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Online doctor reviews: not ready for prime time yet

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It sounds like a useful idea: online ratings that help consumers sort through their choice of doctors and pick the one who's the best match.

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In real life, though, the concept doesn't seem to have flourished as well as expected. An intriguing piece published this past weekend in the New York Times explores why this would be the case for what writer Ron Lieber calls "the highest-stakes choice of service provider that most people make."

Litigation is one obvious concern. Patients don't want to be sued for posting an online review that may be negative. In case you think this would never happen, think again: A Duluth, Minn., man was sued by a neurologist after making critical comments on three consumer rating sites about the doctor's bedside manner. The case was thrown out by the St. Louis County District Court but the Minnesota Court of Appeals ruled this January that a jury should be allowed to decide.

Sometimes patients worry their anonymous comments will be recognized and that there'll be retaliation in some form, Lieber wrote. He spoke to an Angie's List customer who "said she would never talk negatively about her doctors on the site because there were only two decent hospital systems where she lived and she didn't want to end up blackballed by doctors at either."

The biggest issue I've seen, however, is that most of the online rating sites simply aren't that robust. I've browsed through RateMDs, which purports to have more than a million consumer-written reviews of physicians in the United States and Canada. A search for Minnesota physicians revealed very few reviews for any doctors outside the Minneapolis-St. Paul area and most of the doctors had fewer than five reviews posted for them - not a particularly strong sample size and not very useful if you don't live in the metro area.

And what should the average doctor-shopper make of comments such as "Best pediatrician I have ever encountered!" or "not helpful, bizarre comments and behavior"? Without context, it's difficult to judge, making the value of many of these reviews limited at best.

Certainly there are more objective rating sites online - for instance, HealthGrades, which provides information on both physician and hospital quality. But again, most physicians outside the metro area have only a small number of reviews, or none at all. (I also noticed the lists don't seem to be updated when doctors retire or leave the community. How would someone who's new to town and in search of a doctor be expected to know this?)

Nor are most of the online rating sites very helpful when it comes to judging physician quality on the basis of outcomes or best practices. Here in Minnesota, Minnesota Community Measurement seems to come the closest to reporting how medical practices stack up overall in outcomes and the use of evidence-based medicine. But either I'm a klutz or the site is overly cumbersome, because I've found it difficult and time-consuming to truly use effectively. And although it could probably guide consumers to a quality medical clinic, it doesn't really help them choose an individual doctor, a decision that often comes down to personal values, preferences and communication styles.

Studies examining actual consumer use of online rating sites are rather thin on the ground. One survey, conducted in 2008 by the Center for Studying Health System Change, found that only about 10 percent of the 13,500 adults who were queried turned to an online rating site to help them find a new primary care doctor. The majority relied on old-fashioned word of mouth from family and friends.

What's a consumer to do? Lieber writes:

Until a single one-stop shop exists for both reviews and data that are fair and useful, we are left with one another. The problem with asking friends for a doctor recommendation is that even if they are a lot like you, they may not have any idea whether the doctor is a good clinician or not.

Careful readers can probably find some sites with listings for certain doctors that in number and detail add up to a useful measure of many of their skills. But you may not know anything about whether the reviewers are people similar to you.

In light of all this, it's curious to see policymakers continuing to forge ahead with all kinds of online data, from hospital performance to outcomes to patient satisfaction. Not that the trend isn't welcome; we need more - not less - data and public reporting. Sharing the data is no guarantee, however, that consumers will be able to use it effectively, or indeed whether they'll use it at all. It seems that in spite of all their promise, the online rating sites still aren't quite ready for prime time.

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