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April 17, 2008
CNN Takes on Doctor Ratings... And Gets it Wrong
CNN has recently published an article about what to look for in a doctor rating website. Unfortunately, they repeat some misconceptions and errors about these services.
The most serious error is the claim that the greater volume a website has of doctor ratings, the more reliable or statistically valid it will become.
It's a matter of statistics: The more reviews you read, the more likely you are to get an accurate assessment. "I would check a lot of different Web sites," says Carol Cronin, executive director of the Informed Patient Institute. "Look across them, not just within one."
Speaking of volume, a common concern about doctor rating sites is that one angry patient can make multiple nasty comments, using a different name each time (or, conversely, that the physician herself could go on and make multiple glowing comments).
But Martin Schneider, chairman of the Informed Patient Institute, says these sites have ways of detecting when one person is making several comments under different names. Back in the 1990s, Schneider was president of a now-defunct doctor rating site called thehealthpages.com. "Even back then, we had to the technology to stop that from happening," he says.
These claims are commonly made, but they are largely incorrect. Here's why...
In survey research (which is basically what a doctor rating site is trying to be), you need a sample that is both large and randomized. That is, you do not go out and post an announcement saying, "Take our survey if you think you have depression" if you're looking for an unbiased data sample on depression in the general population. You need to have a group of people that both have and don't have depression in order to obtain generalizable results.
The same is true with ratings sites. They may get the volumes needed, but none of these sites have any way of addressing the biased sample problem. People who rate their doctors are likely to fall into one of two categories -- they either had a horrible experience with them and want others to know, or they had a wonderful experience with them and want others to know. But most people who fall in between these two extremes and have run-of-the-mill experiences with the doctor will likely never rate, because they have little incentive to do so.
You will also need a humongous number of patients rating each doctor -- at least 20 to 30% of their entire patient list -- in order to for the ratings to start gaining enough power to be reliable and valid (notwithstanding the population sample bias issue).
CNN admits as much later on in the same article quoting Dr. Robert Wachter:
While patient reviews might be useful, they have several clear drawbacks, our experts say. First, many doctors have just a few reviews or none at all. Second, even if a doctor has 20, 30, 50 or 100 reviews, that's still only a small fraction of his entire patient population -- and a warped fraction at that.
"The person most likely to write is the one who's most enthralled with the doctor, or the one who's most pissed," Wachter says. "You're getting a skewed view."
The other advice -- decide what's important to you, look for patterns in the ratings, look for specifics in people's ratings of their doctor and put more weight onto detailed reviews rather than general comments, and consult objective data already available -- is generally solid, but still doesn't address the foundational statistical problems with these types of online ratings systems. All the business people gloss over these problems, but if a rating isn't scientific, its value is diminished substantially.
And honestly, Martin Schneider is a bit naive if he thinks it isn't a simple thing to rate one doctor multiple times on all of these sites. Simply by clearing one's cookies, using a few webmail addresses and using a Web proxy, you can register as many accounts as you would like on any of these services in a matter of minutes.
Posted by John Grohol at April 17, 2008 11:41 AM | blog this | Email to a friend
Comments
I couldn't agree more. I know here on this blog we've considered the topic of "rate your doctor" sites but I don't think it's comparable to the value of Consumer Reports car ratings.
I hadn't thought about the randomization issue. I had, otoh, thought about the broader issue of self-selection bias: flaming idiots (and upset people) might be far more likely to post a rating than others, or not - who can tell.
Completely agreed re repeat raters. Didn't I hear that TV talent shows gave up and now let you vote as often as you want? Otherwise, the vote would be biased in favor of more devious citizens - just as you suggest about doctor ratings. Not good.
Posted by: e-Patient Dave at April 17, 2008 9:37 PM
Consumers need to take back control of their patient satisfaction, and as in other industries, only the consumer can effect change. So in the case of MyDocHub.com, patients rate their doctor based on waiting room times, total wait time including the time in the patient room with the doctor, and a simple rating of 1 to 5, 5 being the highest on how satisfied they were with that appointment. The doctor ratings are averaged out, so one poor score does not hurt the doctor, but on the other hand, various poor ratings may indicate poor performance by the doctor, since the wisdom of crowds determine a more accurate assessment of the doctor.
Posted by: David at April 19, 2008 6:50 AM
The only site I found to have more detailed physician information (including physician ratings) would be www.mdnationwide.org. I used several other "free" services, however information generic, and I never did find his rating until I ordered a report from this site mdnationwide.org. The report also showed two malpractice judgments, which I never found anywhere else.
I think consumers should browse the Internet and not solely rely on free information, after all - you get what you pay for.
Posted by: Darren at May 20, 2008 10:38 AM
the mydochub.com post above has also been posted on another discussion board under a different name> ignore it.
Posted by: benny at June 20, 2008 9:21 PM