Online scrutiny is stressful for doctors

Online ratings and discussions about the quality of care American doctors provide can add to their stress levels. Patients, on the other hand, feel that such information empowers them to make better informed health-related choices. This is according to a study¹ in the Journal of General Internal Medicine², published by Springer. Led by Alison Holliday of Harvard Medical School in the US, the study highlights how important it is to monitor the impact of independent and health system physician rating websites on both physicians and patients.

Independent sites are hosted by private companies such as Healthgrades.com, and reflect crowd sourced numerical ratings and free-text narrative comments freely posted by online users. These sites tend to carry reviews on a small percentage of physicians, and then only a handful of comments per doctor at that. Health systems sites, in contrast, portray numerical ratings and explanatory comments collected from standardized health system patient experience surveys. These surveys are carried out as part of internal quality improvement programs of hospitals and health practices.

To get a sense about the views and use of such sites, Holliday's team surveyed physicians and patients from four hospitals in a large accountable care organization in Massachusetts in the US. Their web-based survey was completed by 828 doctors, and a mailed survey by 494 patients.

One in every two doctors (53 percent) said that they had read online reviews about themselves, while two in every five patients (39 percent) used the web to look up comments about their doctors. It was a more popular practice among younger people, women, and those with a college education.

In general, doctors were less supportive than patients of sharing data publicly. They trusted information on health system websites more, while independent sites were the preferred go-to source for patients.

"Patients may lack trust in health system websites due to concerns regarding bias, as these publish reviews regarding their own physicians," says Holliday. "Health systems seeking to publish patient experience survey data will therefore need to engage patients in their trust of what is very likely a new and complicated data source to them."

It was found that online ratings and comments place an extra weight on doctors' shoulders. The majority (78 percent) surveyed noted that the possibility of negative online comments increases their job stress. Among physicians, 46 percent thought the practice could harm physician-patient relationships.

Patients were more supportive of making in-house health system patient experience data available publicly. One in every four patients (29 percent) surveyed, however, said that their comments might be less candid if they knew beforehand that these would become public knowledge online.