The online sport of provider-bashing

I belong to an online community where the hot topic last week was doctor-bashing – more specifically, whether it’s OK to name names when patients are criticizing an individual physician or institution.

The discussion started innocently enough with a posting from someone who wasn’t happy with the care a relative received at a large hospital somewhere on the East Coast. Then things escalated. Accusations were made about only telling one side of the story. Names were named. Folks got angry. A moderator stepped in and started editing names out of posts, resulting in cries of censorship.

I’m not sure the argument was resolved to anyone’s satisfaction. But it points to a thorny modern-day issue: the use of online forums to exchange recommendations (or warnings) about individual providers and the ethics of truth-telling vs. smear campaigns.

It seems to be human behavior to compare notes about health care providers. Even the Neanderthals probably sat around the fire and griped about the caveside manner of their local shaman. To the degree that interactions with a health care provider often are highly individual and tend to be colored by emotion, it’s logical that people would want to know if others have had the same experience. Similar experiences can help validate people’s perceptions that Dr. X or Hospital Z is [insert failing of your choice].

It’s one thing, though, to grouse among a small circle of friends and family, and quite another to broadcast your dissatisfaction online where the whole world can see.

There are plenty of Internet forums where this takes place. At RateMDs.com, you can see the good, the bad and the ugly – mostly neutral to good reviews but also more than a few that are negative and even scathing. Healthcare Scoop, a Minnesota site, is a little more sedate (it has its own code of conduct) but has a similar purpose in giving consumers a place to swap stories and information.

Yes, names are named – otherwise what’s the point? No, there’s no way to verify whether commenters are actually being truthful or whether they’re biased or telling only part of the story.

Physicians and, to a lesser extent hospitals, often feel threatened by this, and rightfully so. It’s hard for them to defend themselves against anonymous online comments, and in any case they’re generally barred by privacy regulations from responding. Some attorneys have gone so far as to suggest that physicians ask their patients to sign a contract agreeing not to comment online about the doctor. Sometimes, physicians fight back with a lawsuit, as a Duluth neurologist recently did after being criticized by a patient’s son for his bedside manner (although this particular case apparently didn’t involve online commenting).

The larger question, it seems to me, is whether consumers truly benefit from sharing personal stories and experiences, good or bad, that they’ve had with health care providers. There are plenty of caveats, to be sure. A rating site might contain only one or two reviews of an individual physician – hardly enough information with which to draw any conclusions. If a patient or family member is upset about the care they’ve received, you don’t know how accurate their perceptions might be. Sometimes people misunderstand a situation, or their emotions simply are running a little too high. Under these circumstances, does it unfairly tarnish someone’s professional reputation if names are named?

Naming names can have another impact that’s not as readily recognized: undermining the confidence of someone who has chosen a particular hospital or physician and causing them to question whether they’ve in fact made the right choice. At the very least, it might prompt patients and families to search for faults that aren’t really there, and thus unwittingly erode the relationship.

But there’s another side to this: the value of honesty and disclosure. As one of the participants in my online group said, "Why would we have a double standard – OK if people have something nice to say and not OK if they have something critical to say? There are times when patients/families really need to hear an honest opinion."

Despite the growing prevalence of online ratings for physicians and hospitals, word of mouth remains a significant force in helping people choose a provider. Online ratings don’t always capture nuances that might matter to patients. One or two bad reviews don’t necessarily constitute a trend, but consistently low or lukewarm ratings can help signal deeper issues – for instance, a physician who’s not a good communicator, or a hospital that’s not responsive to problems that crop up during a patient’s stay. To many consumers, this is important to know.

For the record, I’m not a fan of bashing. If you have something negative to say, you can say it without resorting to insults or anger. There’s nothing inherently wrong, however, with criticism. If providers are too thin-skinned about it, they risk losing an opportunity to identify areas that need improvement. Inevitably, it sometimes means names are going to be named, and the responsibility that comes with this applies to both sides of this particular fence.

Photo: Wikimedia Commons

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