"But His Yelp Reviews Are Awful!": Analysis of General Surgeons' Yelp Reviews

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.

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.

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.

Adolescent and Young Adult Perspectives on Quality and Value in Health Care

OBJECTIVE

To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment.

METHODS

A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses.

RESULTS

Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality.

CONCLUSIONS

When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.

Patient-Centered Insights and Biases Regarding Cardiologists Via Online Review Platform Analysis

Background Online cardiologist reviews, such as those on the Yelp website, are a frequently used method for patients to find a cardiologist. It remains unknown how bias may influence such reviews. Our objectives for this study were to (1) determine which cardiologist- or practice-related factors influence the overall rating of cardiologists and patient satisfaction and (2) discover any associations between sex and race with the overall rating of cardiologists or with cardiologist- or practice-related factors. Methods and Results Cardiologist Yelp reviews from practices in the United States from 2007 to 2020 were analyzed. A total of 563 reviews were coded for positive and negative themes. Binary logistic regression was used to determine whether certain factors increased the likelihood of high ratings. Chi-squared tests were used to determine associations between sex and race with certain factors and overall cardiologist ratings. Cardiologists were more likely to receive higher ratings when reviewers noted the characteristics of competency/knowledge base and thoroughness, positive interactions with staff, and when the cardiologist's name was mentioned in the review. Negative interactions with staff were associated with lower ratings. Female cardiologists received lower ratings and more negative mentions of cardiologist-patient communication than expected. White and Black cardiologists received lower ratings than expected compared with other racial groups. Conclusions Patient-perceived cardiologist competency, thoroughness, and positive staff interactions were associated with positive reviews in online assessments. Sex and racial differences were also found. Further research must be done to confirm these findings and to understand the association of online reviews with clinical care and patient outcomes.

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.

Use of Online Patient Reviews to Assess Medical Oncologist Competency: Mixed-Method Sequential Explanatory Study (Preprint)

BACKGROUND

Patients increasingly use web-based evaluation tools to assess their physicians, health care teams, and overall medical experience.

OBJECTIVE

This study aimed to evaluate the extent to which the standardized physician competencies of the CanMEDS Framework are present in web-based patient reviews (WPRs) and to identify patients' perception of important physician qualities in the context of quality cancer care.

METHODS

The WPRs of all university-affiliated medical oncologists in midsized cities with medical schools in the province of Ontario (Canada) were collected. Two reviewers (1 communication studies researcher and 1 health care professional) independently assessed the WPRs according to the CanMEDS Framework and identified common themes. Comment scores were then evaluated to identify κ agreement rates between the reviewers, and a descriptive quantitative analysis of the cohort was completed. Following the quantitative analysis, an inductive thematic analysis was performed.

RESULTS

This study identified 49 actively practicing university-affiliated medical oncologists in midsized urban areas in Ontario. A total of 473 WPRs reviewing these 49 physicians were identified. Among the CanMEDS competencies, those defining the roles of medical experts, communicators, and professionals were the most prevalent (303/473, 64%; 182/473, 38%; and 129/473, 27%, respectively). Common themes in WPRs include medical skill and knowledge, interpersonal skills, and answering questions (from the patient to the physician). Detailed WPRs tend to include the following elements: experience and connection; discussion and evaluation of the physician's knowledge, professionalism, interpersonal skills, and punctuality; in positive reviews, the expression of feelings of gratitude and a recommendation; and in negative reviews, discouragement from seeking the physician's care. Patients' perception of medical skills is less specific than their perception of interpersonal qualities, although medical skills are the most commented-on element of care in WPRs. Patients' perception of interpersonal skills (listening, compassion, and overall caring demeanor) and other experiential phenomena, such as feeling rushed during appointments, is often specific and detailed. Details about a physician's interpersonal skills or "bedside manner" are highly perceived, valued, and shareable in an WPR context. A small number of WPRs reflected a distinction between the value of medical skills and that of interpersonal skills. The authors of these WPRs claimed that for them, a physician's medical skills and competence are more important than their interpersonal skills.

CONCLUSIONS

CanMEDS roles and competencies that are explicitly patient facing (ie, those directly experienced by patients in their interactions with physicians and through the care that physicians provide) are the most likely to be present and reported on in WPRs. The findings demonstrate the opportunity to learn from WPRs, not simply to discern physicians' popularity but to grasp what patients may expect from their physicians. In this context, WPRs can represent a method for the measurement and assessment of patient-facing physician competency.

Lurking or active? The influence of user participation behavior in online mental health communities on the choice and evaluation of doctors

BACKGROUND

Web-based psychological counseling sites have become an important source of health information and expert assistance. Although many studies have suggested the feasibility and effectiveness of online consultation, there is an insufficient understanding of the influence of the distinction of users' participation behaviors online on health behavior decision-making.

OBJECTIVE

This study aimed to investigate whether and how the differences in the online participation behaviors of users affect their doctor selection and evaluation characteristics.

METHODS

First, we collected information from 7,781 paid consultation clients from a professional mental health service platform in China. Effective indicators and variables were formed through data cleaning and classification. Next, we used a mixed methods research approach that included qualitative text analysis (topic and sentiment) and quantitative statistical analysis (ANOVA).

RESULTS

The ANOVA results show that differences in online participation behaviors (diving, searching and socializing) have a significant impact on doctor selection based on consultation price (F_7,780=6.05; P = 0.00), online service volume (F_7,780=4.76; P = 0.00), online reputation (F_7,780=4.30; P = 0.01) and online answers (F_7,780=5.76; P = 0.00). When evaluating doctors, the frequency of reviews (F_7,780=69.62; P = 0.00) and the average length of the text (F_7,780=15.33; P = 0.00) were significantly different among users. Two of the three topics, namely, service attitude (F_7,780=28.63; P = 0.00) and self-expression (F_7,780=40.83; P = 0.00), had significant effects. In addition, our results show that differences in participating behaviors have a significant impact on both the positive (F_7,780=7.30; P = 0.00) and negative (F_7,780=9.44; P = 0.00) emotions involved in evaluating doctors.

CONCLUSIONS

Our findings provide preliminary insights for establishing the relationship between users' online information behavior and health decision-making. Further research should be conducted to verify the validity of the results and help apply them to the design of personalized customized services for the users in an online health community.

Analysis of Online Reviews of Orthopaedic Surgeons and Orthopaedic Practices Using Natural Language Processing

BACKGROUND

There is growing interest in measuring and improving patient experience. Machine learning-based natural language processing techniques may help identify instructive themes in online comments written by patients about their healthcare provider. Separating individual surgeon and orthopaedic office reviews, we analyzed themes that are discussed based on the rating category, the association with review length, the number of people posting more than one review for a surgeon or office, the mean number of reviews per rating category, and the difference in review tones.

METHODS

On Yelp.com, we collected 11,614 free-text reviews-together with a one- to five-star rating-of orthopaedic surgeons. Using natural language processing, we identified the most frequently occurring word combinations among rating categories. Themes were derived by categorizing word combinations. Dominant tones (emotional and language styles) were assessed by the IBM Watson Tone Analyzer. We calculated chi-square tests for linear trend and Spearman's rank correlation coefficients to assess differences among rating category.

RESULTS

For individual surgeons and orthopaedic offices, themes such as logistics, care and compassion, trust, recommendation, and customer service varied among rating categories. More positive reviews are shorter for individual surgeons and orthopaedic offices, while rating category was comparable among people posting more than one review for both groups. Tones of joy and confidence were associated with higher ratings. Sadness and tentative tones were associated with lower ratings.

DISCUSSION

For individual orthopaedic surgeons and orthopaedic offices, patient experience may be influenced mostly by the patient-clinician relationship. Training in more effective communication strategies may help improve self-reported patient experience.

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.

The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication

This study aims to understand the underlying reasons for poor doctor-patient relationships (DPR). While extant studies on antecedents of poor DPR mainly focus on the offline context and often adopt the patients' perspective, this work focuses on the mobile context and take both doctors' and mobile consultation users' perspectives into consideration. To fulfill this purpose, we first construct a theoretical framework based on the Computer-Mediated Communication (CMC) literature. Then we coded 592 doctor-user communication records to validate and elaborate the proposed theoretical model. This work reveals that characteristics of mobile technologies pose potential challenges on both doctors' and patients' information providing, informative interpreting, and relationship maintaining behaviors, resulting in 10 and 6 types of inappropriate behaviors of doctors and users, respectively, that trigger poor DPR in the mobile context. The findings enrich the research on online DPR and provide insights for improving DPR in the mobile context.

Data Mining of the Reviews from Online Private Doctors

Background: User-generated content shared in the online health communities (OHCs) is becoming a valuable resource for researchers to understand patients' decision-making behaviors in the management of their health. Many studies have focused on how to obtain useful information from online reviews in OHCs. Introduction: This study focuses on a telemedicine service called Online Private Doctor (OPD), which is offered by a leading Chinese physician review website (PRW). OPD reviews have not received much attention. By data mining the reviews, our goal is to determine what patients are talking about when they use the OPD service and whether they are satisfied with the service or not. Materials and Methods: We used a Python web crawler to collect 41,029 reviews and 84,510 short reviews (labels) of all 5,645 physicians who offered the OPD service on a PRW (haodf.com) in China. Mixed methods (i.e., a literature review, topic discovery, annotation, and a sentiment analysis) were used to determine the information that the OPD reviews are meant to express. Results: We discovered that the OPD reviews can be categorized into four subjects: competence (35.1%), communication (29.4%), treatment (26.0%), and convenience (9.5%). In terms of previously discovered topics, we found that competence, communication, and treatment have been discussed before, but convenience is an emerging subject. The sentiment analysis indicated that 93.67% of the reviews indicated positive emotions, and the area under the receiver operating characteristic (ROC) curve is 0.64. Furthermore, the labels indicated that only 0.72% (603/84,570) of reviews were negative toward the OPD service. The subjects of the labels were distributed according to competence (34.7%), communication (23.8%), treatment (33.5%), and convenience (8.0%). Discussion: The findings of our study suggest that patients who ever used OPD have been quite satisfied with the service. From their reviews, we discovered that OPD has its special characteristics and is convenient. However, it still has some shortcomings, for example, the quality of the phone connection. In terms of both the platform and the doctors, more efforts should be made to make the OPD better and more regulated. Conclusion: OPD is an emerging telemedicine service that still needs more time and space to evolve. For patients, it helps reduce problems such as scheduling and queuing. Therefore, it brings more convenience to people's daily lives. In the future, more attention should be paid to this service, as it is helpful in reducing the uneven distribution of medical resources.