It’s been said that doctors approach online profiles and patient ratings in a style that mimics the five stages of grief—denial, anger, bargaining, depression and acceptance. If you’re still in the denial stage, consider: Research by the Pew Internet and American Life Project showed that, in 2012, 72 percent of internet users said they’d looked online for health information in the previous year. They were looking most often for information about health conditions and symptoms, treatments and doctors. Findings by Manhattan Research in the same year revealed that 54 percent of respondents “did online research to determine what services they might need and who should provide them.” Indeed, the American Medical Association was already warning then that “physicians who don’t manage their online presence run the risk of failing to attract new patients.”
Let’s try to move to acceptance by considering that, four years on, those numbers are probably even larger. The internet is a fact of everyday life. Pew is no longer researching whether patients are conducting health research online; they are delving into much deeper questions such as how mobile technology can be deployed for population health support, patients’ access to evidence and how patients form virtual communities.
Further, you’re probably a reader or writer of online reviews and ratings yourself. Whether it’s Angie’s List for a contractor, Trip Advisor for a hotel, Yelp for a restaurant or Amazon for everything else, you personally can attest to the value of learning from the experiences of those who have gone before. Patients feel the same way—but with far greater emotional investment—about finding a doctor and a medical practice. They want to know what you’re like before they meet you—and it’s possible that they will want to tell other patients about their experience.
“Many patients know about you already from Google searches,” says Kevin Pho, MD, creator of the popular KevinMD blog and author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices (Greenbranch
Publishing, 2013). “A physician’s online presence is key, and it’s in their best interest to control it.”
Resistance is futile
The alternative is such third-party (meaning not yours or your employer’s) sites as HealthGrades and Vitals. HealthGrades has profiles for every doctor in the United States—over 1 million, about half of whom are currently practicing—and more than 3.5 million allied health professionals. The site receives 30 million visits per month, according to Chief Strategy Officer Evan Marks. The profiles contain contact information, board certifications, specializations and any disciplinary activity.
Marks recommends that doctors be as aware of online profiles as they would be of appearing in any publication, and that you should review your HealthGrades (and any other) profile to ensure the information is accurate.
In 2004–2005, HealthGrades inaugurated its patient experience survey. More than 6.5 million surveys have been completed and published. Anyone can click on a link in a physician profile to complete a survey; the only safeguard to authenticity is that the person “must attest that they were a patient” of that provider, according to Marks. The survey asks about the appointment process, the conduct of office staff, cleanliness, the doctor’s listening skills and whether the patient would recommend the provider to others. In early 2016, HealthGrades introduced an area for open text comments.
“The key piece that physicians must understand is that we all have online profiles, whether we like it or not,” says Richard Duszak, MD, FSIR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University School of Medicine, Atlanta. He points out that thirdparty sites have significant downsides: “The quality is thin, the accuracy is variable, and your ability to correct it is small.”
The best defense is a strong offense
To counter these limitations, experts recommend creating and managing your own online profiles in order to control results through search engine optimization. In other words, you want your profile to be as accurate, complete and robust as possible, so that it will end up at the top of a patient’s search results. (Research shows that as few as 10 percent of online searchers venture past the first page of results.)
“You can’t keep your head in the sand or the top page of results will be things over which you have no control,” says Dr. Duszak. So what should you do? Begin with creating or enhancing your profile on such professional social media sites as LinkedIn and Doximity. Drs. Pho and Duszak are especially enthusiastic about Doximity because the site’s content feeds into the physician ratings issued by US News & World Report. Further, they emphasize, it’s easy: Doximity provides a tool that allows you to upload your CV; the site does the rest.
Next, review and correct the information on third-party sites. In the case of negative reviews that you suspect to be erroneous or egregious, report them to site management. Dr. Pho had this experience, in which suddenly multiple negative reviews appeared online, all nearly identical except with many different usernames. “The terms of service [of those sites] are designed to protect providers,” he says.
Under guidelines established by HealthGrades’ Editorial Policy Review Board, site management monitors reviews for fraudulent activity. If more than one survey is received from the same email address, only the most recent is published. Marks reports that the company receives about 300 inquiries per month from providers; research finds basis for removal in about half the cases.
There is no doubt that negative reviews are not necessarily about you—people comment about parking, support staff and old magazines in the waiting room, but this online feedback can be valuable, says Dr. Pho.
“The physician may not know about the quality of experience; these are things they want to know if they are interested in understanding the reputation of their business,” says Marks. If you find that legitimate surveys are returning comments and results that concern you, take the opportunity to do some service recovery. Thank the commenter online and ask them to call the office to discuss their experience. “Trying to clear up the problem offline can work—patients may then amend the reviews online,” says Pho.
If you are affiliated with a large academic medical center, it is likely that it provides support and personnel who work to protect physicians’ reputations. Staff at the Johns Hopkins Hospital, for example, have been working for the past couple of years to create robust, accurate online profiles for their employed physicians—and even to get doctors to create thought leadership through original online content such as blog posts.
At the far end of the spectrum are organizations such as University of Utah Hospitals & Clinics, which took total control of patient reviews by conducting its own survey and publishing the results. Although some of their doctors were nervous initially, the campaign was “based on a sense of the future,” says Tom Miller, MD, chief medical officer. When Dr. Miller came across Trip Advisor and recognized it as a game-changer for the travel industry, he said, “This is coming our way. We won’t get away from it; the public will have their say.”
“You can’t keep your head in the sand or the top page of results will be things over which you have no control,” says Dr. Duszak.
So what should you do? Begin with creating or enhancing your profile on such professional social media sites as LinkedIn and Doximity. Drs. Pho and Duszak are especially enthusiastic about Doximity because the site’s content feeds into the physician ratings issued by US News & World Report. Further, they emphasize, it’s easy: Doximity provides a tool that allows you to upload your CV; the site does the rest.
Next, review and correct the information on third-party sites. In the case of negative reviews that you suspect to be erroneous or egregious, report them to site management. Dr. Pho had this experience, in which suddenly multiple negative reviews appeared online, all nearly identical except with many different usernames. “The terms of service [of those sites] are designed to protect providers,” he says.
Under guidelines established by HealthGrades’ Editorial Policy Review Board, site management monitors reviews for fraudulent activity. If more than one survey is received from the same email address, only the most recent is published. Marks reports that the company receives about 300 inquiries per month from providers; research finds basis for removal in about half the cases.
There is no doubt that negative reviews are not necessarily about you—people comment about parking, support staff and old magazines in the waiting room, but this online feedback can be valuable, says Dr. Pho.
“The physician may not know about the quality of experience; these are things they want to know if they are interested in understanding the reputation of their business,” says Marks. If you find that legitimate surveys are returning comments and results that concern you, take the opportunity to do some service recovery. Thank the commenter online and ask them to call the office to discuss their experience. “Trying to clear up the problem offline can work—patients may then amend the reviews online,” says Pho.
If you are affiliated with a large academic medical center, it is likely that it provides support and personnel who work to protect physicians’ reputations. Staff at the Johns Hopkins Hospital, for example, have been working for the past couple of years to create robust, accurate online profiles for their employed physicians—and even to get doctors to create thought leadership through original online content such as blog posts.
At the far end of the spectrum are organizations such as University of Utah Hospitals & Clinics, which took total control of patient reviews by conducting its own survey and publishing the results. Although some of their doctors were nervous initially, the campaign was “based on a sense of the future,” says Tom Miller, MD, chief medical officer. When Dr. Miller came across Trip Advisor and recognized it as a game-changer for the travel industry, he said, “This is coming our way. We won’t get away from it; the public will have their say.”
Seize the power of the keyboard
Dr. Miller emphasizes that Utah’s efforts are not intended to be punitive: “I said, ‘Look at all the great positive stuff patients are already saying.’ Plus, the best defense is a good offense. In the spirit of continuous improvement, you should know what your patients think of you.” Surveys are issued via email immediately after patients leave the doctor’s office, ensuring reliability of the source; response rates average 16 percent. Doctors have one week to review the comments before they are posted; the ratings and the survey are anonymous so there is no opportunity to identify the patient or practice service recovery. Although Utah neither incentivizes nor penalizes on the basis of survey results, coaching is available to physicians who have persistent low ratings in a certain area. Proactive training and support also are provided around specific survey skills, such as the doctor’s ability to engage patients in a meaningful way that makes them feel valued and respected.
The process has only made the good better, says Dr. Miller. In 2009, 15 percent of Utah’s doctors were in the top 90th percentile nationwide; in 2015, 50 percent were. The average provider score is a 92, and the lowest-scoring provider is an 82.
“Don’t focus on the negative,” Dr. Miller advises. “Patients like their doctors and they tell you that. Focus on the good that you do. Patients are craving that information.”
University of Utah Patient Experience Survey
- Was this your first visit here? (y/n)
- How many minutes did you wait after your scheduled appointment time before you were called to an exam room?
- How many minutes did you wait in the exam room before you were seen by the doctor, PA, NP or midwife?
The following questions are evaluated on a 1–5 ranking (very poor, poor, fair, good, very good):
- Ease of getting through to the clinic on the phone
- Convenience of our office hours
- Ease of scheduling your appointment
- Courtesy of the staff in the registration area
- Degree to which you were informed about any delays
- Wait time at clinic (from arriving to leaving)
- Friendliness/courtesy of the nurse/assistant
- Explanations the care provider gave you about your problem or condition
- Concern the care provider showed for your questions or worries
- Care provider’s efforts to include you in decision about your treatment
- Information the care provider gave you about medications (if any)
- Instructions the care provider gave you about follow-up care (if any)
- Degree to which care provider talked with you using words you could understand
- Amount of time the care provider spent with you
- Your confidence in this care provider
- Likelihood of your recommending this care provider to others
- How well staff protected your safety (by washing hands, wearing gloves, etc.)
- Our sensitivity to your needs
- Our concern for your privacy
- Cleanliness of our practice
- How well the staff worked together to care for you
- Likelihood of your recommending our practice to others
Jennifer J. Salopek is a freelance writer in McLean, Virginia; she can be reached at jjsalopek@cox.net.
