I speak to health care audiences frequently about the role of Social Media and public data (this topic is becoming more popular every day) and their increasing influence on the practice of medicine. I cite a recent study that stated a patient will investigate a new physician on-line 60% of the time before even making an appointment. I typically follow this study up by asking the physicians in the room if they have ever checked themselves out on-line and reviewed their own data. I am surprised at how few have actually done that. In fact, many attendees simply scoff at the thought and roll their eyes.

The other day I did a very non-scientific, but nevertheless instructive and thought-provoking exercise. I randomly picked three physicians in Austin that I thought were professionally outstanding and three physicians that I felt were not, and looked all of them up on the Internet to see what the public data said about them. Sure enough, for each physician I was immediately bombarded by a half dozen or so sites — Health-grades, Yelp, Vitals.com, BetterDoctor.com, just to name a few. They all contained patient ratings and testimonials. A few had some quality data, usually taken from other sites such as CMS.
Interestingly, all six physicians had remarkably similar profiles. In fact, all six physicians had comments on these sites that were very positive and comments that were very negative. There was little that I saw that would differentiate these physicians in my mind at all. Frankly, it was disturbing to see such similar and virtually bipolar profiles about all of these physicians. It seemed patients either liked them or hated them. Not much in the middle. After looking at those reports, I was not convinced I would want to see any of them as my doctor.

How do we as physicians deal with this issue? The following are some thoughts.

1. Acknowledge that: The data is significant, whether it is significant or not. This is one of the most important rules of data. And this significance must be respected. The public has no way to validate these websites. It is only human nature that the data is taken as relevant and factual. I often use the everyday example of using consumer reports to buy an item such as a car or computer. Most of us simply buy the product based upon the number of stars in the rating. Few of us ever question the validity of the data. As a consumer, we simply do a “star count” and buy accordingly. Why should we think consumers of health care would be any different when looking at physician data?

I am sure you heard the following joke:

Person 1: Everything on the Internet is true.

Person 2: Where did you hear that?

Person 1: On the Internet!

The fact is, this data is significant an d could have consequences, especially for that particular physician. To simply dismiss these reports as irrelevant, or just some rambling of a disgruntled patient is not prudent. A physician has no way to know how many of these patients would have made an appointment to be seen, but elected not to after reading the testimonies on the websites. These profiles are in the public domain and patients can freely access them. Whether we like it or not, and whether the data is even valid, is completely immaterial. This data is indeed significant– and very well could effect a physician’s bottom line and reputation. It is imperative that the physician be aware of what is contained in these websites.

2. Beware the “Inverse Outlier” effect. This is a common occurrence with self-reported data. Put simply, if a patient had a very positive experience with the physician, that patient will take the time and effort to submit an opinion. Likewise, if the experience was very negative, that patient would equally take the time to enter a testimonial. For anything in between, the patient will usually never make the effort to report it. As such, the outliers, both positive and negative, have a very powerful and over-inflated effect on these ratings. I was struck by the patient comments about one particular physician, whom I very much respect in the community. He had ten total patient responses. On a one-to-five rating scale, five patients gave him a five and five patients gave him a one! Nothing in between. Sounds bipolar to me. A doctor Jeckyl and Hyde, perhaps?

Bottom line, we are only going to see more of these sites on Social Media, and their influence will continue to increase. Once a comment is posted, it might be there forever. There is no vetting out of any of these testimonials– if it is written, then it must be true.

Additionally, some of these statements may deliberately not tell the whole picture: Someone may write that the physician was a jerk, but neglected to say that the physician was a jerk because he/she did not refill the Vicodin prescription as the patient had requested! Yes, the data is significant whether it is significant or not ! And outliers rule, both positive and negative.

At a minimum, more of a physician emphasis on customer service is always warranted. I do fall short of advocating that we solicit our “happy” patients to write something about us on line. In the long run, we as physicians need to develop a strategy to deal with these sites. But until we get to the point of more randomized and statistically significant reporting, this issue will continue to haunt us.

Bottom line:

If you search for yourself on the Internet today, based upon what is written there, would you ever let that physician take care of you?

Feel free to comment below!

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