What a total waste of ProPublica's time. A recent Mixergy interview[0] of MD Insider[1] paraded useless Yelp interviews of doctors as one of the reasons for starting their company. In one of the cleverest applications of big data I've seen, they process billions of medical billing records to generate the actual performance records of specific doctors for specific procedures. Alas, their business model requires selling to big companies with health plans, instead of allowing access by individuals. So we will all need to identify a friend who has access to MDinsider... :-)
It's weird how outright hostile doctor reviews are on Yelp. Every practice of more than 10 people in my area has reviews saying it's horrible. I can only imagine that there are doctors out there making sure every other practice has negative reviews.
> I can only imagine that there are doctors out there making sure every other practice has negative reviews.
Then your imagination is limited. It's more a function of the entire medical experience. Sick people are grouchy. Busy places with waiting rooms make people grouchier. Few doctors provide immediate relief, which means their patients often leave just as grouchy. And upset customers are drastically more likely to leave reviews than satisfied customers. It's just the nature of the business.
Also people are always upset when they visit the doctor. Because the vast majority of people will get told "you need to change your diet and exercise more" and that is not what people want to hear.
People (including doctors with regards to themselves) are terrible at judging health outcomes that don't involve a transition from "I'm going to die" to "now I will live" - the biggest predictor of patient opinion of the quality of their medical care in a hospital, for example, was always how nice the room was.
In addition, the realities of managed care and reimbursement rates mean that--for many types of practices--doctors have to see a pretty large volume of patients every day to be able to stay afloat. No doctor I've talked to likes this state of affairs, but it's a reality. This leads to dissatisfaction because patients feel that their doctor is rushing through the appointment without giving them adequate time. It doesn't necessarily mean they're getting substandard care, but it's also reasonable to feel angry or annoyed by that kind of interaction.
Conversely, many practices will do everything they can to maximize physician utilization, including scheduling lots of back-to-back appointments. Inevitably, if a doctor is actually doing a good job, some visits will uncover more complex health issues than planned and require more than the 15 or 30 minute allotted to address. This means that appointments start to back up, people start having long wait times to see their doctor, and patient dissatisfaction ensues. Again, this isn't a problem with individual doctors or practices-- although it may seem that way to patients--it's systemic.
>Every practice of more than 10 people in my area has reviews saying it's horrible.
People who have bad experiences tend to look for an outlet, and there aren't many ways to "punish" your doctor. The good experiences are never thought about again...
Honestly, I think it's more a function of culture in medicine. I've had many doctors, and the majority of them I could charitably call callous. It hasn't been just my experience, but those of most people I know as well.
That being said, both my current doctor and dentist were chosen partially on the basis of Yelp reviews. It's been a huge help, far nicer and far better service than I've ever had previously.
The truth is that many medical and dental offices offer horrible customer service, and patients aren't likely to leave a positive review for a medical or dental office on Yelp.
A couple of my family members have put their medical and dental offices through the Scheduling Institute[1]'s on-site consulting. The day starts with an institute trainer picking up the phone book, and calling several competing practices in the area to try and make an appointment.
Invariably, the receptionists are brisk, and often outright hostile. They get long hold times, and very poor customer service. And that of course doesn't end once the patient actually makes it to the practice.
There are reasons behind this (overworked providers and office staff, a limited marketplace, poor customer service training), but the result is even if the actual provider gives great care, the overall patient experience can be pretty shitty.
The other challenge I've experienced with my wife's medical practice (which puts an emphasis on customer service) is that patients don't really think about reviewing their doctor on yelp for a "good" experience. We do patient satisfaction surveys, and while the vast majority of patient's who respond to the surveys are very happy with their care, very few will leave a Yelp review about it.
We do just about everything we can without outright asking for Yelp reviews (check-in offers, prominently linking to Yelp from our site etc.), and still only 0.2% of her patients have left a review on Yelp, and only about 25% of those reviews have made it through Yelp's filtering process to actually post.
The other contributing factor is that older people use healthcare more than younger people, and older people aren't as likely to use Yelp. When I have a positive experience at a local business, I'll leave them a review on Yelp as a way of saying "thank you." If my wife could trade every jar of jam, or tray of cookies she got from a grateful patient for a positive Yelp review, she'd have hundreds of 5* reviews and I'd probably be a few lbs thinner.
There is a very strong correlation between a doctor caring about you and giving you good care. So I think the Yelp reviews are somewhat valuable.
On the other hand, the woman who gave her dentist a low score should also be considered. Was the treatment her dentist recommended really unnecessary? My dentist has told me that I should look into getting my wisdom teeth removed, since they might become a problem later. Is this necessary? Right now it isn't. Tomorrow my gums could become inflamed and I would be unable to chew and will need immediate surgery. At what point is that surgery necessary?
However, a good dentist should have given her enough explanation so she can make the choice herself.
In the end, I don't really want to end up in a situation where doctors optimise for good review scores on Yelp at the expense of providing good care.
I have found that at least dentists often have a perverse incentive to provide unnecessary treatment. I was told I needed the wisdom teeth pulled, fell for that. Then that my front tooth that has a crown "was just about to break" needed some other expensive thing done -- except that "just about to break tooth" was fine 10 year before and is still fine 5 years later.
Then went to see another one, she zoomed on another tooth and said that one "needed urgent root canal" while previous dentist had something else "urgent" in a completely different tooth.
I've had around 4 dentists over the space of ~3 years since my long time one retired, and they all seem to have vastly different opinions about what dental work is necessary, preventative, unnecessary.
With my original dentist I never had any fillings.
As soon as the next dentist came in she recommended 2 fillings and then a later 3rd. Of these filings, one didn't even require anaesthetic for her to drill and complete the filling.
After this dentist left, the next had a policy of, if it isn't causing you pain, filling it is unnecessary (because you often have to drill a tooth slightly to fill it, damaging the tooth worse).
That dentist eventually moved on, and two of those earlier fillings fell out within a month of each other (really not a good time having to carefully eat around these teeth, one on each side of my mouth), and the new dentist gave me two root canals because the roots in the affected teeth had apparently died (potentially my fault, for delaying an appointment due to the timing being several weeks before I was to leave uni). Several months after these root canals had been completed, I had an abscess on one of these teeth, but it passed after a weekend of paracetamol(?). One of these root canal'd teeth then further broke, and the dentist recommended having a crown placed on the tooth, I did enquire about simply having the tooth removed because it had become so much hassle, but the dentist was really against it.
Due to my situation of being at university, and having to travel several hours down the country for each dental appointment, and the need for 4+ appointments to have 2 crowns I opted to visit a dentist local to my university. They ended up recommending removing both the root canal'd teeth (one specifically because the tooth had broken below the gum-line, so it should not be crowned/filled) and they also applied dental sealant to an unrelated tooth. This dentist also stated, if you have an abscess on a root canal'd tooth, that it has become infected, and that infection is unlikely to ever go away, it will simply come back when your immune system is weak (at the initial abscess I had been doing a 48 hr all-nighter for a large assignment deadline), so it's best to have these teeth removed.
tldr; Dentists in my own anecdotal experience can have vastly different opinions of best practise.
I'm also UK based, so dental treatment is relatively inexpensive, due to the NHS funding a large part of it.
I...just...Where I am, a root canal runs to 2k USD, and a crown to 1k USD, out of pocket because dental is often not covered by medical insurance. Can you feel my jealousy?
> Acupuncturists, chiropractors [...] did far better, with average ratings of 4.5 to 4.6.
Surprise, charlatans who promise that they'll make everything ok by poking you with needles/adjusting your spine get better reviews than the honest doctor who says "Quit smoking or you'll get emphysema".
To be fair the " Acupuncturists, chiropractors [...]" have to learn to sell themselves, and market themeselves because people are more likely to be paying out-of-pocket for the services. If people have a bad experience they won't come back, they go out of business. With doctors if they have a bad experience they will probably still come back because they need some medicine, whatever.
Completely agree, but I think there is definitely a place for the "office staff were rude and/or incompetent" type of stuff. Been to too many places where the staff acts all annoyed or put off at having to reschedule, or update my information, or even just check in when I arrive for an appointment. "Sorry for annoying you with my business"
Definitely, but I always take Yelp complaints of rudeness with a grain of salt. I swear some of these reviewers sit in restaurants with a stopwatch timing how long the waiter takes to check up on them... too long and they were "inattentive and rude", too short and they were "rude and trying to hustle us out the door".
I have always been interested in the fact that many insurance companies will pay for acupuncture. My guess was that their statisticians must of been able to determine that getting those treatments will at the very least reduce the overall cost of treating a patient.
That always led me to believe it must be having some sort of a provable positive effect on the patients.
Or it may simply be cheaper than having them go through the regular medical circuit with essentially no effect at the end of the bunch of expensive diagnosis. Some people just want the attention of a doctor and already feel better just because of that. A real doctor will tell them there is nothing wrong with them so there is nothing to fix which won't leave them satisfied so they'll go back over and over again.
By contrast, an acupuncturist that charges a fraction and pretends to cure them is more effective.
"Well, there's probably nothing wrong, but there are some test we can run to be sure."
The patient agrees to the tests because it gives them peace of mind and they mostly don't pay for them, their insurance does.
The doctor orders the test because if they don't and there is some sort of rare problem that was actually present, they can be sued for malpractice. GPs in the US generally aren't making any money from these tests, but they do have a strong incentive to avoid a malpractice lawsuit as those are costly and time consuming.
But yes, this is part of why US healthcare is so expensive.
There are studies that show that sticking needles into the skin have various positive effects, but the whole chi/meridians/acupuncture points is complete pseudoscience.
So sticking needles places --which is what acupuncture does-- works fine, but the names used to describe it --which is what that chi/meridians stuff is-- mean that it's bunk? Why --because you saw a bunch of films attributing magic powers to chi? How are those films significantly different than any science-based event in any Hollywood film ever?
The difference is that acupuncturists claim that it is far more nuanced than it has been scientifically proven to be and justify that claim with a lot of pseudo-scientific woo.
There is basis for the claim that sticking needles in people can help with some ailments. There is no basis for the claim that meridians are a thing and in any way relevant to those effects.
Acupuncturists may not entirely be charlatans. When I went to Physical Therapy I had dry needling done which is basically acupuncture on the effected area. It really helped with inflammation and gave me relief.
Most times I've never had any relief after going to a doctors office. Muscle and back problems are like moving teeth with braces, you need to keep working on it or the muscles (or teeth) will go back to the original position.
No doubt there is interesting data to be mined here, but I wouldn't rely on it solely. The vast majority of patients are not in a good position to evaluate the quality of care they received. The kind of things they typically judge by are often fairly superficial attributes:
* did I have a long wait time?
* was the office staff polite and helpful?
* was my physician/NP/PA polite and helpful?
* were there billing problems after the appointment?
These things do matter, but there are more important factors in play that patients are not in a position to judge:
* were standards of care followed by the provider?
* were unnecessary tests ordered or unnecessary drugs proscribed?
* were necessary tests skipped or necessary drugs not proscribed?
* if they had access to my medical history, did the provider bother to review it before seeing me
* etc, etc.
Quality of care can absolutely be evaluated, and that's happening more and more, it's just that patient satisfaction is only one small part of the whole picture.
Yeah, that's a big problem with democratization of these kinds of things. It's hard for me as a layperson to judge the the talent a specialized professional. All I'd be able to judge are the softer qualities.
The things which actually matter like total cost and effectiveness of treatment, etc. Are hard for a single person to judge -teams would have to study and compare data, rather than feelings.
So what we can end up getting, if this how doctors get reviewed, is them acting more as feel good doctors, than actual physicians giving you hard advice.
True, but Dr. Offices are a business. And in smaller offices, the Dr. is the Owner/Manager. Frankly, for the vast majority of Dr. visits, you're there for routine or minor care, and a badly run business will simply keep me away.
I don't care how good a chef at a restaurant is, if it takes me 2 hours to order and wait for food, the silverware is dirty, and the surroundings are miserable, I'm never coming back.
The concern is that increased attention to superficial details will advantage poorer doctors who are better at customer service, which isn't a win for consumers.
Already in this story you see the effect of massage therapists being statistically advantaged over internal medicine doctors. That's obviously silly, but the same effect happens within the medical profession, between different doctors.
It's true in the short run, though it will also place a much higher value on those doctors that are good at what they do, and run a good business. And those are the offices that will benefit the best in the long run.
At the very top tier, the most advantaged professionals will be those doctors who are fundamentally effective and apt at customer service. Surfacing them is a win for consumers.
But the next tier after that will be a raft of professionals who are not necessarily effective, but still apt at customer service. Elevating them is a loss for consumers.
The question you then want to ask is, is it harder to be good at customer service, or harder to be good at internal medicine? I think customer service is easier, and thus worry that the second tier will be the largest of the tiers.
An easy response to this is to say that doctors will learn to get better at customer service. Maybe. But the effect I'm talking about also happens if we stipulate that none of these professionals really change at all, and instead the market just changes the way we sort them. I think that is likelier than the scenario where doctors who are not simultaneously good at medicine and managing an office suddenly figure out customer service.
Small single practices office are going away. Doctors are corporatizing either by merging with other practices or being bought out by hospitals or hospital groups. The reason: electronic medical records and new regulatory requirements. The burden of these regulations has been making it increasingly costly to run single doctor practices. So the result is less choice (in business) and less control for the doctor over the patient experience.
In conclusion, it is a nice idea to think of the doctors as "business people" but the reality is there are fewer and fewer who are. Most are now employees in a large corporate system.
A long time ago, I made a chart containing the density histogram for ratings in each category of Yelp businesses via the academic dataset: http://i.imgur.com/PqU30Ma.png
Health and Medical reviews in general are skewed a bit toward 5 stars. The average rating for Health business in general (3.87) is on par with that of other categories.
Not a Yelp apologist but this confirms how easy it is to maintain decent Yelp reviews: don't be rude. Pretty much every complaint can be rectified by politeness. Any polite person should be able to easily get a job.
Would it make sense or be workable for Yelp to somehow take into account geo-location? I know it would not make sense to limit reviews to people who have been at the location but there must be some way to usefully take this into account.
> “Choosing a physician is more complicated than choosing a good restaurant, and patients owe it to themselves to use the best available resources when making this important decision.”
And what are those resources?
I'm actually looking for a new PCP in NYC and there are hundreds or thousands of options. It feels like my best course of action is to just pick one at random.
43 comments
[ 3.5 ms ] story [ 97.0 ms ] thread[0] http://mixergy.com/interviews/david-norris-md-insider/
[1] http://mdinsider.com/
Then your imagination is limited. It's more a function of the entire medical experience. Sick people are grouchy. Busy places with waiting rooms make people grouchier. Few doctors provide immediate relief, which means their patients often leave just as grouchy. And upset customers are drastically more likely to leave reviews than satisfied customers. It's just the nature of the business.
People (including doctors with regards to themselves) are terrible at judging health outcomes that don't involve a transition from "I'm going to die" to "now I will live" - the biggest predictor of patient opinion of the quality of their medical care in a hospital, for example, was always how nice the room was.
Conversely, many practices will do everything they can to maximize physician utilization, including scheduling lots of back-to-back appointments. Inevitably, if a doctor is actually doing a good job, some visits will uncover more complex health issues than planned and require more than the 15 or 30 minute allotted to address. This means that appointments start to back up, people start having long wait times to see their doctor, and patient dissatisfaction ensues. Again, this isn't a problem with individual doctors or practices-- although it may seem that way to patients--it's systemic.
People who have bad experiences tend to look for an outlet, and there aren't many ways to "punish" your doctor. The good experiences are never thought about again...
That being said, both my current doctor and dentist were chosen partially on the basis of Yelp reviews. It's been a huge help, far nicer and far better service than I've ever had previously.
A couple of my family members have put their medical and dental offices through the Scheduling Institute[1]'s on-site consulting. The day starts with an institute trainer picking up the phone book, and calling several competing practices in the area to try and make an appointment.
Invariably, the receptionists are brisk, and often outright hostile. They get long hold times, and very poor customer service. And that of course doesn't end once the patient actually makes it to the practice.
There are reasons behind this (overworked providers and office staff, a limited marketplace, poor customer service training), but the result is even if the actual provider gives great care, the overall patient experience can be pretty shitty.
The other challenge I've experienced with my wife's medical practice (which puts an emphasis on customer service) is that patients don't really think about reviewing their doctor on yelp for a "good" experience. We do patient satisfaction surveys, and while the vast majority of patient's who respond to the surveys are very happy with their care, very few will leave a Yelp review about it.
We do just about everything we can without outright asking for Yelp reviews (check-in offers, prominently linking to Yelp from our site etc.), and still only 0.2% of her patients have left a review on Yelp, and only about 25% of those reviews have made it through Yelp's filtering process to actually post.
The other contributing factor is that older people use healthcare more than younger people, and older people aren't as likely to use Yelp. When I have a positive experience at a local business, I'll leave them a review on Yelp as a way of saying "thank you." If my wife could trade every jar of jam, or tray of cookies she got from a grateful patient for a positive Yelp review, she'd have hundreds of 5* reviews and I'd probably be a few lbs thinner.
1: https://www.schedulinginstitute.com/
On the other hand, the woman who gave her dentist a low score should also be considered. Was the treatment her dentist recommended really unnecessary? My dentist has told me that I should look into getting my wisdom teeth removed, since they might become a problem later. Is this necessary? Right now it isn't. Tomorrow my gums could become inflamed and I would be unable to chew and will need immediate surgery. At what point is that surgery necessary?
However, a good dentist should have given her enough explanation so she can make the choice herself.
In the end, I don't really want to end up in a situation where doctors optimise for good review scores on Yelp at the expense of providing good care.
It's a thorny issue.
Then went to see another one, she zoomed on another tooth and said that one "needed urgent root canal" while previous dentist had something else "urgent" in a completely different tooth.
With my original dentist I never had any fillings.
As soon as the next dentist came in she recommended 2 fillings and then a later 3rd. Of these filings, one didn't even require anaesthetic for her to drill and complete the filling.
After this dentist left, the next had a policy of, if it isn't causing you pain, filling it is unnecessary (because you often have to drill a tooth slightly to fill it, damaging the tooth worse).
That dentist eventually moved on, and two of those earlier fillings fell out within a month of each other (really not a good time having to carefully eat around these teeth, one on each side of my mouth), and the new dentist gave me two root canals because the roots in the affected teeth had apparently died (potentially my fault, for delaying an appointment due to the timing being several weeks before I was to leave uni). Several months after these root canals had been completed, I had an abscess on one of these teeth, but it passed after a weekend of paracetamol(?). One of these root canal'd teeth then further broke, and the dentist recommended having a crown placed on the tooth, I did enquire about simply having the tooth removed because it had become so much hassle, but the dentist was really against it.
Due to my situation of being at university, and having to travel several hours down the country for each dental appointment, and the need for 4+ appointments to have 2 crowns I opted to visit a dentist local to my university. They ended up recommending removing both the root canal'd teeth (one specifically because the tooth had broken below the gum-line, so it should not be crowned/filled) and they also applied dental sealant to an unrelated tooth. This dentist also stated, if you have an abscess on a root canal'd tooth, that it has become infected, and that infection is unlikely to ever go away, it will simply come back when your immune system is weak (at the initial abscess I had been doing a 48 hr all-nighter for a large assignment deadline), so it's best to have these teeth removed.
tldr; Dentists in my own anecdotal experience can have vastly different opinions of best practise.
I'm also UK based, so dental treatment is relatively inexpensive, due to the NHS funding a large part of it.
Surprise, charlatans who promise that they'll make everything ok by poking you with needles/adjusting your spine get better reviews than the honest doctor who says "Quit smoking or you'll get emphysema".
http://well.blogs.nytimes.com/2012/09/11/acupuncture-provide... http://archinte.jamanetwork.com/article.aspx?articleid=13575...
THAT SAID anybody who claims they can adjust your chi or cure cancer is a charlatan and deserves prison time.
That always led me to believe it must be having some sort of a provable positive effect on the patients.
By contrast, an acupuncturist that charges a fraction and pretends to cure them is more effective.
"Well, there's probably nothing wrong, but there are some test we can run to be sure."
The patient agrees to the tests because it gives them peace of mind and they mostly don't pay for them, their insurance does.
The doctor orders the test because if they don't and there is some sort of rare problem that was actually present, they can be sued for malpractice. GPs in the US generally aren't making any money from these tests, but they do have a strong incentive to avoid a malpractice lawsuit as those are costly and time consuming.
But yes, this is part of why US healthcare is so expensive.
There is basis for the claim that sticking needles in people can help with some ailments. There is no basis for the claim that meridians are a thing and in any way relevant to those effects.
Most times I've never had any relief after going to a doctors office. Muscle and back problems are like moving teeth with braces, you need to keep working on it or the muscles (or teeth) will go back to the original position.
* did I have a long wait time?
* was the office staff polite and helpful?
* was my physician/NP/PA polite and helpful?
* were there billing problems after the appointment?
These things do matter, but there are more important factors in play that patients are not in a position to judge:
* were standards of care followed by the provider?
* were unnecessary tests ordered or unnecessary drugs proscribed?
* were necessary tests skipped or necessary drugs not proscribed?
* if they had access to my medical history, did the provider bother to review it before seeing me
* etc, etc.
Quality of care can absolutely be evaluated, and that's happening more and more, it's just that patient satisfaction is only one small part of the whole picture.
The things which actually matter like total cost and effectiveness of treatment, etc. Are hard for a single person to judge -teams would have to study and compare data, rather than feelings.
So what we can end up getting, if this how doctors get reviewed, is them acting more as feel good doctors, than actual physicians giving you hard advice.
I don't care how good a chef at a restaurant is, if it takes me 2 hours to order and wait for food, the silverware is dirty, and the surroundings are miserable, I'm never coming back.
Already in this story you see the effect of massage therapists being statistically advantaged over internal medicine doctors. That's obviously silly, but the same effect happens within the medical profession, between different doctors.
/endrant
But the next tier after that will be a raft of professionals who are not necessarily effective, but still apt at customer service. Elevating them is a loss for consumers.
The question you then want to ask is, is it harder to be good at customer service, or harder to be good at internal medicine? I think customer service is easier, and thus worry that the second tier will be the largest of the tiers.
An easy response to this is to say that doctors will learn to get better at customer service. Maybe. But the effect I'm talking about also happens if we stipulate that none of these professionals really change at all, and instead the market just changes the way we sort them. I think that is likelier than the scenario where doctors who are not simultaneously good at medicine and managing an office suddenly figure out customer service.
In conclusion, it is a nice idea to think of the doctors as "business people" but the reality is there are fewer and fewer who are. Most are now employees in a large corporate system.
(also +1 to the sibling comments)
Health and Medical reviews in general are skewed a bit toward 5 stars. The average rating for Health business in general (3.87) is on par with that of other categories.
And what are those resources?
I'm actually looking for a new PCP in NYC and there are hundreds or thousands of options. It feels like my best course of action is to just pick one at random.