Be wary about online sites that review physicians

Q: Can I trust online review sites to find the doctor I need?

A: That's a great question, and one that I've been thinking about lately.

Are doctor reviews as useful as reviews of other consumer services? After all, I frequently turn to Yelp or similar sites to find a contractor, a new gardener or even a hair cutter. The criteria are straightforward: Did they show up on time and do a good job? Was the price fair? But there's a reason to be wary about finding doctors this way. While people can generally agree on what a five-star dry cleaner is, what is a five-star doctor? That's pretty complicated – and my list of criteria that matter may be different from yours.

Take one of my own new doctors: A top urologist at an academic medical center near me. RateMD.com graded him 4.7 (where 5 is the top score), giving him strong marks for punctuality, helpfulness, staff and knowledge. Several patients praised him highly, echoing this review: "The best doctor ever! He literally saved my life and shows such care and compassion!" On the other hand, one patient claimed he "always seems to be in such a rush," with another posting, "There was little or no discussion of what was going on."

None of those comments really helped me understand his ability to correctly diagnose and treat my condition (although it turns out he's been very good).

Many Americans consult online physician ratings, with a 2012 University of Michigan study finding that 59 percent reported that such sites are "somewhat important" or "very important" in choosing a doctor, although a recent Mayo Clinic survey found that the influence of the ranking sites "on [a patient's] decision to seek (or not seek) care from a particular physician appears to be limited."

How much – or how little – should we rely on ratings sites?

Many are focused on customer service. For instance, Healthgrades asks reviewers to consider eight criteria, including the ease of scheduling urgent appointments, office comfort, staff friendliness, wait time and whether the doctor spent "an appropriate amount of time" with the patient. None of the questions focus on quality of care – that is to say, a physician's diagnostic skills, experience or success rates – nor on value or unnecessary or overly costly care.

Andrea Pearson, Healthgrades's chief marketing officer, explained in an email that "consumers make decisions with their emotions first," much as they do when choosing a spouse.

Healthgrades also presents what it calls an "experience match," a number that relies on such objective criteria as the number of patients treated in the past year and whether any malpractice claims or medical-board actions have been found. All doctors on Healthgrades have such a grade, and that can be very helpful for health consumers. Other physicians, usually specialists, have what Pearson says is "an even more refined view," a score that describes the top conditions or procedures a specific doctor treats.

Yelp, which has had doctor ratings since its inception 13 years ago, simply asks patients to choose a rating from one to five stars for their doctor, and then has them enter comments as they might for any other service. Shannon Eis, speaking for Yelp, told me that factors such as bedside manner, waiting times and a doctor's level of compassion are important to many Yelp users.

But consumers may be wise to consider different criteria when choosing, say, a general practitioner, where waiting time can be an important criterion, vs. a heart surgeon, whose success rate and depth of experience is probably more significant. A recent study published in the Journal of Medical Internet Research examined mortality rates for cardiac surgeons and found no correlation between those with low death rates and high rankings. "Physicians with high death rates often had great ratings," wrote Roy Benaroch, a pediatrician blogger, in a post titled "Physician rating sites deserve their own 'Black Box Warning.' "

"If your goal is to survive heart surgery," he wrote, "those physician rating sites tell you nothing;" if you use them, do so in conjunction with recommendations from friends, neighbors and other physicians. (By the way, Benaroch has an excellent rating on Healthgrades and Vitals.com, another physician rating service.)

It can be hard to know whether posts are legitimate. Yelp allows people to report suspect reviewers but does not verify posts. A representative of the ZocDoc site says, "Every review is written by an actual patient, only after their appointment is confirmed to have taken place."

Kevin Pho, founder and editor of KevinMD.com, an influential blog for physicians and the author of a social media guide for doctors, said he worries that "many doctors have very few ratings, so a single rating – whether low or high – may disproportionately skew the overall score."

So how do you find a good doctor, not just one with a good bedside manner?

Ask people whose opinions you trust. If your community has a neighborhood email group, ask for recommendations. This can be helpful because you're more likely to know who's posting and you can follow up to get specifics of their experience.

Check out services that provide objective data. ProPublica's Vital Signs database aggregates Medicare data about physicians' fees and the number of procedures they have performed, which is generally an important factor in the quality of care you're likely to receive; its Surgeon Scorecard includes complication and mortality rates for eight of the most commonly performed surgical procedures for more than 16,000 doctors nationwide. While a start, it's only a drop in the bucket considering there are almost a million active doctors in the United States, according to the Kaiser Family Foundation, a nonprofit focusing on national health issues.

PubMed, from the National Library of Medicine, is an index of academic publications; a doctor who publishes peer-reviewed articles on your condition is more likely than not to be an expert in it, though not every good doctor does research and publishes papers.

When you look at reviews, bear in mind that both five-star and one-star reviews can be skewed by the emotion of either overly enthusiastic patients or deeply unhappy ones. It's worth digging more deeply if you can.

So how did I select my new urologist? He'd trained with my previous one, who highly recommended him, and then I went online to see his ratings, which were excellent. He has also published several papers on what ailed me. In the end, he turned out to be a very skilled doctor who helped resolve a chronic and painful condition. Personally, I'd give him a 4.5 out of 5 because he's sometimes rushed or late.

But don't just take my word. Do your own research, talk to trusted friends (including longtime doctors). And then consult an online rating service.

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This story is part of an occasional series of health questions, answered. Send general questions – but not specific ones – dealing with personal health problems to stevenpetrow@gmail.com.