Peter Korn; Portland Tribune
Thursday, April 02, 2009
The free flow of information made possible by the Internet – good information and information of the not-so-reliable kind – has finally come to medicine in the form of Web sites where patients can post their impressions of their doctors.
One national expert says there are at least 40 Web sites now where patients freely and anonymously post their impressions of physicians.
Now, some physicians – including a few in Portland who may not like what patients are saying about them – are responding.
One national firm is providing physicians a way to fight back, by offering them a waiver they can ask patients to sign, in which the patients promise not to post.
And Portland health insurance giant Regence Blue Cross Blue Shield is joining in – by encouraging its patient members to post their comments about doctors and other health care providers on its own site, which is available for view to Regence subscribers.
Some physicians say they like the posting Web sites. Others aren’t quite sure about their value, questioning whether a representative sample of patients are posting, as opposed to an angry few.
Jan Maybee, a Tigard family practice and mental health nurse practitioner, says she has never looked herself up on any of the posting sites, even though friends have told her a number of positive patient comments have been posted about her.
Maybee says she likes the idea and eventually will take a look. “That’s great feedback to get,” she says. “It can help you become better at what you do, and people may be more comfortable posting than saying it to your face.”
Maybee says she considers patient posts useful information for prospective patients. But Maybee might be influenced by the fact that the 11 posts about her on RateMDs.com range from “wonderful” to “She’s the best.” There is only one negative post, from a patient who said Maybee made her wait too long.
Betsy Boyd-Flynn, deputy executive director of the Oregon Medical Association, says the posting sites are only going to become more significant as greater numbers of patients become accustomed to them.
“A satisfied person tells two people, a dissatisfied person tells 10,” Boyd-Flynn says. “The Internet magnifies that. People have always done this; they’ve just done it over their back fence.”
In response, the medical association has been pushing doctors to spend more time maintaining their “online reputations,” Boyd-Flynn says. For a start, Boyd-Flynn says, doctors can set up their own Web sites and work to get them placed high by search engines.
“You’re generating your own information into the blogosphere, and you hope that offsets anything that’s negative about you,” Boyd-Flynn says.
Jeffrey Segal, the physician founder and president of North Carolina-based Medical Justices Services Inc., which provides legal services to doctors, says physicians don’t have a fair fight when it comes to patient posts. Medical confidentiality laws don’t allow them to respond.
“You have sites where people pose as patients – disgruntled employees or ex-spouses – and with the click of a mouse are able to even the score,” Segal says.
Segal says he’d like to see rules governing the posting sites – that site managers verify a post is from a genuine patient, and that patient posts be limited to subjects such as bedside manner and demeanor, but not actual patient care. And Segal would like sites to not allow posts about individual doctors until a critical mass of about 50 comments are available, so a few disgruntled posters can’t easily ruin a physician’s reputation.
Segal says that nationwide, 2,000 physicians members have begun asking patients to sign their waiver forms, promising they won’t post about their doctor.
Angie Hicks, founder and chief marketing officer of Indiana-based Angie’s List, objects to the waivers.
Last year, Angie’s List, a Web site at which subscribers provide and access reviews about local service companies, added doctor posts to its more established categories such as home repair services, and the new category has quickly become its fastest growing. More than 10,000 posts about physicians are coming in each month, Hicks says. RateMDs.com says it is getting more than 24,000 posts about doctors each month.
Hicks says patients confronted with a physician asking them to sign a Medical Justice waiver are forced to choose between health care and their right to free speech.
“If a doctor is taking this type of defensive action, it makes you question how much trust there is in the relationship,” Hicks says.
For the last year, subscribers to Regence health plans have been able to post and read comments about health care providers in Regence’s Oregon-Washington-Idaho-Utah network.
Stephanie Dreyfuss, vice president of provider services with Regence, says more than 31,000 reviews have come in, 5,000 with comments beyond just a numerical rating for physicians. When Regence subscribers log on electronically to check the status of a claim, they are asked to leave a review of the physician who treated them.
“We decided to do it because in lots of conversations with our members, one of the things people really want to know is what other people think of physicians,” Dreyfuss says.
Dreyfuss says that 89 percent of Regence posters say they would recommend their provider to other people.
Frequently, postings for individual doctors reveal a wide disparity in how patients rate their visits. One patient might be satisfied; another might feel, and post, quite the opposite. Dreyfuss says that disparity reflects people’s different expectations, and the danger of a prospective patient taking one or two negative comments out of context.
“It’s a great example of how people have really different perceived experiences,” Dreyfuss says. “It’s possible the day the second person saw him he was rushed, or an additional patient came in with an emergency. And some people really like a doctor who is coddling. And other people like a doctor who just gets to the facts.”
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