding user experiences of these novel structures can help optimize their design and increase patient satisfaction and vaccine uptake. This study drew on user online reviews of vaccination centers to assess user experience and identify its key determinants over time, by sentiment, and by interaction. Machine learning methods were used to analyze Google reviews of six COVID-19 mass vaccination centers in Berlin from December 2020 to December 2021. 3647 user online reviews were included in the analysis. Of these, 89% (3261/3647) were positive according to user rating (four to five of five stars). A total of 85% (2740/3647) of all reviews contained text. Topic modeling of the reviews containing text identified five optimally latent topics, and keyword extraction identified 47 salient keywords. The most important themes were organization, friendliness/responsiveness, and patient flow/wait time. Key interactions for users of vaccination centers included waiting, scheduling, transit, and the vaccination itself. Keywords connected to scheduling and efficiency, such as "appointment" and "wait", were most prominent in negative reviews. Over time, the average rating score decreased from 4.7 to 4.1, and waiting and duration became more salient keywords. Overall, mass vaccination centers appear to be positively perceived, yet users became more critical over the one-year period of the pandemic vaccination campaign observed. The study shows that online reviews can provide real-time insights into newly set-up infrastructures, and policymakers should consider their use to monitor the population's response over time.

Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study

PURPOSE

Hospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany.

METHODS

From 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics.

RESULTS

Our study includes n = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists' recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% (n = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8-2.1).

CONCLUSION

In Germany, HRWs play a minor role for uro-oncologic patients undergoing elective surgery. Instead, personal consultation of the treating urologist seems to be far more important. Although patients predominantly rated the provided information of the HRW as positive, only a quarter of users changed the initial choice of hospital.

Awareness of and interaction with physician rating websites: A cross-sectional study in Austria

To date, the digital assessment of service experiences represents a decisive process step of a feedback culture in numerous economic areas. In view of this digitalization of service assessments, the importance of Physician Rating Websites (PRWs) has also increased steadily in recent years. Even though these websites could be perceived as a powerful communication tool for the exchange of health specific information, the knowledge about whether and how different population segments use these portals has been limited so far. For this reason, our aim was to investigate the level of awareness regarding PRWs among the study population and to discover how users interact with this specific type of online portals. We performed an online survey including 558 participants. To ensure the attention and integrity of participants, attention checks were included in the questionnaire. Study participants who did not exceed the mentioned security levels were excluded from the study. Statistical analyses were carried out, using IBM SPSS Statistics 27. To illustrate the relationship between demographic variables and dependent variables, two tailed chi square tests were performed. Comparison of means and t-testing was used to investigate the relationship between psychographic variables and the dependent variables. In addition to that, the awareness levels regarding different rating portals were evaluated using descriptive methods. Our results suggest that the general awareness regarding PRWs is relatively high (75.6%, 423/558), especially among female (x21 = 9.880, P = .002), middle-aged (x29 = 26.810, P = .002), more highly educated (x24 = 19.038, P = .001), urban (x21 = 6.274, P = .012), digitally literate (t203 = 2.63, P = .009) individuals and particularly among respondents with a higher eHealth literacy (t203 = 2.37, P = .019). Even though more than three quarters of the respondents know that PRWs exist, compared to other rating platforms, they are only in the lower midfield. The upper ranks are taken by websites on which restaurant visits (98.9%, 552/558), hotel stays (97.7%, 545/558) or movies (95.5%, 533/558) can be rated. The most popular PRWs in Austria include Docfinder.at (31.3%, 175/558; 77.8%, 434/558) followed by the evaluation tools provided by Google.at (8.24%, 46/558; 70.3%, 392/558) and Herold.at (1.61%, 9/558; 44.8%, 250/558). In Austria, PRWs seem to be characterized by a high degree of interaction (89.2%, 498/558) with a wide variety of different types of interactions. While many respondents use PRWs to retrieve general information (83.2%, 464/558), there are significantly fewer who read physicians' reviews (60.9%, 340/558) and use this portal to select a physician (60.6%, 338/558). Respondents who have already rated a doctor themselves belong to the smallest group accounting for just 14.7% (82/558). Significant effects regarding the interaction with PRWs exist between different genders, ages, education levels, marital statuses, occupations and areas of living. In addition to that, respondents with better feelings towards the internet, greater digital literacy as well as a higher eHealth literacy were also characterized with a higher interaction rate regarding PRWs. According to the high level of awareness of and interaction with PRWs within our study population, PRWs appear to be a successful medium for health-related communication. Especially for female, middle-aged, more highly educated, urban and more technology savvy population segments, PRWs seem to represent an effective tool to support the health-specific decision-making process.

Findings From Implementing a Patient Experience Survey in a Quality Measurement System for Substance Abuse Disorder Treatment Facilities in 6 States

OBJECTIVES

Patient experience surveys (PESs) are an important component of determining the quality of health care. There is an absence of PES data available to people seeking to identify higher quality substance use disorder treatment providers. Our project aimed to correct this by implementing a PES for substance use disorder treatment providers and publicly disseminating PES information.

METHODS

We created a population frame of all addiction providers in 6 states. Providers were asked to disseminate a survey invitation letter directing patients to a survey Web site. No personally identifiable information was exchanged. We developed a 10-question survey, reflecting characteristics National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Substance Abuse and Mental Health Services Administration (SAMHSA) have identified as reflecting higher-quality addiction treatment.

RESULTS

Nineteen percent of facilities participated; among participating facilities, 9627 patients completed the survey. Patient experience varied significantly by facility with the percentage of a facility's patients who chose the most positive answer varying widely. We calculated that between-facility reliability will meet or exceed 0.80 for facilities with 20 or more responding patients. We searched for but did not find evidence of data falsification.

CONCLUSIONS

This cost-efficient survey protocol is low burden for providers and patients. Results suggest significant differences in quality of care among facilities, and facility-level results are important to provide to consumers when they evaluate the relative patient-reported quality of facilities. The data are not designed to provide population-based statistics. As more facilities and patients per facility participate, public-facing PES data will be increasingly useful to consumers seeking to compare and choose facilities.

Rating Spine Surgeons: Physician Review Websites Versus a Patient-reported Outcomes-derived Ranking

STUDY DESIGN

This was an observational study.

OBJECTIVES

This study aims to determine the correlation between patient-reported outcomes (PROs) pulled from a national spine registry and physician ratings from physician review websites (PRWs).

SUMMARY OF BACKGROUND DATA

PRWs are frequently utilized by patients to make health care decisions; however, many PRWs appear to incorporate subjective experiences unrelated to a surgeon's clinical performance into ratings. As such, their utility as a health care decision-making tool remains unclear.

MATERIALS AND METHODS

This study evaluated 8834 patients from the Quality Outcomes Database (QOD) who underwent 1-level elective lumbar spine surgery. The lumbar module of QOD was queried to rank 124 surgeons using PROs (Oswestry Disability Index, EuroQOL, Numerical Rating Scale-back/leg pain, and patient satisfaction). The QOD PRO-ranking system was compared against PRWs including Healthgrades, Vitals, WebMD, and Google. The Spearman correlation coefficients, Kruskal-Wallis tests, and multiple linear regression models were used for statistical comparison. The primary outcome was the correlation between PRW scores and PROs.

RESULTS

Surgeon PRO-derived ranking showed high intercorrelational congruence with coefficients between the 3 PROs (Oswestry Disability Index, EuroQOL, Numerical Rating Scale back/leg) ranging between 0.70 and 0.88. Low correlations were observed between PRO-derived rankings and PRWs, ranging from 0.23 to 0.37. Healthgrades performed most similarly to PRO-derived rankings, correlating best with patient satisfaction, though the correlation was low (ρ=0.37).

CONCLUSIONS

While PRWs are often used to evaluate surgeon competency, these results demonstrate they poorly correlate with a surgeon's clinical ability measured by PROs. PRWs should be used with caution when making health care decisions by patients, payers, and administrators.

LEVEL OF EVIDENCE

Level III.

The 'five star' fallacy: an analysis of online reviews and testimonials of dental practices in Northern England

Aims and objectives To develop a greater understanding of how dental practices in the UK utilise and promote patient reviews and testimonials. To compare and contrast the star ratings, levels of engagement and levels of identifiability by comparing those placed by patients on social media, review websites and search engines, to those placed on providers' own websites. To provide recommendations for future advertising guidance.Materials and methods All practices providing dental services in North East England and Cumbria were identified from the Care Quality Commission database. A web-based Google search for the respective dental practice websites, NHS listings, Facebook pages and Google results page listings was performed. The presence or absence of patient testimonials and reviews was recorded, alongside the total number of testimonials/reviews and the number of non-identifiable testimonials/reviews. Data were analysed using Microsoft Excel and SPSS Statistics.Results Of the 401 practice websites, 19.7% (n = 79) contained at least one graded review, while 40.9% (n = 158) of the 386 NHS listings; 87.2% (n = 272) of the 343 Facebook pages; and 94.4% (n = 442) of the 468 Google listings also contained at least one graded review. All of the 1,798 testimonials observed on practice websites were positive in their sentiment. Further, 22 practices utilised video testimonials. Each of the online review locations showed overall mean scores above 4.5 out of 5 stars.Conclusions Dental practice websites, the NHS website, Facebook and Google utilise testimonials and reviews in distinct and diverse ways. Unlike other jurisdictions around the world, the UK does not have guidance in this area. Electronic word of mouth is often replete with bias, and as such, patients need to be encouraged to seek out multiple sources before decision-making. Facebook and Google may be perceived to be more 'trustworthy' sources of information as they appear less curated and less susceptible to manipulation than practice websites, which the public may feel gives greater credence to the information they provide. In order to achieve the highest standards of integrity and honesty, advertising guidance surrounding reviews and testimonials would benefit from future revision.

Should Doctors Open Online Consultation Services? An Empirical Investigation of Their Impact on Offline Appointments

Online healthcare portals have become prevalent worldwide in recent years. One common form of healthcare portal is the online consultation website, which provides a bridge between patients and doctors and reduces patients’ time and cost when seeking healthcare services. Another form is the healthcare service appointment website, which facilitates offline visits for patients. Though nominally separate, the behaviors of the users (including patients and doctors) on these two types of websites could be related to each other. In particular, how does opening online consultation services impact the offline appointments of doctors? Although this is an important question for healthcare portals, doctors, and policy makers, it has not been rigorously examined in the literature. We examine the overall impact of opening online consultation services on offline appointments and show that the number of offline appointments for doctors increases after opening online consultation services. Given that online consultation is a new but important way to connect patients and doctors, our findings provide useful implications for all the stakeholders—doctors, patients, hospitals, and policy makers—regarding how to integrate online and offline channels in the healthcare context.

What Affects an Orthopaedic Surgeon's Online Rating? A Large-Scale, Retrospective Analysis

Introduction:

In the past decade, online physician review websites have become an important source of information for patients, with the largest and most popular being Healthgrades.com. Our study aims to investigate demographic and volume-based trends for online reviews of every Healthgrades-listed orthopaedic surgeon through a nationwide, retrospective analysis.

Methods:

All available demographic and rating information for orthopaedic surgeons (n = 28,713; Healthgrades.com) was analyzed using one-way Analysis of Variance, Tukey Studentized Range (Honestly Significant Difference), linear regression, and Pearson correlation coefficient.

Results:

The mean rating for all surgeons was 3.99 (SD 0.92), and the mean number of ratings was 13.43 (SD 20.4). Men had a greater mean rating at 4.02 compared with women at 3.91 (P < 0.0001), and DO surgeons had greater mean rating at 4.11 compared with MD surgeons at 3.90 (P < 0.0001). The correlation between rating and age had a significant negative correlation (P < 0.0001). The correlation between average online rating and number of reviews had a significant positive correlation (P < 0.0001).

Discussion:

Our analysis suggests that greater online ratings are associated with the male sex and DO degrees. In addition, our study discovered that the number of ratings was positively correlated with greater mean online ratings, whereas older age was negatively correlated with greater mean online ratings.

Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors

Background

Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons.

Objective

The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level.

Methods

This was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information.

Results

Patient-reported referral sources included the emergency room (29/329, 8.8%), friend (42/329, 12.8%), insurance company (47/329, 14.3%), internet search/website (28/329, 8.5%), primary care physician (148/329, 45.0%), and other (34/329, 10.3%). Among the 329 patients, 130 (39.5%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon’s website to be useful (P<.001), with the relative frequency increased in younger age groups.

Conclusions

This study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors.

Patient Satisfaction of General Dermatology Providers: A Quantitative and Qualitative Analysis of 38,008 Online Reviews

Measuring patient satisfaction of general dermatology providers is an important goal because it can lead to improved clinical outcomes. Online reviews are emerging as the newest forum for evaluating physicians in real time and provide a valuable tool for measuring patient satisfaction. We analyzed both quantitative and qualitative online reviews of general dermatology providers at 121 Accreditation Council for Graduate Medical Education‒accredited dermatology programs across the country to determine which elements are most discussed in online ratings using the online platforms Vitals, US News, WebMD, Google Reviews, and Healthgrades. There were 38,008 online reviews included from general dermatology providers at Accreditation Council for Graduate Medical Education‒accredited programs. The median average overall quantitative rating of providers was 4.35 of 5. There were more positive (77%) than negative (23%) comments. The overall ratings of general dermatology providers were favorable. The most influential factors in both positive and negative comments were patient’s perceived experience and physician’s bedside manner (26% and 17%, respectively). Less important factors included office space, treatment by auxiliary staff, wait time, costs, and time spent with patients. This suggests that a provider’s personality, expressed compassion, empathy, and kindness may overcome other issues and create an overall positive experience.

Negative reviews online: an exploratory analysis of patient complaints about dental services in Western Australia

OBJECTIVE

Rates of online reviews are continually increasing. Coinciding with this, is the beneficial abundance of subjective information that is now available to patients. Such information can be persuasive in selecting a healthcare provider. This analysis of one-and-two-star Google reviews received by dental practices within the Perth metropolitan region aims to identify common themes within dental practice complaints.

METHODS

This mixed-methods study was conducted by gathering reviews from the 'Google review' feature, which have been published by users between 2013 and 2020. These data were then coded into recognised themes, and crucial quotes were selected and de-identified creating a narrative about the themes present which formed the qualitative component of this research.

RESULTS

A total of 413 negative reviews were included in this study. From these, 1071 specific complaints were identified. Major themes identified included treatment issues, staffing, communication and professionalism, finance, and premise. Spread across these five themes were an additional thirty-eight subthemes. Overall, treatment was a primary concern for patients, making up 37.1% of the results. Within the subthemes 'treatment dissatisfaction (unspecified)' was also high, at 23.1%.

CONCLUSION

This study identified the most common complaints received by dental clinics on Google review within the Perth metropolitan area. Further investigation is required to provide supplementary data regarding factors that may influence complaint rates and types, such as the socio-economic status of areas and geographical factors such as distance from the Perth metropolitan.

One Decade of Online Patient Feedback: Longitudinal Analysis of Data From a German Physician Rating Website

Background

Feedback from patients is an essential element of a patient-oriented health care system. Physician rating websites (PRWs) are a key way patients can provide feedback online. This study analyzes an entire decade of online ratings for all medical specialties on a German PRW.

Objective

The aim of this study was to examine how ratings posted on a German PRW have developed over the past decade. In particular, it aimed to explore (1) the distribution of ratings according to time-related aspects (year, month, day of the week, and hour of the day) between 2010 and 2019, (2) the number of physicians with ratings, (3) the average number of ratings per physician, (4) the average rating, (5) whether differences exist between medical specialties, and (6) the characteristics of the patients rating physicians.

Methods

All scaled-survey online ratings that were posted on the German PRW jameda between 2010 and 2019 were obtained.

Results

In total, 1,906,146 ratings were posted on jameda between 2010 and 2019 for 127,921 physicians. The number of rated physicians increased constantly from 19,305 in 2010 to 82,511 in 2018. The average number of ratings per rated physicians increased from 1.65 (SD 1.56) in 2010 to 3.19 (SD 4.69) in 2019. Overall, 75.2% (1,432,624/1,906,146) of all ratings were in the best rating category of “very good,” and 5.7% (107,912/1,906,146) of the ratings were in the lowest category of “insufficient.” However, the mean of all ratings was 1.76 (SD 1.53) on the German school grade 6-point rating scale (1 being the best) with a relatively constant distribution over time. General practitioners, internists, and gynecologists received the highest number of ratings (343,242, 266,899, and 232,914, respectively). Male patients, those of higher age, and those covered by private health insurance gave significantly (P<.001) more favorable evaluations compared to their counterparts. Physicians with a lower number of ratings tended to receive ratings across the rating scale, while physicians with a higher number of ratings tended to have better ratings. Physicians with between 21 and 50 online ratings received the lowest ratings (mean 1.95, SD 0.84), while physicians with >100 ratings received the best ratings (mean 1.34, SD 0.47).

Conclusions

This study is one of the most comprehensive analyses of PRW ratings to date. More than half of all German physicians have been rated on jameda each year since 2016, and the overall average number of ratings per rated physicians nearly doubled over the decade. Nevertheless, we could also observe a decline in the number of ratings over the last 2 years. Future studies should investigate the most recent development in the number of ratings on both other German and international PRWs as well as reasons for the heterogeneity in online ratings by medical specialty.

A good dentist or not: understanding the role of storytelling in online dentist reviews

Purpose

Narrative comments about dentists on physician review sites have been documented to increasingly influence people's selection of their dentists. From a communication standpoint, these comments are a type of narrative communication that people share their experiences with dentists by telling stories. Based on the frameworks of rhetoric structure theory and extended elaborated likelihood model, this study aimed to examine the effects of such storytelling from two perspectives including narrative structure and narrative focus.

Design/methodology/approach

A 4 (narrative structure) × 2 (narrative focus) between-subjects experiment was conducted to examine the proposed hypotheses and research questions

Findings

The results showed that a one-sided comprehensive comment focusing on technical competence generated the strongest persuasion effects measured by attitude and behavioral intention. These effects were mediated by perceived narrative credibility and enjoyment.

Originality/value

This study contributes to the extant literature in two ways. First, it extends previous studies of online narrative comments by showing which narrative structure and focus are deemed to be more persuasive when selecting a dentist. Second, it offers a test of two routes of information processing (i.e. cognitive and experiential) to understand the mechanism underlying the effects of narrative comments.

Peer review

The peer-review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0359

Factors Affecting Orthopedic Sports Medicine Surgeons' Online Reputation

Physician rating websites (PRWs) rate physicians based on experiences of previous patients. Although a high rating is desirable, it may not correlate with quality of care, experience, or other physician-specific variables. This study examined the impact of physician-specific variables, such as American Board of Orthopaedic Surgery Sports Certificate of Added Qualification (CAQ) status, years in practice, sex, and geographic location, on the PRW patient satisfaction rating and number of ratings. A list of orthopedic sports medicine surgeons was obtained from the American Orthopaedic Society for Sports Medicine database. Demographic data were recorded. Surgeon profiles were gathered from the most commonly used PRWs (Healthgrades and Vitals), and a mean rating value was recorded on a 1- to 5-star scale. The t test and analysis of variance were used for comparisons. Multivariable linear regression was used to identify factors contributing to PRW ratings. Female sex had the biggest positive effect on PRW rating (R=0.04, P=.029). The PRW rating was positively affected by the number of ratings (R=0.04, P<.001) and negatively affected by an increase in years of practice (R=0.04, P<.001). Surgeons with fewer than 10 years in practice had higher PRW ratings than surgeons practicing longer than 10 years. The PRW ratings were not affected by sports CAQ status or geographic location. Fewer years in practice, female sex, and greater number of reviews were associated with higher PRW ratings. Number of reviews was the only modifiable factor. There was no observed association between sports medicine CAQ status and PRW rating. [Orthopedics. 2021;44(2):e281-e286.].

Consumer Engagement With Information on Performance: A Narrative Review

BACKGROUND AND OBJECTIVES

Efforts to provide information on quality of providers assume that consumers and patients are able to use information effectively to guide their decisions. We conducted a narrative literature review to better understand how consumers use information on quality to ultimately select a provider.

METHODS

We used Berwick's Pathways to Quality Improvement Framework to guide a narrative literature review to synthesize past research on consumer choice and to identify and evaluate factors affecting provider selection.

RESULTS

Reviewed articles reflected factors affecting provider selection, including: information needs, content and delivery of information, use and engagement with information, and social and behavioral mechanisms, such as trust. We also identified gaps in the literature for further study (eg, loyalty to physicians) that have been identified as important for optimal decision-making but are not well explored in the literature.

DISCUSSION

Health care providers and managers can learn from a more complete model of consumers' selection process to systematically evaluate and improve service provision and information for consumers. Administrators and providers may consider using patient feedback to identify ways to improve their quality and should streamline information for consumers to facilitate thorough, informed decision-making.

The Effects of Log-in Behaviors and Web Reviews on Patient Consultation in Online Health Communities: Longitudinal Study

Background

With the rapid development of information technology and web-based communities, a growing number of patients choose to consult physicians in online health communities (OHCs) for information and treatment. Although extant research has primarily discussed factors that influence the consulting choices of OHC patients, there is still a lack of research on the effects of log-in behaviors and web reviews on patient consultation.

Objective

This study aims to explore the impact of physicians’ log-in behavior and web reviews on patient consultation.

Methods

We conducted a longitudinal study to examine the effects of physicians’ log-in behaviors and web reviews on patient consultation by analyzing short-panel data from 911 physicians over five periods in a Chinese OHC.

Results

The results showed that the physician’s log-in behavior had a positive effect on patient consultation. The maximum number of days with no log-ins for a physician should be 20. The two web signals (log-in behavior and web reviews) had no complementary relationship. Moreover, the offline signal (ie, offline status) has different moderating effects on the two web signals, positively moderating the relationship between web reviews and patient consultation.

Conclusions

Our study contributes to the eHealth literature and advances the understanding of physicians’ web-based behaviors. This study also provides practical implications, showing that physicians’ log-in behavior alone can affect patient consultation rather than complementing web reviews.

Cyberspace and Libel: A Dangerous Balance for Physicians

Freedom of speech and expression is one of the core tenets of modern societies. It was deemed to be so fundamentally essential to early American life that it was inscribed as the First Amendment of the United States Constitution. Over the past century, the rise of modern life also marked the rise of the digital era and age of social media. Freedom of speech thus transitioned from print to electronic media. Access to such content is almost instantaneous and available to a vast audience. From social media to online rating websites, online defamation may cause irreparable damage to a physician’s reputation and practice. It is especially relevant in these times of political turbulence where the battle to separate facts from misinformation has started a debate about the responsibility of social media. The historical context of libel and its applicability in the age of increasing online presence is important for physicians since they are also bound by duty to protect the privacy of their patients. The use of public rating sites and social media will continue to be important for physicians, as online presence and incidents of defamation impact the practice of medicine.

Publicly Reported Patient Satisfaction Scores in Academic Otolaryngology Departments

OBJECTIVES/HYPOTHESIS

Despite controversy regarding their impact and validity, there is a rising national focus on patient satisfaction scores (PSS). We describe the landscape of online PSS as posted by academic otolaryngology practices.

STUDY DESIGN

Retrospective cross-sectional study.

METHODS

Websites of academic otolaryngology programs were reviewed for PSS scores, provider type, and geographic location. Gender was determined by picture or profile pronouns. Years of experience were determined by year of initial American Board of Otolaryngology-Head and Neck Surgery certification. We defined PSS derived from Press-Ganey or Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys as "standardized PSS". We determined potential associations between provider characteristics and standardized PSS.

RESULTS

Out of 115 Otolaryngology-Head and Neck Surgery academic programs, 40 (35%) posted a total of 64,638 online PSS surveys (nonstandardized plus standardized) of 507 unique otolaryngology care providers. Standardized PSS were posted for 473 providers (370 [78%] male; 446 physicians; 27 advanced practice providers). Median overall standardized PSS was 4.8 (interquartile range 4.7-4.9; range 3.8-5.0). PSS were similar between gender, provider type, and years of experience. Male providers had more surveys than female providers (149 vs. 93; P < .01). There was a linear relationship between number of surveys and years of experience (P < .01), but no relationship between number of surveys and overall standardized PSS.

CONCLUSIONS

Patient satisfaction with otolaryngology providers at academic institutions is consistently high, as demonstrated by high online PSS with little variability. The limited variation in PSS may limit their usefulness in differentiating providers and quality of care.

LEVEL OF EVIDENCE

NA Laryngoscope, 2021.

Comparison of Internal Patient Satisfaction Scores at a Cancer Center With Star Ratings on Online Physician-Rating Websites

PURPOSE

Patients have been increasingly using physician-rating websites (PRWs); however, few studies have analyzed the validity of star ratings on PRWs. We aimed to compare PRW patient satisfaction scores with internally generated patient satisfaction scores (internal scores) of physicians at a large quaternary cancer center.

METHODS

We collected internal scores and PRW scores for physicians at MD Anderson Cancer Center. Internal scores were based on patient responses to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems patient experience (CG-CAHPS) survey. Only physicians with an internal score on the basis of ≥ 30 patient reviews were included. The median numbers of reviews and median scores were compared between internal data and four PRWs (Google, HealthGrades, Vitals, and WebMD). Both internally and on PRWs, possible scores ranged from 1 (least satisfied) to 5 (most satisfied).

RESULTS

Of 640 physicians with an internal score, 510 (79.7%) met the inclusion criteria. For these 510 physicians, the median (IQR) number of internal reviews was 49.5 (30-93) and the median (IQR) internal score was 4.89 (4.81-4.93); the median number of reviews on PRWs ranged from 2 to 7, and the median score on PRWs ranged from 4.40 to 5.00. No physician had an internal score < 4, but the proportions with score < 4 on PRWs ranged from 16% to 30%.

CONCLUSION

Internal patient satisfaction scores were higher and calculated from more reviews than PRW patient satisfaction scores and correlated weakly with PRW scores. Given that patients rely on PRWs when evaluating potential physicians, we recommend publishing internal scores online to give patients more complete information regarding physician performance.

Visibility Versus Privacy of Physicians in the Age of Social Media

As access to the internet has grown over the years, social media has become an important resource in the health care sector. Third-party physician-rating websites in particular have gained popularity. However, there are ethical implications of such websites. These websites provide a platform for patients to evaluate and review physicians and likewise increase visibility and advertisement of physicians, but they also violate the rights to privacy that these doctors should have. This paper aims to study and assess the ethical implications of these websites on the visibility and privacy of physicians. After presenting the ethical dilemma associated with such websites, it provides guidelines that can be incorporated by both physicians and third-party sites to help maintain physician privacy while providing public service in the form of advertisement and visibility.

Ethical Considerations in Pediatricians' Use of Social Media

Increasing use of social media by patients and clinicians creates opportunities as well as dilemmas for pediatricians, who must recognize the inherent ethical and legal complexity of these communication platforms and maintain professionalism in all contexts. Social media can be a useful tool in the practice of medicine by educating both physicians and patients, expanding access to health care, identifying high-risk behaviors, contributing to research, promoting networking and online support, enhancing advocacy, and nurturing professional compassion. At the same time, there are confidentiality, privacy, professionalism, and boundary issues that need to be considered whenever potential interactions occur between physicians and patients via social media. This clinical report is designed to assist pediatricians in identifying and navigating ethical issues to harness the opportunities and avoid the pitfalls of social media.

Digital Footprint of Academic Vascular Surgeons in the Southern United States on Physician Rating Websites: Cross-sectional Evaluation Study

Background

The internet has become a popular platform for patients to obtain information and to review the health care providers they interact with. However, little is known about the digital footprint of vascular surgeons and their interactions with patients on social media.

Objective

This study aims to understand the activity of academic vascular surgeons on physician rating websites.

Methods

Information on attending vascular surgeons affiliated with vascular residency or with fellowships in the Southern Association for Vascular Surgery (SAVS) was collected from public sources. A listing of websites containing physician ratings was obtained via literature reviews and Google search. Open access websites with either qualitative or quantitative evaluations of vascular surgeons were included. Closed access websites were excluded. Ranking scores from each website were converted to a standard 5-point scale for comparison.

Results

A total of 6238 quantitative and 967 qualitative reviews were written for 287 physicians (236 males, 82.2%) across 16 websites that met the inclusion criteria out of the 62 websites screened. The surgeons affiliated with the integrated vascular residency and vascular fellowship programs in SAVS had a median of 8 (IQR 7-10) profiles across 16 websites, with only 1 surgeon having no web presence in any of the websites. The median number of quantitative ratings for each physician was 17 (IQR 6-34, range 1-137) and the median number of narrative reviews was 3 (IQR 2-6, range 1-28). Vitals, WebMD, and Healthgrades were the only 3 websites where over a quarter of the physicians were rated, and those rated had more than 5 ratings on average. The median score for the quantitative reviews was 4.4 (IQR 4.0-4.9). Most narrative reviews (758/967, 78.4%) were positive, but 20.2% (195/967) were considered negative; only 1.4% (14/967) were considered equivocal. No statistical difference was found in the number of quantitative reviews or in the overall average score in the physician ratings between physicians with social media profiles and those without social media profiles (departmental social media profile: median 23 vs 15, respectively, P=.22; personal social media profile: median 19 vs 14, respectively, P=.08).

Conclusions

The representation of vascular surgeons on physician rating websites is varied, with the majority of the vascular surgeons represented only in half of the physician rating websites The number of quantitative and qualitative reviews for academic vascular surgeons is low. No vascular surgeon responded to any of the reviews. The activity of vascular surgeons in this area of social media is low and reflects only a small digital footprint that patients can reach and review.

Online Ratings and Perceptions of Pediatric Otolaryngologists

OBJECTIVE/HYPOTHESIS

To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings.

STUDY DESIGN

Online database analysis.

METHODS

All American Society of Pediatric Otolaryngology (ASPO) members were queried on Healthgrades, Vitals, RateMDs, and Yelp for their online ratings and comments as of June 2020. Ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and positive or negative quality.

RESULTS

Of the 561 ASPO members, 489 (87%) were rated on at least one online platform. Of those rated, 410 (84%) were on Healthgrades, 429 (88%) on Vitals, 236 (48%) on RateMDs, and 72 (15%) on Yelp. Across all platforms, the average overall rating was 4.13 ± 0.03 (range, 1.00-5.00). We found significant positive correlations between overall ratings and specific ratings (P < .001) on all individual topics. In addition, the majority of all narrative comments were related to perceived physician bedside manner and clinical outcome, with negative comments correlating negatively with overall score (P < .05). Time spent with the physician was the only category in which both positive and negative comments showed significant correlation with the overall physician rating (P = .016 and P = .017, respectively). Attending a top-ranked medical school or residency program did not correlate with higher or lower ratings.

CONCLUSIONS

Online ratings and comments for pediatric otolaryngologists are largely influenced by patient and parent perceptions of physician competence, comforting bedside manner, and office and time management.

LEVEL OF EVIDENCE

N/A Laryngoscope, 2021.

Are Online Reviews of Physicians Reliable Indicators of Clinical Outcomes? A Focus on Chronic Disease Management

Are Online Reviews of Physicians Reliable Indicators of Clinical Outcomes? A Focus on Chronic Disease Management

Cross-sectional analysis of online patient reviews of infertility care providers

Objective

To observe the effects of practice type, location, and mandated insurance coverage on infertility physician online reviews by patients.

Design

Retrospective cohort study.

Setting

Not applicable.

Patient(s)

Patient online reviews of fertility specialists from 2016 to 2019.

Interventions(s)

None.

Main Outcome Measure(s)

The analysis consisted of the average rating out of 5 for each physician published on Vitals, RateMD, and Healthgrades.

Result(s)

Data were collected on 1,097 specialists. Physicians practicing in states with versus without mandated insurance coverage received an average rating of 4.093 versus 4.076, respectively. The average rating was 3.964 for physicians affiliated with a university or hospital versus 4.128 for those working in a private practice. Significant differences were found in physician ratings from the four regions. It was revealed that physicians who practiced in the South (n = 354) received significantly higher mean average ratings than those in the Northeast (n = 327) and Midwest (n = 175). Physicians practicing in the West (n = 241) received significantly higher ratings than those in the Midwest (n = 175).

Conclusion(s)

The average online patient rating of infertility specialists was found to be significantly higher for physicians working in a private practice compared with those affiliated with a university or hospital system. No significant difference was found between the average rating in states with versus without mandated insurance coverage for infertility treatment. We propose that qualities other than patient financial responsibility are implicated in the factors used to rate physicians.

1.

The average online patient rating of infertility specialists was found to be significantly higher for physicians working in a private practice than for those affiliated with a university or hospital system.

2.

No significant difference was found between the average rating in states with mandated insurance coverage for fertility treatment and that in states without mandated insurance coverage.

3.

The average online patient ratings of infertility specialists were found to be significantly higher for physicians working in the South and West.

Negative Patient Reviews and Online Defamation: A Guide for the Obstetrician-Gynecologist

Physician review websites can serve as a means for patients to address physician actions, both good and bad. At times, patient reviews may be negative and perceived as defamatory. Yet there are specific legal requirements that must be met for an online review to be considered defamatory. Prior cases indicate that pursuing a defamation lawsuit, although appropriate in some circumstances, is oftentimes a difficult and futile endeavor. To avoid litigation, physicians can take proactive approaches to address questionable reviews and to bolster their online reputations.

Correlation of Online Physician Rating Subscores and Association With Overall Satisfaction: Observational Study of 212,933 Providers

BACKGROUND

Online physician rating websites commonly ask consumers to rate providers across multiple physician-based (eg, spending sufficient time, listening) and office-based (eg, appointment scheduling, friendliness) subdimensions of care in addition to overall satisfaction. However, it is unclear if consumers can differentiate between the various rated subdimensions of physicians. It is also unclear how each subdimension is related to overall satisfaction.

OBJECTIVE

The objectives of our study were to determine the correlation of physician-based and office-based subdimensions of care and the association of each with overall satisfaction.

METHODS

We sampled 212,933 providers from the Healthgrades website and calculated average provider metrics for overall satisfaction (likelihood to recommend doctor), physician-based subdimensions (trust in physician, ability to explain, ability to listen and answer questions, and spending adequate time), and office-based subdimensions (ease of scheduling, office environment, staff friendliness, and wait time). We used Spearman rank correlation to assess correlation between subdimension ratings. Factor analysis was used to identify potential latent factors predicting overall satisfaction. Univariate and multivariable linear regression were performed to assess the effect of physician and office-based factors on overall satisfaction.

RESULTS

Physician-based metrics were highly correlated with each other (r=.95 to .98, P<.001), as were office-based metrics (r=.84 to .88, P<.001). Correlations between physician-based and office-based ratings were less robust (r=.79 to .81, P<.001). Factor analysis identified two factors, clearly distinguishing between physician-based metrics (factor loading = 0.84 to 0.88) and office-based metrics (factor loading = 0.76 to 0.84). In multivariable linear regression analysis, the composite factor representing physician-based metrics (0.65, 95% CI 0.65 to 0.65) was more strongly associated with overall satisfaction than the factor representing office-based metrics (0.42, 95% CI 0.42 to 0.42). These factors eclipsed other demographic variables in predicting overall satisfaction.

CONCLUSIONS

Consumers do not differentiate between commonly assessed subdimensions of physician-based care or subdimensions of office-based care, but composite factors representing these broader categories are associated with overall satisfaction. These findings argue for a simpler ratings system based on two metrics: one addressing physician-based aspects of care and another addressing office-based aspects of care.

Correlates of Google Search Rankings for Spine Surgeons: An Analysis of Academic Pedigree, Social Media Presence, and Patient Ratings

STUDY DESIGN

Prospective observational study.

OBJECTIVE

The objective of this study is to identify correlates of search ranking among academic pedigree, online ratings, and social media following.

SUMMARY OF BACKGROUND DATA

Patients increasingly rely on online search in selecting healthcare providers. When choosing a spine surgeon, patients typically value surgical skill and experience as well as demeanor/bedside manner. It is unclear whether current search engine ranking algorithms reflect these preferences.

METHODS

A Google.com search for the top 25 spine surgeon websites by search ranking was conducted for each of the largest 25 American cities. Resulting websites were then perused for academic pedigree, experience, and practice characteristics. Surgeons' research output and impact were then quantified via number of publications and H-index. Online ratings and followers in various social media outlets were also noted. These variables were assessed as possible correlates of search ranking via linear regression and multivariate analyses of variance.

RESULTS

A total of 625 surgeons were included. Three categorical variables were identified as significant correlates of higher mean Google search ranking-orthopedics (vs. neurosurgery) as a surgical specialty (P = 0.023), board certification (P = 0.024), and graduation from a top 40 residency program (P = 0.046). Although the majority of the identified surgeons received an allopathic medical education, there was no significant difference in the mean rank of surgeons who had an MD versus DO medical degree (P = 0.530). Additionally, none of the continuous variables collected, including years in practice (P = 0.947), publications (P = 0.527), H-index (P = 0.278), social media following such as on Facebook (P = 0.105), or online ratings such as on Healthgrades (P = 0.080), were significant correlates of Google search ranking.

CONCLUSIONS

Google search rankings do not always align with patient preferences, currently promoting orthopedic over neurosurgical specialists, graduation from top residency programs, and board certification, while largely ignoring academic pedigree, research, social media presence, and online ratings.

LEVEL OF EVIDENCE

3.

Academic Rhinologists' Online Rating and Perception, Scholarly Productivity, and Industry Payments

INTRODUCTION

The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction.

METHODS

Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1-5 scale.

RESULTS

A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender (p = 0.58), geographic quartile (p = 0.48), social media presence (p = 0.41), or attending top-ranked medical school (p = 0.86) or residency programs (p = 0.89). Years of practice negatively correlated with RS (R = -0.22, p<0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively (p = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments (p<0.01) and H-index (p = 0.02).

CONCLUSION

Academic rhinologists' online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.

Negative online reviews of orthodontists: Content analysis of complaints posted by dissatisfied patients

INTRODUCTION

Patients may express views about their orthodontic care by posting publicly available reviews on the Internet. This study analyzed online reviews of orthodontists with an emphasis on the types and frequency of complaints expressed in negative reviews.

METHODS

A random sample of 10.6% of the American Association of Orthodontists membership was evaluated to identify members practicing in a North American office that is limited to orthodontics and has an online presence. Information regarding those orthodontists and their offices was collected. For offices with Google and/or Yelp reviews, all negative (1- or 2-star) reviews were saved for content analysis. If an office posted a response to a negative review, those responses were also collected for analysis.

RESULTS

Of the 807 eligible orthodontists, 92.4% had reviews on Google and/or Yelp. Average ratings of orthodontists were very positive (ie, 4- and 5-star reviews constituted >97% of Google reviews and >88% of Yelp reviews), yielding an average orthodontist rating of 4.72 on Google and 4.42 on Yelp. However, approximately half of those orthodontists (50.9%) also had at least 1 negative review. The 3 most frequently mentioned categories of complaints were regarding quality of care and/or service, interpersonal interactions, and money and/or financial issues. An analysis of the specific kinds of complaints is described. Orthodontists posting responses to negative reviews had significantly better average ratings than those who did not, but this association does not demonstrate a causal relationship.

CONCLUSIONS

Understanding the complaints orthodontic patients express in online reviews may suggest strategies to improve patient satisfaction and an orthodontist's online reputation.

Rejected Online Feedback From a Swiss Physician Rating Website Between 2008 and 2017: Analysis of 2352 Ratings

Background

Previous research internationally has only analyzed publicly available feedback on physician rating websites (PRWs). However, it appears that many PRWs are not publishing all the feedback they receive. Analysis of this rejected feedback could provide a better understanding of the types of feedback that are currently not published and whether this is appropriate.

Objective

The aim of this study was to examine (1) the number of patient feedback rejected from the Swiss PRW Medicosearch, (2) the evaluation tendencies of the rejected patient feedback, and (3) the types of issues raised in the rejected narrative comments.

Methods

The Swiss PRW Medicosearch provided all the feedback that had been rejected between September 16, 2008, and September 22, 2017. The feedback were analyzed and classified according to a theoretical categorization framework of physician-, staff-, and practice-related issues.

Results

Between September 16, 2008, and September 22, 2017, Medicosearch rejected a total of 2352 patient feedback. The majority of feedback rejected (1754/2352, 74.6%) had narrative comments in the German language. However, 11.9% (279/2352) of the rejected feedback only provided a quantitative rating with no narrative comment. Overall, 25% (588/2352) of the rejected feedback were positive, 18.7% (440/2352) were neutral, and 56% (1316/2352) were negative. The average rating of the rejected feedback was 2.8 (SD 1.4). In total, 44 subcategories addressing the physician (n=20), staff (n=9), and practice (n=15) were identified. In total, 3804 distinct issues were identified within the 44 subcategories of the categorization framework; 75% (2854/3804) of the issues were related to the physician, 6.4% (242/3804) were related to the staff, and 18.6% (708/3804) were related to the practice. Frequently mentioned issues identified from the rejected feedback included (1) satisfaction with treatment (533/1903, 28%); (2) the overall assessment of the physician (392/1903, 20.6%); (3) recommending the physician (345/1903, 18.1%); (4) the physician’s communication (261/1903, 13.7%); (5) the physician’s caring attitude (220/1903, 11.6%); and (6) the physician’s friendliness (203/1903, 10.6%).

Conclusions

It is unclear why the majority of the feedback were rejected. This is problematic and raises concerns that online patient feedback are being inappropriately manipulated. If online patient feedback is going to be collected, there needs to be clear policies and practices about how this is handled. It cannot be left to the whims of PRWs, who may have financial incentives to suppress negative feedback, to decide which feedback is or is not published online. Further research is needed to examine how many PRWs are using criteria for determining which feedback is published or not, what those criteria are, and what measures PRWs are using to address the manipulation of online patient feedback.

Physicians' Earnings Do Not Affect Their Online Ratings

Objective: Physician-rating websites have exploded in popularity in recent years. Consequently, these sites have garnered attention from researchers interested in factors influencing patient satisfaction. A doctor's earnings might reflect practice patterns that could influence their patients' perceptions. We sought to explore any association between physicians' earnings and their online ratings. Methods: The names and billings of 500 physicians from British Columbia, Canada were randomly extracted from the 2016-17 BC Blue Book and matched to their profiles on RateMDs.com. Physicians' earnings were compared to their global ratings and to their Staff, Punctuality, Helpfulness, and Knowledge scores. Earnings and ratings were also compared between men and women, as well as between family medicine, surgical, and internal medicine and subspecialties cohorts. Results: We found no significant correlation between physicians' earnings and their global online ratings (p = 0.304). Weak negative correlations existed between earnings and Staff and Helpfulness ratings (Spearman's rho = -0.055, p < 0.001; rho = -0.033, p < 0.028). Online ratings were largely favorable (mean MD rating of 3.85/5. Male physicians earned significantly more than their female colleagues ($371,734.85 and $261,590.82, respectively; p < 0.001), but no significant difference existed between men and women with regards to online ratings (mean 3.87 and 3.81, respectively, p = 0.191). Surgical and Family Medicine specialties showed a negative correlation between income and ratings; no relationship was seen in the internal medicine and subspecialties cohort. Conclusions: No meaningful association was found between physicians' earnings and their online ratings, although there is an impact of specialty grouping. Patients tend to review doctors favorably online; these data add to the discussion of whether male and female doctors are differentially rated. Trends toward increased transparency in health care systems may help to elucidate how doctors' earnings influence patients' perception of and satisfaction with the care they receive.

Attitudes, Provider and Treatment Selection of Complementary and Integrative Health among Individuals with Pain-Related Conditions

Complementary and integrative therapies are used by people to address many conditions, including pain-related conditions. There has been concern about the quality of online health information, including information pertaining to complementary and integrative health (CIH). In this qualitative interview study, we sought to investigate how individuals interact with CIH-related information online and how this might affect their subsequent behavior. We conducted semi-structured interviews with 14 individuals with chronic pain conditions. We report findings based on three main themes: individuals' beliefs about CIH; approach to CIH, including how people view provider information and personalize their CIH use strategy; and factors that affect trust in the information encountered. Overall, study participants believed there was value in CIH therapies and that treatments were effective. Many described experiences that had influenced their views of complementary therapies over time. We also found that individuals form impressions of CIH providers based on structural and personal characteristics, particularly cost and proximity, that are conveyed in information to which they are exposed. These findings have various implications. First, over time individuals with chronic pain conditions develop their own beliefs and attitudes, which play a role in their selection of providers and modalities relating to CIH. Health care providers should consider how people view information relating to, and make decisions about, CIH therapies and work collaboratively with patients to develop effective health management strategies. Information services should also consider patients' perspectives in developing websites and other informational materials.

Factors Associated With the Actual Behavior and Intention of Rating Physicians on Physician Rating Websites: Cross-Sectional Study

BACKGROUND

Although online physician rating information is popular among Chinese health consumers, the limited number of reviews greatly hampers the effective usage of this information. To date, little has been discussed on the variables that influence online physician rating from the users' perspective.

OBJECTIVE

This study aims to investigate the factors associated with the actual behavior and intention of generating online physician rating information in urban China.

METHODS

A web-based cross-sectional survey was conducted, and the valid responses of 1371 Chinese health consumers were recorded. Using a pilot interview, we analyzed the effects of demographics, health variables, cognitive variables, and technology-related variables on online physician rating information generation. Binary multivariate logistic regression, multiple linear regression, one-way analysis of variance analyses, and independent samples t test were performed to analyze the rating behavior and the intentions of the health consumers. The survey instrument was designed based on the existing literature and the pilot interview.

RESULTS

In this survey, 56.7% (778/1371) of the responders used online physician rating information, and 20.9% (287/1371) of the responders rated the physicians on the physician rating website at least once (posters). The actual physician rating behavior was mainly predicted by health-related factors and was significantly associated with seeking web-based physician information (odds ratio [OR] 5.548, 95% CI 3.072-10.017; P<.001), usage of web-based physician service (OR 2.771, 95% CI 1.979-3.879; P<.001), health information-seeking ability (OR 1.138, 95% CI 0.993-1.304; P=.04), serious disease development (OR 2.699, 95% CI 1.889-3.856; P<.001), good medical experience (OR 2.149, 95% CI 1.473-3.135; P<.001), altruism (OR 0.612, 95% CI 0.483-0.774; P<.001), self-efficacy (OR 1.453, 95% CI 1.182-1.787; P<.001), and trust in online physician rating information (OR 1.315, 95% CI 1.089-1.586; P=.004). Some factors influencing the intentions of the posters and nonposters rating the physicians were different, and the rating intention was mainly determined by cognitive and health-related factors. For posters, seeking web-based physician information (β=.486; P=.007), using web-based medical service (β=.420; P=.002), ability to seek health information (β=.193; P=.002), rating habits (β=.105; P=.02), altruism (β=.414; P<.001), self-efficacy (β=.102; P=.06), trust (β=.351; P<.001), and perceived ease of use (β=.275; P<.001) served as significant predictors of the rating intention. For nonposters, ability to seek health information (β=.077; P=.003), chronic disease development (β=.092; P=.06), bad medical experience (β=.047; P=.02), rating habits (β=.085; P<.001), altruism (β=.411; P<.001), self-efficacy (β=.171; P<.001), trust (β=.252; P<.001), and perceived usefulness of rating physicians (β=.109; P<.001) were significantly associated with the rating intention.

CONCLUSIONS

We showed that different factors affected the physician rating behavior and rating intention. Health-related variables influenced the physician rating behavior, while cognitive variables were critical in the rating intentions. We have proposed some practical implications for physician rating websites and physicians to promote online physician rating information generation.

The Influence of Physician-Rating Websites on Patient Physician Preference

Backgroud

Physician-rating websites (PRWs) are designed to publicly report physician quality information while bringing forth a sense of transparency. This study looks to identify the influence PRWs have on a patient's choice of orthopedic hand surgeon while stratifying patient physician preference by various demographic characteristics.

Methods

This survey-based study was conducted in a suburban outpatient orthopedic hand practice. All patients between 18 to 89 years of age who presented for an appointment were asked to participate. Survey questions aimed to identify patient demographics and the sources patients used to choose their hand surgeon.

Results

Overall, 104 patients completed our survey. Our study population was predominantly between 51 and 70 years of age (50.0%), women (60.6%), and Caucasian (84.6%), received a general education degree or high school diploma (36.5%), was employed (49.0%), and owned private health insurance (59.6%). One hundred and two patients (98.1%) answered that their physician's reputation is important. Seventy-five patients (72.1%) reported that they heard about their surgeon by physician referral, while only two (1.9%) used online search engines. Sixty-six patients (63.5%) noted that physician referrals were most trustworthy. Only 10 patients (9.6%) consulted PRWs to choose their surgeon, most of whom were younger than 50 years (n = 6), Caucasian (n = 8), and employed (n = 7) and had schooling after high school (n = 8).

Conclusions

Despite increases in digital information exchange platforms, PRWs are not commonly used by suburban orthopedic hand patients to exchange information about or choose their hand surgeon. Patients still primarily rely on physician referrals and word of mouth from family and friends to choose their surgeon.