Doctor ratings: Is your healthcare hot or not?

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Doctor ratings: Is your healthcare hot or not?

Dr. Fischel hired a lawyer after he says a patient

posted " slanderous " comments about him online. Online, patients-as-

consumers are reviewing doctors. It shifts the balance of power, but

raises the question of whether consumers can simply rate an M.D. like

they'd review an HDTV.

http://www.latimes.com/features/printedition/health/la-he-

docratings19-2008may19,0,549695.story?page=1

By Shari Roan, Los Angeles Times Staff Writer

Distraught over the results of cosmetic surgery on her nose,

Chen did what many people do when they're unhappy with a

doctor. She consulted a malpractice lawyer and filed a complaint with

the Medical Board of California.

But the 22-year-old college student didn't stop there. Chen logged

onto her home computer and wrote a tearful review about her

experience, posting it to a website that encourages consumers to rate

their healthcare providers. " I wasn't nasty about it, " the West

Covina resident says. " But I posted a comment about what I went

through. These websites are useful. Doctors still have a lot of

power. "

Chen and thousands of other consumers are trying to rein in that

power. They're saying what they think about the current state of

healthcare and, more specifically, the doctors who provide it. Dozens

of websites that permit people to rate, review, spin or flame their

doctors have sprung up in the last year, operating in much the same

way as online services that help people find the best hotels or avoid

plumbers who overcharge.

Patients and site operators say the trend is good for consumers and

good for healthcare. Thoughtful doctors, they say, will provide

better customer service because of the feedback, and the bad ones

will no longer be able to hide. And, they add, why should doctors be

immune from the trend toward better customer service?

Physicians aren't so sure of such reasoning. Many say the reviews on

RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by

disgruntled patients and are thus unfair, pushing some doctors to

near-ruin after a single post.

" These sites don't yield enough power yet to get bad doctors to

change. And in the meantime, they may hurt good doctors, " says Dr.

Phyllis Hollenbeck, a Washington, D.C., family physician and author

of " Sacred Trust: The Ten Rules of Life, Death and Medicine, " a new

book promoting patient empowerment. " It only takes one or two

scathing comments and a doctor is put in a terrible position. "

The sites, more than two dozen of them, vary in how they operate,

their scope of information provided and their efforts to be fair. But

the trend is toward free, anonymous, no-holds-barred forums. Some

sites have grown out of existing ratings services. Five years after

he started the hugely popular RateMyProfessors.com, Swapceinski

and his business partner turned to medicine, launching RateMDs in

2004.

" You can find ratings on cars and flat-screen TVs, but it's hard to

rate professional services, " he says. " I think that's overlooked. "

Angie's List, a membership-based service that allows consumers to

rate dozens of types of local service providers -- painters, piano

movers -- and then access those ratings, added healthcare services to

its roster in March.

The operators of Vitals.com, which launched nationally in January,

say their goal is to provide people with free, fair and balanced

information to help them select a doctor.

" We think of it as something closer to Match.com, in which we want to

match up patients with doctors who are right for them, " says Mitchel

Rothschild, chief executive of the Lyndhurst, N.J., company.

The restaurant survey company Zagat has even gotten into the act,

teaming up with the national health benefits company Wellpoint Inc.,

parent company of Anthem Blue Cross, to provide some Blue Cross

members with an online tool to evaluate their doctors. The service

started in January and allows members to issue scores on a health

professional based on specific criteria: trust, communication,

availability and environment.

" Consumers can pretty much go on the Web and get information on

anything, from what is a better shampoo to what is a better airline, "

says Dr. Zeinab Dabbah, chief medical officer of Anthem Blue

Cross. " We're offering this to meet all of the expectations that

consumers have about the marketplace. "

An empowering tool

The ease of sharing information on the Web has given consumers a

powerful hammer.

" The Internet is such a great tool for transparency, " Swapceinski

says. " In every profession there are some bad apples. In the medical

profession, in particular, you really want to avoid them. "

But viewing a doctor in the same manner as any service provider or

product represents a dramatic shift in Americans' perception of

healthcare. Once reverential of doctors, consumers today are more

comfortable criticizing their physicians, says Dr. Weiss,

president of the American Board of Medical Specialties, an

organization that sets performance standards and certifies doctors.

" There is a lot of pent-up frustration, " he says. " Costs are going

up, and people are paying more out of pocket. Plus, there is a lot of

data now on how the healthcare system needs to do better in terms of

quality and safety. "

The tradition of doctors monitoring their own conduct through state

medical boards and peer organizations is failing, Swapceinski

says. " There is a lot of protection for doctors, " he says. " Even with

the state medical boards there is recognition that doctors policing

doctors is not the best way to handle things. Most complaints about

doctors are never made public. "

Chen says she did her homework -- checking the doctor's credentials

and history of malpractice lawsuits and studying his website --

before the surgery last year to shorten her nose. " It was minor, " she

says, ruefully, of her dissatisfaction with her long nose. " I

actually shouldn't have done anything, but I wanted to be perfect. "

She found no red flags in the surgeon's background. The results of

the operation, however, horrified her. After removing the bandage on

her face, she says, " I started crying. I didn't recognize

myself . . . . I spent the next nine months at home. I was

embarrassed to go out. I quit my job and dropped out of school. "

Chen says her nose was crooked and much too short, and that she was

left with breathing problems and nose bleeds. She filed a complaint

with the Medical Board of California, a process she later abandoned,

and consulted a lawyer who discouraged her from filing a lawsuit

because of the up-front costs involved. At the time, she was also

facing the cost of surgery to correct her nose. Ultimately, Chen

says, she felt exposing the doctor on the Internet was her only

recourse.

Later, pleased with her revision surgery, Chen also used a ratings

website to write favorably about the doctor who performed it. " I

wanted people to know about my experience with him because he didn't

really have any feedback on the site, " she says.

Some state medical boards provide consumers with limited information

on doctors, such as any disciplinary actions recorded and whether

their licenses are current. Moreover, state governments, insurance

companies and private organizations have attempted in recent years to

gather data on physician performance that can be compiled

into " report cards " to help consumers choose doctors wisely. Such

measures have been shown to improve healthcare quality, according to

the Agency for Healthcare Research and Quality. But those tools are

in their early stages and are rarely consumer-friendly or easy to

locate.

Gail Weiss, 30, of Los Angeles (no relation to Dr. Weiss)

recently did a Google search to check out a new doctor who had joined

the pediatric practice where she takes her three children. The search

led her to a doctors' ratings website that, she says, was so

interesting and easy to use that she ended up trolling for

information on all of the family's doctors. She then posted an

evaluation of her own doctor, whom she " loves, " and Weiss' husband

posted a positive rating of the family's former pediatrician.

" I wanted to know the doctor's credentials and the school she went

to, " Weiss says. " But the comments from other patients also made an

impression on me. They said things like, 'the office staff isn't that

courteous but the doctor is good.' I think these sites empower

consumers. "

Reputation on the line

That's the goal, say the site operators: help the consumer find a

suitable doctor. Many doctors scoff at that description, however,

saying the sites mislead potential patients and are unfair.

Dr. Fischel, a thoracic surgeon in Orange, says his life was

turned upside-down after a patient began posting vicious remarks

online regarding a surgery Fischel performed. Fischel says the

surgery was an elective procedure, that he and the patient discussed

the pros and cons, and that the patient signed a consent form

acknowledging that discussion.

The operation went well, Fischel says. But after the surgery, the

patient complained bitterly about a previously discussed side effect

that can sometimes occur as a result of the surgery, Fischel says.

" He decided his life was ruined and destroyed, " says Fischel, who

graduated from UCLA medical school in 1984 and is now director of

thoracic oncology at Hoag Hospital in Newport Beach. Online, Fischel

says, the patient posted " slanderous rants and raves. "

Fischel, who says he can't reveal further details of the case because

of a legal agreement he has since reached with the patient, soon

discovered the pervasive power of the Internet. He says that his

business was severely affected and that he suffered significant

monetary and emotional costs because of the patient's postings.

Fischel hired a lawyer to try to make the patient stop writing about

him and became so depressed he considered leaving medicine.

" Doctors, in general, are sitting ducks, " Fischel says. " It's

impossible to fight back. The courts make it so you have almost no

options. "

Federal laws protect patient privacy and prohibit doctors from

discussing an individual's healthcare in public. But the right of

patients to criticize their doctors online has been established.

Federal law asserts that the hosts of websites on which consumers

post anonymous opinions are immune from charges of defamation.

The courts have also ruled on specific cases in which the identity of

the patient is known. Last year, the 3rd District Court of Appeal

ruled that a UC plastic surgeon could not stop a patient from

making negative public comments about him on the Internet because he

was a " limited purpose public figure. " The court noted that the

doctor advertised his practice and had appeared on local television

shows.

The case unfolded in 2003 when a Sacramento-area woman, tte

Gilbert, filed a malpractice lawsuit against Dr. Sykes,

saying the brow lift he did had left her unable to close one eye

fully and with one eyebrow higher than the other, creating

a " permanently surprised look " on her face. Gilbert also took her

dissatisfaction public -- creating a website detailing her experience.

Sykes said the results of the surgery were satisfactory and filed a

defamation counterclaim, which the 3rd District Court ultimately

rejected.

" There is a lot of power in the Internet and, in a way, certain

doctors have used it to become famous, " says Sykes, who is vice

president of education for the American Academy of Facial Plastic and

Reconstructive Surgery and director of facial, plastic and

reconstructive surgery at UC . " But it works in both directions.

The Internet has a long voice. Something negative gets perpetuated

because the website stays up. Good reputations can be tarnished by a

sinister person. "

Doctors shouldn't be rated like any other product or service

provider, such as a car or car mechanic, says Dr. Weiss.

Medicine involves highly individual and personalized interactions, he

says, and each medical case and doctor-patient relationship is unique.

" With TVs and cars, people can subjectively talk about their

experience because you have a consistent product, " he says. " But with

healthcare there is so much blended into the experience, it's hard to

do an evaluation. You want a doctor who is both technically competent

but also one who can communicate and understand the human dimensions

beyond the technical aspect of good care. "

Case for transparency

Operators of the websites say that consumer feedback can improve

relations between doctors and patients.

The operators of RateMds.com read every comment and delete ones that

are " blatantly libelous, " Swapceinski says. About 5% of the posts are

taken down. Still, he admits, he gets threats from doctors'

lawyers " on almost a weekly basis. "

Some sites, such as Wellpoint's Zagat tool, will not post doctor

ratings until at least 10 consumers have weighed in. DrScore.com,

which was founded by a doctor, allows only numerical doctor ratings

to be posted online -- no anonymous comments.

However, Swapceinski says his experience running RateMyProfessors.com

convinced him that even a handful of rankings and comments typically

bears the ring of truth.

" It's hard to prove it scientifically, but I truly believe that the

averages are a reflection of what people think, " he says. RateMDs.com

attracts about 450,000 visitors a month and has 600 to 1,000 new

posts a day.

But many doctors think most of the sites are of limited value and

that consumers could be as easily led astray as informed by them.

" I wish I could say that this kind of forum will motivate the doctors

who are jerks to change, " Hollenbeck says. " But what you see is an

awful lot of baloney on these sites, a lot of unedited venting.

Feedback would be more useful when it tries to say what works and

what doesn't work. "

Physician organizations support evaluating doctors with empirical

measures and making the information public -- as long as it's fair,

says Dr. H. Nielsen, president-elect of the American Medical

Assn. In January, the AMA released a statement urging consumers to

ignore anonymous doctor rating sites, saying they " have many

shortcomings. "

" We are very concerned with how we serve patients, " Nielsen

says. " Many doctors use patient satisfaction surveys. Many insurance

companies use surveys too. Doctors are comfortable with that. But we

would like to see a turning away from the pointing fingers, laying

blame, 'gotcha' approach. "

To protect himself, Fischel recently signed up for services with

Medical Justice, a Greensboro, N.C., company that provides doctors

with contracts and services to guard against frivolous malpractice

lawsuits. Last year, the company designed a contract doctors can use

asking their patients to " respect their physician's privacy on the

Internet " by not participating in online ratings.

If a contract is in place beforehand, a doctor can force a website to

take down the offending material, says Dr. Segal, a physician

who runs the company.

To a doctor, reputation is everything, Segal says, adding that

doctors shouldn't bear the brunt of dissatisfaction with the

faltering healthcare system.

" All stakeholders -- consumers, doctors and payers -- are frustrated

right now, " Segal says. " Because of that there is a lot of finger-

pointing and a lot of anger, some of which is unproductive. "