Should reviews of physicians be allowed on Yelp?

Issue: January 2019

Patient expectations have been shown to be a driver of antibiotic overprescribing. Some physicians say they are nervous that a bad review on the crowd-source review forum Yelp can hurt their bottom line and are more inclined to prescribe an antibiotic — even when it is not needed — to avoid negative attention online. Infectious Diseases in Children asked Sheryl Recinos, MD, a family medicine physician and a full-time hospitalist in Lancaster, California, if physician reviews should be allowed on the website.

Technology has revolutionized customer satisfaction, and people are able to rate everything from restaurants to hotels to consumer purchases. But should they be allowed to rate physicians? Websites like Yelp allow customers to rate businesses and services and place feedback in an open forum. This may come in handy when a consumer is looking for a place to eat or when they are considering local services.

A growing number of physicians are concerned with the current rating system, and there is a petition currently circulating on www.change.org recommending the removal of physician ratings on websites like Yelp. Comments posted on websites like Yelp are not vetted, and patients can freely vent about their physicians. However, physicians cannot respond to their patients because confirming or denying a patient’s concerns online would violate patient privacy protected by HIPAA laws. Angry comments have been posted on physician pages regarding a myriad of complaints, including racist, homophobic and sexist remarks that have nothing to do with the actual medical care that has been provided. Other times, patients are upset because they do not receive the prescriptions that they request, such as antibiotics or pain medications.

Additionally, most physicians do not see patients as customers, and patient satisfaction often must take a necessary back seat to patient safety.

“Patients should not be allowed to rate physicians based on consumer satisfaction because our patients are not customers. They come to the physician for life-saving services and we provide them to the best of our knowledge and training,” stated Xiao Wan, DO, an internal medicine physician in California.

Moreover, a landmark study from the University of California, Davis in 2012 showed that highly satisfied patients were more likely to have poor health care outcomes. In fact, among the patients that they studied with the highest patient satisfaction scores, they were 26% more likely to have a significantly higher risk of death over the course of the 6-year study. For example, patients often do not understand when antibiotics are indicated and often request them for viral illnesses. Physicians who are overly focused on patient satisfaction might be persuaded into giving unnecessary medications, which can cause harm. Additional pitfalls of high patient satisfaction were discovered during their study, including higher health care costs and increased use of health care. Physicians determine when to order lab or imaging studies based on their history and physical exam, but often patients request more testing than what is necessary. This issue increases health care costs overall and can have a detrimental effect on health because patients who have incidental findings may undergo further unnecessary testing.

Therefore, an online rating system for medical care is an inappropriate location for patients to list their concerns. Websites like Yelp should remove physicians from their algorithm and return their focus to goods and services. Patients are best served by seeking medical attention from physicians that provide evidence-based medicine, and the evidence shows us that patient satisfaction is inherently unsafe because patients are not customers. Rating physicians on Yelp will not improve medical care and should not be permitted.

References:
Fenton, JJ, et al. JAMA. 2012;doi:10.1001/archinternmed.2011.166.

Disclosure: Recinos reports no relevant financial disclosures.