I’m all for medical transparency – as long as it really exposes the truth. The problem is what passes for such can be very misleading.
Vanderbilt University Medical Center recently announced plans to publicly share the results of patient surveys – including reviews and ratings of individual physicians and practices on its website. You would expect marketing experts to be thrilled with this initiative. Not so.
Matthew S. Isaac, a marketing professor at Seattle University Albers School of Business and Economics, astutely makes us aware of the drawbacks inherent in the new wave of medical transparency. The problem, says Isaac, is that people often overrate things that are unimportant – like how easily doctors are manipulated into providing what patients ask for – and underrate the important –like how well physicians provide what patients really need.
The classic example is the patient who pressures his physician to give him antibiotics for the common cold. The antibiotics won’t help treat a virus and may contribute to the development of antibiotic resistant bacteria. But if the well-meaning doctor refuses the request he or she risks an unhappy patient and a negative comment on the internet websites that track doctor ratings like Yelp or Healthgrades.com.
A recent report by bioethicists at the Hastings Center noted that “good ratings depend more on manipulable patient perceptions than on good medicine.” In fact, the Hastings Center report states “the pressure to get good ratings can lead to bad medicine.”
As an orthopedic surgeon I am constantly inundated with requests to get MRI scans on everyone. Generally speaking, I don’t object, because there is no harmful radiation with MRIs, unlike x-rays. However, there is such a thing as “too much information” when an abnormal result pressures you to take invasive measures that do not seem warranted by clinical signs and symptoms.
It is best to ask the question, “Will the results of this scan alter my treatment plan if abnormal?” When the answer is “no” the test is unnecessary, even counterproductive. An unnecessary test will sometimes lead to harmful consequences.
The evidence of this is seen in the surprising association that researchers from the University of California Davis observed between high levels of patient satisfaction and mortality rates. Apparently, when providers perform discretionary services – such as CT scans for ordinary headaches – to appease their patients, the risk of potential adverse effects increases.
On-line Rating Services
Isaac says a large body of research in social and cognitive psychology has found evidence that negative information wields much more influence than positive information on evaluations and choices – resulting in a negativity bias. He explains:
“This means that a faceless consumer without just cause who spews venom online from behind a keyboard or smartphone has the power to affect the decisions of many other prospective patients. . . . The negativity bias also suggests that a few glowing reviews won’t be able to offset a single scathing one.”
Unfortunately, the anonymity of online rating services makes it more likely people will post negative comments – and therefore have more influence than justified. Furthermore, these online rating services have shown their own bias by keeping negative comments online much longer than positive comments. Like newspapers that have a bias toward bad news, these services have an equal bias toward bad reviews. Both see negativity as good for their business.
Suggestions For the Future
Isaac rightly is concerned about the potential impact that revealing every single patient review would have on healthcare providers. There is already a doctor shortage, which will undoubtedly get worse if this pattern continues. He offers some suggestions to smooth out the system as we embark on greater medical transparency:
- Report numerical patient-satisfaction scores only – be more judicious when sharing qualitative comments, especially those contained in “outlier” reviews that may not reflect the majority. Perhaps not report the top and bottom “10%” of scores and accompanying reviews.
- Keep close tabs on provider morale and motivation – before and after shifting to a more transparent model.
- Recognize what patient satisfaction surveys can and cannot reveal – the doctor or healthcare system’s overall performance. The front office staff can give both an undeserved negative as well as positive impression that does not reflect the competency of the physician.
Isaac concludes, “After all, patient-centered medicine and patient-satisfaction-centered-medicine are not the same.”