The Ups and Downs of Patient Ratings of Doctors

Rating things are all the rage, whether it’s semi-celebrities and their dance moves or food-truck burritos. Patients have always rated doctors, but until recently only in a casual, personal reference way.

Thanks to the changing landscape of health care and the increasingly important issue of cost-effectiveness, more codified attempts at consumer health care ratings are in order. As discussed on Wachter’s World, a blog written by Dr. Bob Wachter, chief of the Medical Service at the University of California, San Francisco Medical Center, consumers can check with Hospital Compare to see how certain hospitals are rated by patients.

Currently in development is a similar patient-feedback system for individual doctors.

Wachter believes that when data are gathered scientifically and professionally, everyone benefits. Unfortunately, the scientifically professional approach can’t compete with popular web-based ratings “in all their über-democratic, Yelpy glory,” Wachter says. And that makes some objections all the more righteous.

RateMDs, for example, was started by the fellow responsible for, which includes criteria such as “hotness.”

A more grown-up effort at doc-rating occurs in Britain, where the National Health Service hosts NHS Choices. It invites patients to rate practices and hospitals, but not individual doctors. Comments are screened (“inflammatory” comments are blocked) and practices are encouraged to post responses.

Reasonable objections to patient surveys of doctors include the fact that it’s human nature for the most disgruntled people to weigh in. That’s not a fair representation of whole-practice results. The fact that there was a relatively small number of responses by physicians skews the results even more.

But Wachter says the data reflect that most reviews are positive. Recently, of 386,000 physicians rated on RateMDs, nearly 1 in 2 was given a perfect 5 out of 5; only slightly more than 1 in 10 got 2 out of 5. And 2 in 3 patients responding to NHS Choices said they’d recommend a practice or hospital to a friend.

Another objection is that ratings would be insignificant-fluffy, not substantial. But that doesn’t seem to be supported by experience. In the RateMDs survey, board-certified physicians, those who attended highly rated medical schools and those who had never been sued for malpractice were rated higher.

Wachter was involved in a study of more than 10,000 patient ratings of hospitals for NHS Choices in which positive ratings correlated with lower mortality and readmissions rates. “While disentangling cause and effect is challenging,” Wachter writes, “these results support the notion that patient ratings are capturing other important elements of care.”

Wachter recalls a nurse’s recent New York Times commentary noting that, “[W]e hurt people because it’s the only way we know to make them better … which is why the growing focus on measuring ‘patient satisfaction’ as a way to judge the quality of a hospital’s care is worrisomely off the mark.”

But as Wachter notes, all medical practitioners have the capacity to hurt people on the road to getting them well, and some just do it with more compassion and grace than others. As he says, “I’d like to know who they are.”

What if people submit ratings only because they have an axe to grind? What if doctors write themselves glowing reviews?

Wachter says such concerns are legitimate, but that with large enough numbers, “the truth generally wins out. … The solution to problems with voting, it seems, is more voting.”

Wachter is most concerned about patients who would rate doctors poorly because they had refused to provide unnecessary or inappropriate care-for example, the patient who wants an antibiotic prescription for a sinus infection for which antibiotics are not the solution. “One hopes that future quality measures,” Wachter writes, “will include not only patient experiences but also other measures of appropriateness and evidence-based care designed to counteract this perverse incentive.”

“As we work our way through this new world of patient surveys and ratings,” Wachter concludes, “there will be some hazards to overcome and some unfair results to contend with. We’ll need to do all we can to anticipate these problems and mitigate them, and to try to bring some order to a chaotic marketplace. These seem like surmountable issues, and I am confident that the outcome of capturing the patient’s voice and giving it some real weight is sure to be better care.”

We agree.

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