In 2012, tension over online doctor reviews ran high. As the New York Times reported, physicians were turning to third-party reputation management firms who used legal threats to silence critical patients on the Web. Information freedom non-profits and tech media outlets responded with investigations and an FTC complaint.
As a former practitioner, I sympathize with some doctors’ apprehension about online reviews; the desire to protect oneself from unfair or unwarranted criticism is all too relatable. But patients have a right to talk about their experiences. Censorship also doesn’t work, especially in the age of the Internet. Gag orders will not silence angry patients. Those patients will simply find ways to air their opinions anonymously, regardless of whether their grievances are legitimate.
And other patients will listen. According to Nielsen’s 2011 Global Trust in Advertising Survey, 70 percent of global consumers trust online reviews, making them the second-most trusted form of advertising. In a recent survey conducted by Search Engine Land, 72 percent of consumers said they give the same weight to online reviews that they do to personal recommendations. In other words, consumers rely heavily on online resources to make purchasing decisions – and healthcare consumers are no different.
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The significance of this trend has not been lost on policymakers and other healthcare architects, who are working quickly to advance pay-for-performance healthcare models. Patient satisfaction, as measured through ratings and reviews, will soon be tied to compensation for employed doctors. In the independent setting, online reviews already affect income directly to the extent that potential new patients are attracted or repelled.
For patients to broadcast their opinions to the world – impacting physicians’ reputations and their wallets – is a major change, and perhaps alarming. But I believe that healthcare providers should actively support reviews for reasons beyond transparency and future-preparedness: reviews are meaningful and empowering for patients, and can be a valuable business driver.
The first concern to allay is providers’ fear that a few negative reviews could poison their reputations. In fact, this could not be further from the truth.
Determining this empirically was simple for Zocdoc, the company I cofounded. Zocdoc allows patients to book appointments online; only patients who have seen a physician through our service are allowed to review that physician. This means that the Zocdoc review system is closed-loop (currently the only such service that is doctor-specific and publicly accessible). Open-loop review systems, on the other hand, allow anyone to post a review, and are more vulnerable to fraud, system-gaming, and cases of mistaken identity.
We studied the behavior of our users, and found that patients are happy to book appointments with doctors who have received some negative reviews – so long as their reviews aren’t overwhelmingly negative. It is not until a physician’s overall rating falls to 2.5 stars out of five that patient preference for that provider begins to decline significantly. In fact, of the 10 percent of doctors who receive the most appointments through our service, about three fourths have at least one negative review.
Clearly, patients interpret online reviews in a balanced and thoughtful way. But this phenomenon is not merely harmless to providers; it’s actively beneficial, especially for those who can navigate it knowledgeably. There are a number of steps providers can take to optimize the benefits for their practices.
The most important element, unsurprisingly, is overall score. By driving up his or her overall rating by one half of one star (for instance, from 3.5 stars to 4 stars), the average provider will increase his or her number of monthly appointments by 37 percent.
The total number of ratings itself is quite important, as well. In Zocdoc’s data, the 25 percent of doctors with the most patient reviews received five times more appointments than the bottom 25 percent. In other words, professionals with more ratings are more appealing to patients.
We also found that ratings which came through closed-loop services were significantly better than their open-loop counterparts. Specifically, 84 percent of reviews on the closed-loop site we studied (Zocdoc) were of the highest possible score. On the open-loop site we studied, only 65 percent were of the highest score.
One reasonable explanation is that the closed-loop review system actively solicits reviews from all patients, leading to a relatively fair and representative score. Open-loop systems, on the other hand, may be more likely to attract outliers, i.e. patients who take to the internet in order to vent a negative opinion.
There are also effects within each review profile that healthcare providers should consider. Zocdoc asks patients to rank providers not just on overall experience, but on bedside manner and wait-time. We found that bedside manner score alone has a strong effect on patient interest. Providers with a bedside manner score of four stars or above receive on average nearly three times more appointments than doctors with a lower score.
But while bedside manner scores tend to be either very high or very low (falling in an ‘all or nothing’ pattern), wait-time scores are more varied. Practitioners who make small improvements in their punctuality (i.e. showing up five minutes late instead of 15) can expect patients to notice – and to give them a better score.
Interesting and informative patterns also emerge from the language that patients use. In a semantic analysis, we found that the word used most commonly in negative reviews was “rude.” In average reviews, this word turns out to be “good.” But in positive reviews, the most common words were “professional” and “great,” in closed-loop and open-loop systems, respectively. This type of insight can be an effective, ongoing means for practitioners to understand their patients’ needs, shape their own professional evolution, and become more effective in their work.
As noted above, the majority of consumers give the same degree of credence to online reviews that they do to word of mouth. Consider for a moment this extraordinary fact. The commentary of strangers online has become as important as the opinions of our friends, families, and colleagues. This is clearly an indicator of the public’s growing trust in the quality of information on the web. And there is every reason to believe the trend will continue, and that online reviews will soon eclipse word of mouth in their importance for patients.
Perhaps more than any other fact, this should convince providers to think seriously about leveraging online reviews. Preparing for the healthcare system’s inevitable drive toward transparency is not just a way for doctors to better serve their patients. It is a potential driver of new business that providers can use to remain viable and competitive in a shifting landscape.
“Win-win-win” solutions – which benefit practices, patients, and the healthcare system alike – are quite rare. When we find these treatments, we should implement them quickly, confidently, and without regret. This is the essence of good medicine.