Online reviews for doctors are here to stay. Letting patients review their doctor sounds great right? What could go wrong?

That being said, there are several things that reviews do that is, in fact, damaging to the care of patients in medicine.  Here are six things that many physicians now do in the world of online reviews.

Focus on showmanship not results. “Sometimes I spend extra time on the exam even when I already have nailed the diagnosis so that patient thinks I am really doing a thorough exam.”

There are times when an experienced physician can walk in the room, take one look at a patient and know exactly what is going on.  That is what training and years of experience teach us. That being said, the average patient really appreciates that. They want the physician to spend time talking, touching and examining them. It is part of the patient experience which has nothing to do with them getting better but everything to do with them feeling better (about their appointment).

I have had colleagues who spend extra time listening to the heart of a patient or performing unnecessary tests during an eye exam, so the patient perceives the doctor is “thorough” for the purposes of getting a good review. Somehow being able to diagnose a rare disease across the room is of no value unless it is accompanied with a 30-minute smoke and mirrors exam.

Turn away patients for fear of bad reviews. “I knew if the surgery didn’t work she was going to destroy me on an online review, so I told her to go to a different doctor.”

There are patients who are tough. Patients are regular people, and there are people who can receive an explanation 100 times the risks or success rates of the surgery and if it doesn’t work get upset and  write terrible reviews of their doctor. Surgeons used to take on those patients to “prove them wrong” or “take on a difficult case.” Now, those patients are being turned away as a “difficult patient” for fear of a bad review.

Not going into “low satisfaction” fields. “Man, who wants to go into ER medicine. It seems like everyone is just pissed at them.”

If you look at reviews of pain doctors, they are usually terrible. Why? Most patients who are going to see pain doctors are either a. In pain and can’t get their pain medicine fast enough or b. are pain seeking and are about to not get pain medicine from the doctor.  Specialties that are more challenging may have people shy away from because of the  constant negative reinforcement they get online.

Focus on “high success” procedures in their own field. “Why do something scary like an orbital decompression when I can just do a blepharoplasty? I get paid almost as much. The patient is happier, and my practice grows.”

Each specialty has more difficult surgeries and also chip shots. Doctors who are tired of bad reviews for difficult cases will simply not do them. There are “oculoplastic surgeons” who do not perform orbital surgery; only eyelid lifts for a simple reason: happy patient, easier procedure,  and good reviews. Taking on tough cases feeds one’s sense of “being a good doctor or a tough doctor.” Your colleagues may respect you but does that matter if you have 1.5 stars?

Offer unnecessary testing and medicine. “If a patient comes with an eye movement problem and you don’t order some test, they are going to leave pissed.”

There are many diseases that get better on their own.  That being said, at the initial exam if you just tell a patient it is going to get better in 12 weeks, patients tend to not like it. To quote a patient speaking to my staff after an exam with a self-resolving problem: “He didn’t even do anything!”

The data shows overwhelmingly that patients prefer more testing. This is not in their best interest in terms of cost and complications. CT scans have radiation exposure. Spinal taps can lead to infections.  There is a doctor who gives an MRI to every patient who walked through his door. He told me that “patients liked it better.” Enough said.

Medications are the same. Giving medications to patients in order to “give them something” exposes them to risks without a clinical benefit. This is one reason that antibiotics are so overprescribed.

Spend time encouraging patients to write reviews instead of focusing on their health. “I ask all my normal patients to write reviews so it cancels out the eventual negative review that will come eventually. If I don’t, my ratings will be terrible.”

Often if a patient has a good experience with a doctor, they don’t write a review unless they are asked. If a patient is very unhappy, they will write a review. So if one of my colleagues sees 10 patients and only the one unhappy patient writes a review, it will appear that their satisfaction is 1 out of 5 stars. To counter it, they have to beg their other patients to write good reviews to cancel out that 10th patient. In some offices, they, in fact, make patients fill out a review before they leave the office. This is time where it could be spent on more important things. Like the well-being of the patient.

As can be seen, the road to online reviews may be paved with great intentions but can have many untoward effects. I am fortunate (and lucky) to have decent online reviews, but I know for a fact that these six points affect all physicians, especially ones who are in tune to the online world. I am not sure if online reviews are having the effect that was intended when they were created.

Chris Thiagarajah oculoplastic surgeon and can be reached at his self-titled site, Chris Thiagarajah, MD.

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