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The wisdom of the crowd is hard to find if too few patients rate their doctors. (Illustration by NPR staff)

Online Grades For Doctors Get An Incomplete

by Nancy Shute
Jan 4, 2013

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Crowdsourced review sites like Yelp can be just the trick for finding a great restaurant or avoiding a bad one.

But when it comes to finding a good doctor, there still aren't enough reviews on sites that rank doctors to make them reliable, a study of urologists' ratings suggests.

Urologists averaged just 2.4 reviews on the big online doctor rating sites like Healthgrades.com, Vitals.com and RateMDs.com. The paltry number of participants means that one cranky patient's complaint — or a rave from one doctor's relative —can skew a rating.

"You can have an angry patient go on and ruin your reputation, or you can have office staff go on and make you look like the best thing around," says Chandy Ellimoottil, a resident in urology at Loyola University Medical Center in Maywood, Ill. His study was published online in The Journal of Urology.

The 500 urologists surveyed averaged 2.4 reviews on 10 physician-ranking websites, with total reviews per doctor ranging from 64 to zero. The reviews were overwhelmingly positive, at 86 percent. But the negative reviews focused more on things like office decor than whether the doctor delivered good health care.

But this study suggests that information from crowdsourced doctor-ranking sites should be taken with a grain of salt, Ellimoottil says. He became interested in the topic when he Googled a prominent surgeon for a research project. "He had a Healthgrades ranking that was 5 out of 5. The next one down was Vitals, and it was 2 out of 5. The reviews were 180 degrees different."

Another study published in early 2012 in the Journal of Medical Internet Research found some correlation between online ratings and quality of Virginia doctors. Overall, the ratings were positive. Patients were most critical about punctuality and staff. Still, like the study of urologists' ratings, this one found ratings were often based on the experience of just a few patients, about three, on average.

People may have figured this out for themselves, according to a survey coming out later this month from the Pew Internet Project. Researchers there found that while 80 percent of Internet users say they research products or services online, just 20 percent say they have used online reviews and rankings for providers of health care.

Three-quarters of Americans say they look for health information online, but surprisingly little research has been done on whether doctor-ranking sites are reliable. One 2012 study of Britain's national hospital-ranking site linked positive reviews with lower death rates. Another study from the University of California, Davis found that people who rated themselves most satisfied with their doctors had higher health costs and higher death rates. That second study didn't look at online ratings.

Most doctors are listed in online rankings, but the information there is indeed sparse. Shots checked out Ellimoottil on Healthgrades. The site gave no reviews, which makes sense, given that he's not yet running his own practice.

It also listed him as a general surgeon, rather than a urologist.That's probably because urologists spend their internship year in general surgery. "It hasn't been updated since I first started practicing," says Ellimootil, who's in his fourth year of residency.

New sites aimed at solving the problems with crowdsourced doctor rankings have cropped up, including a new doctor-rating site from Consumer Reports. The group has crunched numbers from heart-surgery records to come with rankings of bypass surgery groups.

Medicare has started collecting data on physician performance, but so far the government's Physician Compare website is useful only for finding doctors who accept Medicare for payment. That should change in the near future, as performance data mandated by the Affordable Care Act comes online.

But for now, patients may want to revert to pre-Internet traditions, asking the family doctor or friends for recommendations.

A doctor might not have gone to a fancy medical school, Ellimoottil notes, "but if they're at your bedside and they're caring for you, they're there when you need them and they give good advice, they're involved in shared decision-making, those are the qualities you want."

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