Yes To Physician Ratings (2016 Sep)

by Barry A. Liebling

There is nothing new about rating goods and services and sharing your opinions with others. People have always had strong feelings about the value of their purchases, and reputations are influenced by what is said and written. What is relatively new is that with the development of the internet individual ratings can rapidly be communicated to people all over the world.

You can go online and find customer ratings for a wide variety of things. One of the most popular rating sites is where you can read how people praise or trash their recent purchasing experiences. displays consumer ratings for all of its products, and the ratings are updated at least daily. Many retailers have followed Amazon’s example, and customers can read what others have said about products before they buy. There are numerous sites that report consumer ratings of professionals including lawyers, accountants, educators, and physicians.

Of course, savvy readers understand that the quality of online ratings is variable. Some raters are conscientious, have standards similar to yours, and merit your serious attention. At the other extreme are cranks who write nasty emotional notes (or saccharin kisses) that are not a reliable source of information. With a little practice you can (and probably do) peruse the ratings of a product or service, interpret the pattern, and learn more about the vendor than you would if the ratings were not available. On balance, even though some raters’ opinions are not valid, having a lot of ratings available is advantageous to your purchasing decisions.

On numerous occasions I have used rating sites to help me identify physicians who are likely to be competent and compatible with my special requirements. Selecting a health care provider is important, and I seek out all the relevant information I can (knowing that some of it will be tainted). While the ratings do not reveal all the important things about a health care provider, they are part of the total picture when I consider what to expect.

Recently Mathew S. Isaac, a professor of marketing at Seattle University, published a column in The Wall Street Journal that challenged the desirability of having patients rate physicians. The professor does not object to ratings in general, but he argues that health care providers are special and not comparable to other types of providers. In essence he is suggesting that health care providers be treated as a protected class and that rating institutions be more gentle towards them when publishing patients’ opinions.

Let’s consider three concerns regarding patient ratings that are suggested in his column.

First, Dr Isaac worries that if ratings become public physicians might be tempted to comply with the requests of patients – even if the requests are unreasonable and incompatible with medical best practices. For example, he envisions medical doctors ordering unnecessary tests and performing procedures that are not warranted – just to get a high rating from patients and to avoid patient criticism. The professor is anticipating that physicians will be intimidated by the threat of low ratings and cave in to unreasonable patient requests.

There certainly is a possibility that some medical doctors will pander to the demands of their patients, but such unprofessional behavior should be relatively unusual. Physicians who are inappropriately compliant will receive high ratings from some patients but will be detected and exposed as “lacking independent judgement” by others. Showing all the available patient ratings to interested readers is a method of exposing a physician who is using poor judgment.

Also notice that if making ratings public pressures some health care professionals into behaving badly, ratings are likely to have a deleterious effect on other types of professionals as well. Attorneys might be tempted to take legal actions that are foolish, just to please clients who are requesting them. Accountants might report the financial health of a business as better than it really is. Architects could deliberately design a building poorly in response to the foolish requests of customers. Should the ratings of all service providers be curtailed or eliminated? It is better to display everything, and let interested readers sort things out.

Second, Professor Isaac recognizes that patients are not experts in medicine. But patients are fully competent at assessing their own level of satisfaction or disappointment after an encounter with a medical practitioner. Advocates of consumer ratings have never insisted that what customers have to say is the end of the story. It is one very important part of the story. Some people assert that only a qualified medical doctor can properly judge another medical doctor. My response is that perhaps peer ratings should also be published along side the patient ratings. Drawing a more complete picture of a physician’s reputation is a good idea.

Third, when Dr Isaac writes that, “patient satisfaction surveys … can’t reveal whether patients’ health ailments are being competently treated” he hints on an important point. Health care providers really are special in the sense that the end-user of their services are frequently different from their paying clients. Typically, a patient selects a physician, but the physician’s compensation and career success is largely determined by third parties – hospitals, insurance companies, government agencies. Each of the third parties has its own interests which may or may not coincide with the interests of patients. While The Wall Street Journal article does not address this issue, it would be a good idea to reveal to readers the ratings of all the entities that impact on a health care provider’s actions. It may turn out that the possible corrupting effects of patient ratings are tiny compared to the potential damage caused by powerful third parties. If you are concerned that a physician might not do a good job in response to patient pressure, you should consider what incentives powerful outside entities might put on that physician.

What recourse does a physician have to address unfavorable patient satisfaction ratings? From a legal standpoint the options are tricky because the Health Insurance Portability and Accountability Act (HIPAA) makes it unlawful for health care professionals to disclose confidential patient information (including responses to poor reviews) without permission. But some physicians have found legitimate ways of replying to their critics. And in the near future medical doctors might be routinely answering, in public, patients who judge them harshly.

The best scenario for the most transparency is to publish all physician ratings from all sources, and also allow physicians to respond publicly to their critics. Judge and be prepared to be judged.

*** See other entries at in “Monthly Columns.” ***

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