Help! I’m On James A Colbert MD Newton-Wellesley Hospital Brigham & Women’s Hospital Bradley H Crotty MD MPH FACP Beth Israel Deaconess Medical Center How Online Ratings are

2 Department of Medicine Agenda Introduction & Framing Questions Landscape Framework Practical Approach Discussion

3 Department of Medicine 15 YEARS AGO…

44% + of web users search the web about doctors or other health professionals Fox S. Health Topics. A Report of Pew Internet & American Life Project. 2/11/2011 Fox S, Jones S. The Social Life of Health Information. Pew Internet & American Life Project. 6/11/2009.

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6 Department of Medicine Questions Am I being rated? How do patients rate me? Are online ratings correlated with actual quality? Do online ratings matter? Do online ratings change clinician behavior? How do I engage with this new trend? º (How) Do I address negative reviews? º Can reviews help my practice?

8 Department of Medicine The Landscape of Physician Rating Sites Physician Evaluation Websites Health Websites with Physician Evaluation Functionality General Rating Websites Healthgrades.comDoctor.comAngies List Findadoc.comEverydayhealth.comInsiderpages.com Ratemds.comHealthtap.comYelp Zocdoc.comWellness.comYahoo Drscore.com Ucomparehealthcare.co m Vitals.com Docspot.com

13 Department of Medicine 59% of US adults searched for health information online in 2010 (pewinternet.org)

14 Department of Medicine Physician Online Ratings Websites Pros: Provide healthcare consumers with information to help them make better decisions about where to receive care A way to share personal experiences regarding quality of patient experience with others Cons: Ratings and comments can be left anonymously Patients may value customer service more than healthcare quality Small number of ratings could harm a physician’s reputation Reviewer anonymity – can be subject to manipulation by patients or providers

15 Department of Medicine Gao JMIR 2012 As of 2010 approx. 1 in 10 US physicians had an online review OB/GYN most likely to be rated Mean score of 3.93 on 1-5 scale

16 Department of Medicine Gao 2012 JMIR Breakdown of physicians rated online National Physician Population

17 Department of Medicine Specialists Are More Likely To Be Rated Than Generalists Gao 2012 JMIR

18 Department of Medicine Online Sample of 250 MA Physicians

19 Department of Medicine Online reviews of 500 urologists 80% had an online review 86% of reviews were positive 45% had written patient comments online º 25% negative º 22% neutral º 53% positive Ellimoottil, Journal of Urology 2013

20 Department of Medicine Distribution of Online Ratings across Physicians Gao 2012 JMIR

21 Department of Medicine Quality of Ratings by Physician Characteristics Specialty* Medical School Graduation Year* Gao 2012 JMIR * p < 0.05

22 Department of Medicine Quality of Ratings by Physician Characteristics Board Certification Status* Medical School Ranking* Malpractice Claims # Gao 2012 JMIR * p 0.05

23 Department of Medicine National Patient Survey Data Hanauer, JAMA 2014 Aware of Rating Websites Sought Ratings In Last Year Found Reviews Useful *Only 5% had written online ratings

24 Department of Medicine National Patient Survey Data 59% thought ratings to be important when selecting a physician 35% reported selecting a physician based on good ratings and 37% avoided a physician based on bad ratings 34% had concerns about their identify being disclosed 26% were concerned about their physician taking action against them Hanauer, JAMA 2014

25 Department of Medicine To Summarize… Patients are frequently rating their clinicians, though to date any one clinician generally has a low number of ratings. Patients are variably (but increasingly) using these ratings to drive decisions Ratings tend to be positive What are the implications for me? How do I think about this?

28 Department of Medicine Probiotic Indications: º Proactive identity management º Building practice Dosing: º Spectrum of engagement Alternate Dosing: º Outsource reputation management

29 Department of Medicine Do Nothing Encourage Reviews Self Reviews Non-Disclosure Agreements Proactive Identity Management Engage Reviews

30 Department of Medicine Antibiotic Indications º Misinformation º Slander Mechanism of Action º Request of Site º Legal Action

31 Department of Medicine Implications Patient Volume and Referrals Patient-Doctor Relationship Ethical Considerations Patient Privacy Time & Resources

32 Department of Medicine Dual Online Identities

33 Department of Medicine Systematic web searching using search engines List professional information, rating sites, and what personal information is available Note erroneous information Inventory your personal information  Social Networking Sites  Online Contacts  Picture Sharing Sites Adjust privacy settings to match your comfort The Digital Audit

34 Department of Medicine Practical Steps Separate personal from professional identities Perform digital audits or create automated searches Plan goals Decide how best to engage º At a minimum, have an online bio or contact information for your practice available for patients

35 Department of Medicine Make An Individualized Plan… What are your needs? What are your goals? How much time do you want to invest?

36 Department of Medicine Rx Goals Practice Type Referral Source Time / Resources