If you’re looking for a surgeon to remove your gallbladder, you could log into ProPublica’s Surgeon Scorecard. The online doctor rating tool provides nationwide rankings for surgeons who conduct eight elective procedures, such as knee replacements and prostate removals. The website looks clean and is user-friendly, with tabs to look up physicians by name or search for surgeons by region.
The online scorecard compares the complication rates of 16,019 surgeons in the U.S., based on Medicare claims data, and provides a trove of information, such as the fact that 3,405 Medicare patients died during a hospital stay for elective surgery between 2009 and 2013. But using the website isn’t a foolproof way to find a doctor. You probably wouldn’t know — unless you read a 2016 article in the peer-reviewed journal Annals of Surgery — that the scorecard didn’t measure the outcomes of outpatient procedures, of surgeries involving patients younger than age 65 and of people whose cases were emergencies, which collectively excluded 82 percent of the eight types of surgeries. ProPublica only measured outcomes of inpatient procedures, “a unique, high-risk set of patients,” the study says. Reporting on surgical outcomes reliably requires large sample sizes, researchers wrote. (In the fall of 2015, before the peer-reviewed study was published, RAND, a nonprofit that seeks to help improve policy and decision-making through research and analysis, published a piece advising patients not to consider the surgeon scorecard “a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide.” ProPublica responded with a spirited written defense of the Surgeon Scorecard.
Before you peruse websites that rank doctors or provide online evaluations of physicians, here’s what you need to know.
[See: Who’s Who at Your Doctor’s Office.]
A Wide Array of Doctor Ratings Websites
ProPublica is one of a wide range of doctor rating sites available to consumers online. Some websites, like ProPublica, post objective medical performance measures. Other websites like Healthgrades and Yelp post star ratings and comments written by patients. A growing number of health care systems post consumer reviews based on patient surveys. How can you, the consumer, make sense of such a spectrum of doctor ratings resources? How can you tell which sites or reviews to trust to help you find the best physician to safeguard your health? Physicians who have researched websites that rate and review doctors say consumers should be clear-eyed about the limitations of each of these kinds of sites.
“My advice to consumers is, if you want to take a look at a site like ProPublica, be my guest, go ahead,” says Dr. Mark W. Friedberg, director of the Boston office of the RAND Corporation and one of the co-authors of the study that analyzed ProPublica’s surgeon website. “Just take it all with a grain of salt. Don’t make the mistake of believing these sites capture everything there is to know about a surgeon.” Friedberg is also one of the co-authors of the earlier opinion piece by RAND.
Online doctor reviews are popular with consumers. Nearly 60 percent of patients say they like to use online reviews when searching for a physician, according to a research letter published by the Journal of the American Medical Association in 2017. Many consumers search for online reviews using Google search terms like “rate my doctor.”
Though online patient reviews of doctors are popular, consumers should be careful about giving them too much credence, whether they are comments or starred assessments, Friedberg says. Keep in mind is that there’s no way of knowing who’s posting many online doctor reviews or what motivated the reviewer to write about the physician, he warns. “You never know who’s writing these,” Friedberg says. “It could be the doctor, or his friends and family members. It could be a patient who had an unusually good or bad experience, or someone who has a conflict with the doctor that has nothing to do with medical care, something like a land dispute. It could be Russian bots. It’s the Wild West. Buyer beware.”
Some hospitals and health care systems collect results from randomly administered surveys about patient experiences and post those reviews online. But there’s no way of knowing whether those organizations are posting all reviews, including negative ones, says Dr. Tara Lagu, associate professor of medicine at the University of Massachusetts Medical School-Bay State Health in Boston, who has conducted research on websites that rank doctors.
Another problem with patient reviews is there aren’t enough of them for the online appraisals to be considered reliable, Lagu says. There’s no definitive, scientific number of reviews that would be considered voluminous enough to be credible, she says. A handful of doctor reviews could be credible, if they contained enough details about the patient experience and medical performance measures, she says. But many doctors don’t have any online reviews. For example, 34 percent of 600 physicians from Boston, Dallas and Portland, Oregon, did not have a review on any of 28 websites sampled by the authors of the JAMA research letter. “Among physicians with at least 1 review on any site, the median number was 7 reviews per physician across all sites,” the letter states. According to the JAMA research letter, the results “demonstrate that it is difficult for a prospective patient to find [for any given physician on any commercial physician-rating website] a quantity of reviews that would accurately relay the experience of care with that physician.”
[See: 11 Questions You Should Ask Your Cardiologist During Your First Visit.]
Some Physician Ratings Are Based on Objective and Complex Measures
Some rating sites, like ProPublica, post performance results on quality measures. However, there’s no uniform standard regarding what quality information such sites should display or how consumers should consider such information when searching for a health care provider, says Lynn B. Rogut, director of quality measurement and care transformation at the Quality Institute. The institute is part of the United Hospital Fund, a nonprofit based in New York City that analyzes public health policy to inform decision-makers and supports programs to improve the quality, accessibility, affordability and experience of patient care.
“Be sure to look at quality results, but beware of what you find,” Rogut says. “Be aware that search engines influence what you find and may take you to proprietary sites first. Also, the quality of the information on these sites is uneven.” Some sites describe performance results in highly technical language, which may be difficult for a layperson to assess, she advises. Medical performance measures may provide information but not insight. For example, how can a non-expert assess a surgeon’s complication rate or the factors that led to it? “Basically, a consumer needs an expert to travel alongside them on their internet journey,” Rogut says.
A 2017 report by the Quality Institute of the United Hospital Fund looked at 70 websites in New York that provide quality measurements of doctors. Researchers found that most of the websites provided overall performance results on clinical outcomes rather than the overall patient experience; performance data were often several years old; websites often lacked condition-specific or clinician-specific measures, which are of great interest to consumers; few websites provided information about legal actions such as malpractice allegations and none of the websites posted measures or quality information in languages other than English. Consumers should consider online reviews of physicians as “a single data point” about a doctor’s performance, Rogut advises.
Whether you’re looking for a primary care physician or a specialist, experts recommend these strategies:
Ask family members and friends for referrals. Get recommendations from people you know who you think will provide trustworthy recommendations, Rogut says. If you’re looking for a specialist and already have a primary care doctor, ask him or her for referrals. “Get a referral from someone whose evaluation you trust,” she says. Once you have some names, check several sites for online reviews of the doctors.
Look for volume. Surgeons who do a high volume of a specific type of procedure are typically good at that kind of surgery, says Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern Medicine in Chicago. The same principle holds true for nonsurgical physicians who treat a high volume of a particular kind of condition or illness, such as breast cancer, heart disease or diabetes, he says. “The more you do something, the better you are at it.”
[See: 10 Questions Doctors With Their Patients Would Ask.]
Check the websites of state medical boards. These websites should provide the medical credentials of physicians and whether they’ve been involved in legal actions, Rogut says. If the doctor has been involved in civil lawsuits, you may have to go to the courthouse where the case was adjudicated to look at those files.
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Rating Doctors: What You Need to Know originally appeared on usnews.com
Correction 02/15/18: A previous version of this story misspelled Karl Bilimoria’s last name.
