If you Google a physician’s name,  you are likely to find as the first, second and third offerings, descriptions by doctor rating intermediaries. Those come well before biographies from the physician’s employer.  If your doctor is published or well- known, ratings by these agencies still  pop up first on web searches, because they have arranged it that way.  I might never have noticed this except I had an incident about 6 years ago, when someone  wanted me to prescribe narcotics.  Thinking that person might be narcotics-dependent, I declined.  Over prescribing narcotics, like antibiotics, and many drugs, may please patients, but physician prescribing, is just about the most important single cause of iatrogenic illness,  especially drug addiction. In any event, this patient was displeased, but was honest enough to warn me,  along with his partner, that they would go straight to the computer and submit low ratings to these online agencies. I thought little of it at the time.

One day,  in Googling myself. I was mortified to find I my low rating. I had two persons who submitted good ratings and the other two from the above encounter on a  5 star rating system that gave me very low grades. I  found on these sites,  that doctors were rated, not at all by their education, background, experience or qualifications, but entirely on the basis of patient reports. A great doctor had close to a 5 star rating.  A few doctors may have learned to game the system and might have asked patients who liked them to send in a highly rated reports, or perhaps they had their friends do it. But the vast majority had under10 ratings, actually mostly under 5.  Of course, these are not statistically or scientifically valid because people who send in these ratings on their own tend either to be either pleased or disgruntled.

I also found that many of biographical details on these sites, by now I had looked at more than one, were inaccurate. In my own case they had my years of practice, my training institutions, and hospital affiliations all wrong and mine was the simplest of all biographies as I am not an immigrant, trained in one place, and practiced 25 years at one location. I could not understand some of my listed hospital affiliations as I had nothing at all to do with those institutions. It wasn’t because of my name which is very uncommon.  Determined to go a little further I checked the backgrounds of physicians I know and found their particulars to have many inaccuracies as well.

It happened that my brother was out to dinner with his friends and it came up that I am a physician. Without a moment’s hesitation,  one of them flipped out their smart phone and found me. “Yeah but he’s not very good. He rates 2.5 out of five stars.”  On that basis my brother was chagrined but could afford to be more charitable as he knows me, but even he may have had a hard time assessing the validity of such a rating.  Now when you as a consumer are deciding about which  hotel  to stay at,  you look at consumer ratings. In that case you typically have hundreds of opinions and they are collected by a valid method. But doctor ratings are initiated by the rater,  and numbers of ratings are typically in the single digits. We also know that patients may go away dissatisfied especially in the case where, despite your best explanations, the hapless physician, wanting always to do no harm, may let them go without a prescription. The easiest thing in the world for the physician is to write a prescription just to please someone, but drugs may do great harm. The classic case is the mother who just can’t be persuaded  an antibiotic is not the best thing for her infant’s ear infection. Despite all the brochures and explanation people have fixed beliefs and lots of treatments are counterintuitive to a person who has no medical training.  Sometimes a doctor may have to tell patients things they don’t want to hear. Doctors with the 5 star ratings may well be the smiling go along patient- pleasing weak practitioners.

My  patient ratings were on the Internet for years and other “rating companies” obviously copied them too, so if anybody looked, I don’t know how many do, this was a serious problem. I emailed this particular company  a couple of times and got no response at all. I asked them to call and gave all of my contact information. After many tries, years apart, they finally did respond and took off these by then, ancient ratings. But by that time I did not wish to deal with them at all. I vexed myself quite a bit over this. I thought of soliciting patients to write nice things and I suppose I could have done that but it seemed dishonest,  or of hiring an attorney, or going to places like Reputation.com.  If this happened to me, I am not out of the ordinary at all, so I presume it is the same with many thousands of physicians, who are well meaning, build and hone their CV and reputations over years of practice, and then fall prey to dishonesty or, at the least, flawed methodology.

I am writing this now, because just  yesterday I was at our Neurology Academy meeting,  where this company had a booth, so I stopped by.  Of course, the people who actually run things were not there, but I let them know of my displeasure.  They did not care. The fellows that I met were programmed to have physician sign into their  systems and create members.  Everybody wants the doctor’s imprimatur.  They suggested I game the system by having more patients submit ratings.

The Federal Government has long ago gotten into the act of rating physicians and hospital systems on the basis of patient reports. These will determine reimbursements for hospital systems. So physician employers are hounding their doctors to improve their ratings. Hopefully, the statistical method will be a little better than that used by the health grading Internet presences in that the number of ratings is bound to be at least more  than 10, but not necessarily.  I have found patients feel strongly about the darndest things.  You may have saved their life by rushing them into the cath lab and removing a lethal blood clot, or made a timely diagnosis to rescue them from the jaws of death. But then they will complain about a frayed carpet, or that they didn’t get enough steak on their dinner tray which doesn’t teach healthful eating habits. Good and bad aspects of their care are largely invisible to them and they are bound to judge on the basis of superficial criteria.  All of this is hard for doctors to understand because we are used to being graded by people who know more than we do, such as mentors or professors, but now we are rated by those who know little about what we do, and where aiming to please may be equivalent to malpractice.

I suggested the following in communicating with this Internet entity. I doubt they were listening:

1. Using patient ratings is OK as a start, but go out and get these ratings yourself and make sure you’ve collected a large enough statistical sample. Collecting a few comments from patients who happen to feel strongly for one reason or another is  invalid.

2.  There is a high level of inaccuracy also in your physician backgrounds/biographies, thereby further misinforming the public. Take pains to get accurate information.

3.  Valid rating of doctors and health care entities surely must take into account factors other than patient ratings. These factors may be harder to understand but are worth exploring.

What’s more important to any of us, especially professionals,  than our reputation?