How Physicians Can Navigate Online Reviews and Transparency

The best way physicians can adapt to patient feedback online is to actively participate in the online review process, the chief medical officer of Press Ganey says.

Whether physicians like it or not, online reviews and transparency are an expanding feature of the healthcare landscape.

That's the conclusion of Thomas Lee, MD, chief medical officer of South Bend, Indiana-based Press Ganey Associates and a practicing primary care physician.

Prior to joining the Press Ganey staff in 2013, Lee was network president for Boston-based Partners Healthcare System and CEO for Partners Community HealthCare Inc.

In addition to his role at Press Ganey, Lee serves on the board of directors at Geisinger Health System in Danville, Pennsylvania, and holds professorships at Harvard Medical School and the Harvard School of Public Health.

HealthLeaders spoke recently with Lee. Following is a lightly edited transcript of that conversation.

HL: What are the primary online review concerns for physicians?

Lee: Press Ganey has done a lot of quantitative analysis of what really matters to patients—what drives their likelihood to recommend.

The analyses of millions of patient surveys indicate it is more about the "how" of what is delivered rather than the "what." Was the care coordinated? Was the care empathic? Was there good communication?

Our data overwhelmingly indicate that if we get the "how" right, then patients cut us slack on the "what." We rarely find that waiting time is a driving factor of likelihood to recommend. Patients don't like to wait, but the statistical drivers are about the "how." Was the teamwork good? Was there empathy? Was there good communication?

This is good news. These factors are within my control as a physician. I can control whether I am empathic. I can control whether I make an effort to have the care coordinated. I can control whether I communicate well.

HL: Why should physicians participate in online reviews?

Lee: They should participate in the process and drive it for multiple reasons.

A not-so-lofty reason is that it is going to happen to you anyway. HealthGrades, Vitals, and other websites are collecting information and posting it. They won't have very many patients, and the ones who log on will be disproportionately negative. So, you should take control and post reviews on your own website because it's going to happen anyway, and it's going to be done in a way that is not going to make you look great.

A little loftier, posting your reviews online is good marketing. Google and other search engines prioritize the websites that have more data. So, if you take control of online reviews, not only do you have a better snapshot of how your patient population feels—which tends to be positive—your website gets pulled to the top.

The best reason to post reviews online is it makes physicians better. It's a vivid reminder that every interaction with a patient is a high-stakes interaction. All you have to do is be the kind of clinician who patients are hoping for—and the kind of clinician you want to be.

Transparency puts the focus on the future. It nudges physicians to be reliably at their best.

HL: How can physicians promote generation of positive reviews?

Lee: The way to get positive reviews is to be the way you want to think of yourself reliably. It's not hard. If you sent a relative to me, my goal would be for that relative to say to you, "Thanks for sending me to Tom Lee. He was fantastic." Virtually all physicians know how to make that happen.

The real question is, are we going to be reliable in treating our patients. That is all that it takes to get patients to write positive reviews about you.

HL: How can physicians react constructively to negative reviews?

Lee: First, if there are no negative reviews posted, it just doesn't look credible. So, you should not weed out negative reviews.

My last negative comment was from February 2018 about the completeness of my patient notes. When I first saw that review, I felt not all of the patient's comments are important and I'm not going to spend my time typing. Then I calmed down and behaved more maturely. In this era of open notes, I realized the notes I take are not just for me. My notes are a way of communicating with my colleagues as well as the patient, and I needed to improve. I learned from that feedback.

HL: What is the next frontier for online reviews and transparency?

Lee: The broad theme in transparency is collecting information from patients.

For a long time, there has been an information imbalance in medicine, where physicians and other healthcare professionals have known more than patients about medicine. Now that baby boomers have reached Medicare age and are more frequently patients, what is becoming clear is that there is a second information imbalance—patients know more than physicians do about what is important to them.

So, the collection of information from patients to correct that second information imbalance is going to be one of the major themes in the evolution of healthcare over the next 10 to 20 years.