My Nashua, New Hampshire neighbor @KevinMD (Twitter, blog) is known as “social media’s leading physician voice,” and I believe it. His blog is terrific, both technically and in breadth, depth, and consistency. I don’t know how he does it, on top of running a vibrant family practice in a busy area.
I’m late in discussing it, but he recently published a new book with many invited contributions, including one from me. It’s Establishing, Managing, and Protecting Your Online Reputation, and it’s smart.
This is a tricky subject, because online reputation is something consumer/patients are increasingly consulting as they start acting like consumers (trying to be informed), and reputation is a form of data – and as with all data, it’s really hard to know sometimes if the data is high quality. That was precisely my point in my submission, which I’m posting here, with permission (which of course Kevin granted, since I wrote the stuff! :-))
Space didn’t permit all these words to make it into the book, but here’s the full text of what I had to say.
Reputation – online or off – means a lot.
But whose opinion is it?
I never had a “light bulb moment” about online reputations per se; to me reputation is reputation, and the only useful question is whose opinion I’m hearing. Besides, all my life I assumed all doctors and nurses were at the top of their craft. So except for the rare high-profile scandal, who needs reputation?
But as life went on, I heard of differences – big differences – in quality of care and practice variation. Where did I hear it? From people in the profession – family and friends who worked at hospitals. So in the back of my mind, reputation arose as a factor.
Then I found out I was dying: Stage IV renal cell carcinoma, with metastases everywhere. Boy did that get my attention; I wanted the latest, the best. I was already at a big academic medical center; even so, in addition to sending me to top specialists, my primary referred me to the internet: a high quality online patient community. There I learned quickly about treatment options and the best doctors for my condition. (Not all communities are sharp, but this one is; my oncologist has since confirmed it.)
The primary consideration for me, in any reputation, online or off, is whose opinion I’m hearing and how they formed it. Their thought process, mental discipline, and personal values are fundamental; without that I have no idea if their rating would match mine. On a restaurant site such as Yelp, raters know what they were eating. But in medicine how can you tell if a “hater rater” has the perspective of airheads like Jenny McCarthy and Suzanne Somers?
For that reason, I have no use for mere thumbs up/down ratings: I want Amazon-style written reviews, whose thinking and priorities I can assess.
I also yearn for separate ratings for professional competence vs consumer friendliness, such as office hours, appointment lead time, time spent in the waiting room, clear billing, online records, etc.
It’s not just about patients getting what they want: the changes I foresee will make it easier for great providers to be recognized. Right now if a hospital has an amazing transformation in medical errors, quality of care, or customer service it won’t show up in HCAHPS for two years! That’s a huge inhibitor to the normal market forces that reward good performers.
We’ve solved this before. In eBay’s early days people said “Who’s going to buy online?? You have no idea who you’re buying from.” But eBay added reputation, and today a mediocre reputation is death on that site.
And today, Amazon even rates the raters. (Others can rate individual reviews as helpful, and some people become “top 100” reviewers.)
For online medical reputations it’s still early days. The tools are primitive and the culture is unevolved. I expect it will mature, just as Amazon’s did, and as eBay’s has; I can see the future that will “out” the slackers and reward the great. Until then, I won’t put much stock in what I read, unless I’m sure who said it and what they were thinking.
What do you think? Have you had experiences, good or bad, with ratings of doctors, or ratings of anything else, for that matter?
I think that patient and provider “niceness” is a poor indication of patient cooperation or provider competence. This focus results in patients afraid to speak up for fear it will influence the quality of care and providers reluctant to discuss difficult issues.
Since it is assumed to be human nature to default to niceness (real or fabricated) for “successful” interaction with others how do we learn to negotiate a “real” relationship between patients and providers?
Mighty Casey says
To paraphrase the old aphorism on planning: failure to allow feedback on your part does not signal approval on my part.
Reputation management in healthcare is still a sticky wicket, with most facilities and clinicians looking to manage everything into Shiny Happy People or silence. This is largely due to the fact that this is new territory for them, since consumers haven’t been encouraged to weigh in until we realized, only recently, that we could weigh in without being invited to do so. Some chaos has ensued, but smart patients and smart docs are figuring out how to make feedback work for both sides of the equation.
I currently don’t rely on online ratings much for intel/insight on individual providers. What I do look at are the Leapfrog hospital scores, and CMS’ HospitalCompare data. Would that either of those was granular enough to reach the individual MD level. I wait in hope for something like that. In the meantime, I ask questions via social media to gather intel and grow my decision trees.
Tom Kintner says
For me, I like the idea of reputation building and review, but…
A lot of consumer reviews are written by those who want to be in the good graces of the reviewed, or are even paid to write favorable reviews hoping to hype the product or service. Now you’re looking for the reputation of the reviewer!
Well, here’s an interesting essay on crowdsourcing, Everything 2.0, what data is and isn’t good for, thought process, mental discipline, personal values, reputation and a whole lot more:
Mr. O’Reilly’s books are all over this house, what with an IT professional in the family, and both my IT professional and the author of the essay think they are very high quality books. But I’m not sure I’d want his personal values underlying the “platform” for my health care. And I understand he’s got his eye on it.