Rating Doctors: A Rank Practice?

Doctors aren't thrilled about the growing crop of websites that invite patients to post online, Zagat-style ratings and comments about their physicians. Nobody likes having his performance judged, and the anonymity of the Internet encourages the sort of no-holds-barred criticism that can feel—and may be—unfair. But the American Medical Association's stance against them seems shortsighted. Instead of trying to discourage people from logging on and registering their opinions, doctors would be better served using the sites to learn what their patients think.

Sure, the information is subjective, but why should consumers rule it out on that basis? It's sorely needed. Patients are paying more for their health coverage all the time, and they want value for their money. But it's not easy to comparison shop for doctors. It's hard to find out what the fee will be until after the fact, and good luck locating data that help you evaluate whether Doctor A is more nimble with a scalpel than Doctor B. Everyone agrees that we need more reliable tools to help patients evaluate clinical competence and improve pricing "transparency." A doctor's clinical skill, after all, is the most critical measure of his or her abilities. But communication skills and accessibility matter, too, and who better to give you the lowdown on those details than other patients?

Insurers and others have been forging ahead. Earlier this month, the insurer WellPoint announced that it has teamed up with restaurant-rating company Zagat to launch a new physician rating service for plan members in four states beginning in March. The tool will let people rate their physicians, assigning points for their trustworthiness, communication skills, availability, and office environment. It will join other members-only health plan sites as well as several that are open to the general public, like the recently launched TheHealthcareScoop.com, CareSeek.com, and my personal favorite, RateMDs.com.

Beware, says the AMA's president-elect, Nancy Nielsen. Such sites "add nothing to the quality of patient-physician communication and understanding," she said in a statement. "There is no guarantee that the opinions about a physician even come from that physician's patient—anonymous opinions can come from anyone." Still not convinced these sites are risky? "People may express dissatisfaction on these forums because they wanted a medication that wasn't medically necessary, or because they didn't receive a prescription or service that was delayed or denied by their insurance company," said Nielsen.

Fingers tingling in anticipation, I logged in and clicked around the rating sites, on the lookout for bones being picked and axes being ground. What I found surprised me. People are indeed opinionated about their doctors, and they're not shy about saying what they think. But here's the thing: The majority of online posters—75 percent of those on RateMDs, for example, according to the site's cofounder John Swapceinski—want others to know how good their doctors are. They want to share their great experiences, and they go on at (sometimes tedious) length about their doc's terrific bedside manner and extraordinary skill. "The most wonderful doctor," "never felt rushed," "answered all my questions," "a gem." In fact, sometimes the tributes are so over the top it makes you wonder if maybe the doctors themselves are goosing their ratings. Anonymity, after all, cuts both ways.

With ratings on more than 120,000 doctors and about 400 new ones added each day, RateMDs is the heavy hitter in this arena. Warmed by all the sunny accolades, I searched the RateMDs site for my own doctor, a gynecologist in a medium-size group practice whose clinical and interpersonal skills are top notch, in my opinion. But, dismay! Her rating, based on one review, is "poor." Clicking anxiously through to get specifics, I see that the poster thinks the doctor herself is "fine," but dislikes her practice: "I have never been to a doctor's office that is less accessible and less personal than this place," she posted. Well, she's got a point. It's like Grand Central there, and to the extent that a nurturing office environment is important, that feedback could be useful to both prospective patients and to my physician's business. The comment was typical of the negative reviews I saw: thoughtful and specific, a potential gold mine of useful information for any doctor interested in customer service. (Of course, you can't rely too much on one review, or even several of them. The WellPoint site won't rate a doctor until 10 patients have registered their opinions.)

But doctors aren't focused on what they might learn from the ratings. It seems they'd rather control their patients than listen to them. (One website, medicaljustice.com, even offers doctors contracts to use requiring their patients to get doctors' permission to rate them online.) No one is suggesting that people use anonymous doctor rating sites as their sole means of evaluating a physician. It's critical that people evaluate a doctor based on clinical competence, not just bedside manner. But harrumphing that consumers should shun these sites because they can't verify their claims smacks of medical paternalism. After more than a decade of shopping, chatting, dating, and researching all sorts of topics online, people know that on the Internet what you see is not always what you get. Doctors should give them credit for that.