How Yelp Reviews Can Help Improve Patient Care

Choosing a physician based solely on Yelp reviews, or any other social media, is ridiculous.

I am a breast -cancer survivor, and I choose my first plastic surgeon based on recommendations from friends and coworkers--I did not use any social media when I hired him. Unfortunately, due to the poor job he did, I had to replace them, at my own cost. The second, more-qualified plastic surgeon fixed these issues, and he was NOT happy with what he found!

Because so many people rely on Yelp, I tried writing a negative review about the first guy. I carefully outlined the issues, kept emotion out of the review, and posted it. It got deleted entirely.

Indeed, too many of these reviews are inaccurate and biased--very sad. Good luck to future patients of this guy! They will need it.

I would suspect that many aspects of patient satisfaction and the quality of care are related to how well the hospital or practice is managed. Furthermore a bad attitude of the physician may cause both poor patient reviews and poor decisions.

As an Emergency Physician practicing in a private (but inner-city) ER, I have been involved in the discussion of "ratings" and "patient satisfaction" since I entered med school. The pushback from my profession is real and is fairly unified for myriad reasons. Firstly, those who've determined that satisfaction correlates with outcome measures are indeed the hoards of healthcare administrators who are not involved in the medical sciences. These outcomes are rarely "patient centered", and are often arbitrary. As hospital hallways fill with these suited business-folk, the concept of running the place like a hotel instead of a place where we try to heal people and curb suffering takes hold.
Secondly, physicians think with a scientific mind. When a peer survey is published in my favorite Emergency Medicine journal, it is recognized to be one of the LEAST powerful data sets weighed down by enormous bias. Yelp, RateMD.com, and Press-Ganey are all completely unscientific ways of obtaining data on how patients feel about their experience. The sweet 83 year old lady I took care of last night who I developed great rapport with and seemed very happy with her care is not whipping out her iPhone 6s to "hit me up with a Yelp review."
Lastly, most physicians have read large studies showing no benefit and often harm with over-treatment, over-testing, and satisfaction-focused care which are often factors that patients deem important in surveys.
'Do no harm", especially just to satisfy.

It is surprising to read a Times column encouraging Yelp reviews, particularly regarding something as serious as medical care.
I encourage anyone interested in exploring Yelp more in-depth to learn about "Billion Dollar Bully", a documentary film currently in production. It is examining claims about Yelp's reported "extortion, review manipulation and review fabrication." This is a link to the film's site, which includes a trailer:

http://www.prostfilms.com/

Please see: The Cost of Customer Satisfaction Arch Intern Med. 2012;172(5):405-411
I am not convinced that there is a direct correlation between satisfaction and quality outcomes. In fact, the above is an excellent evidence based study following 51,946 patients over a 7 year period that strongly indicates a negative correlation. Patients were divided into 4 quartile from least to most satisfied. For every 100 deaths in the least satisfied quartile there were 126 deaths in the most satisfied quartile . This is quite understandable. Consider the following scenarios: #1 "Doc, I really hurt after this surgery and they are making me get up and walk 4 times per day." Ok, we will change that to twice a day. #2 "nurse, I'm hurting too much to cough like that" ok we will do that latter #3 "I really need that patient controlled analgesia (generally a dilaudid drip which controls pain while it decreases respiration and cough reflex) increased because I need to rest and I hurt " sure I'll get the doctor to increase the dose a bit. #4 "Doc, they are waking me up in the middle of the night to take my vital signs# ok we will change vital signs to ever 8 hours (therefore not catching early a downward trend). In all of these cases the patient is happier and more satisfied but in each case the probability of developing significant complications i.e. pneumonia, pulmonary embolism , decubitus ulcers, is significantly increased . The patient could very well die satisfied.

I'm not using any site that requires me to download their damn app.

Yelp is for naive, whiny, entitled millennials who think they know better than everyone else.

I don't agree with their opinions on restaurants so why exactly would I put any stock in their doctor ratings?

Did you die? If the answer is no, patient satisfaction is 100%.

Thanks NYT for this article. I frequently travel to different places in the USA as I have a sales job and this is my territory. I have always used Yelp to find great restaurants and when I hit looser - I YELP.

Have had some great experiences with a very good hospital group in Atlanta. Also had one with the largest hospital group that was totally unsatisfactory. I had as a primary care physician an internist - that is rare as internists are very well paid. This internist referred me outside her system to some buddies of her own for procedures I did not need.

I will YELP big time about this misguided internist.

My husband is a surgeon. He knows a particularly unscrupulous fellow surgeon who writes his own positive Yelp reviews and pays and cajoles others (staff/family) to do the same (same with the physician review website "Vitals")! Want to know a fairly sure way to know if the reviews are legitimate or not? Look at the dates of the reviews. If you see 5 star reviews, one after the other, day after day, chances are they are totally bogus and the doctor and his staff/friends are writing them themselves. What are the chances that a doctor would receive 20 reviews in a month? My husband will get one or two reviews in a month and then maybe none for months. Buyer beware.

As an MD and someone who has studied qualify of medical care, albeit in nursing homes, I get asked, like all healthcare professionals, who I would recommend. When the person asking is not in my geographic area, I tell them to ask their family and friends for ideas and, if possible, visit 2-3 docs and see how you get along with them before choosing one. I suggest that above using Yelp. Yes, you may need to pay out of pocket to do that.

Especially for common problems or general care, the universities aren't bad but there are also some great community docs whose focus is solely clinical care, not research, not administration.

What I've found is patients may or may not be able to judge technical care but in terms of personalities, one's patients' favorite doc might be another patients' unempathetic clinician. It's that old thing where docs in a practice can guess whose patient is which doc's by the patients' personality. Certain patients over time are drawn to certain docs.

Patient satisfaction is one aspect of quality, not the end all be all. We know that specialty orthopedic hospitals get 5 star ratings from Medicare, but hospitals that manage conditions without good treatment options (e.g. end-stage dementia, chronic non-cancer pain) or populations that have social issues that affect health but are difficult for the hospital to address rarely get 5 star ratings. Similarly, health care organizations that are not cosmetic procedure clinics or stand alone urgent care clinics rarely get Yelp ratings above 3.5 stars. I agree with Dr. Carroll that Yelp and review sites can be helpful to evaluate service quality, but we need to take reviews with a grain of salt given response bias and inherent limits to what modern medicine can and cannot treat.

People don't know the difference between a bad outcome and bad medicine.

I've seen incredible doctors with meh communication skills and very mediocre doctors with fantastic communication skills. Guess who patients like more...

Yes, I'm an M.D.

I would never use a doctor rating site-- yelp or any other -- it is very difficult to understand the level of competence in physicians except at the very far edges of both ends of the bell curve.

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I am a primary care physician who has been dealing with patient satisfaction surveys forever. According to the surveys my patients thought I was wonderful for years.Now I multitask when seeing my elderly complicated patients. I need to type in the computer while scrolling between multiple screens to review prior visits, diagnoses, medicine and allergy lists, lab and x-ray results, 6 page notes from the other eight specialists who expect me to oversee the patient's care as well as the lists of overdue tests (mammograms,etc.) and immunizations. I do all this while analyzing what my patient is saying as I try to figure out the cause of her complaints (this is a cognitive specialty) and how to provide appropriate care when she has a limited income. This is between messages from insurance companies re my treatment. As I multitask in this way I cannot make eye contact and engage my patients as I did in the past.My patient satisfaction scores plummet as may an annual bonus which depends on this.
At the end of the day I know I have done a good job which is verified by multiple objective measures. When forced to choose between engaging my patients on one hand or providing comprehensive affordable care in a complicated system, I choose the latter. Some may interpret this as arrogance. I look it as accepting limitations as a human being and making the well-being of my patients my top priority.

Patients who write reviews for web sites that purport to measure the quality and competence of physicians are in no way a random group; they are usually either especially happy or especially disappointed in whom they take the time to review, and the things they tend to care about the most are frequently not what is most important in effecting a good medical outcome. Good bedside manner, for example, tends to be regarded as one of the best qualities a doctor can have, largely because its easy for patients to gauge this. I believe it is indeed a great quality to have, but there is so much more that goes into making a great physician. I've known doctors who were truly wonderful people, with great bedside manner, but who were awful clinicians in most other ways -- yet their patients usually adored them. These doctors are likely to get rave reviews on the internet. Conversely, I've known a couple who had no people skills to speak of, didn't care to acquire any, but who were brilliant and ultimately very effective physicians -- but with awful reviews.

The major problem with Yelp and similar rating sites is that there is no meaningful verification of the identity, or possible agenda, of the reviewer.

If you live in the metropoltan New York area there is no mystery about how to select a good doctor. We have hospitals that do not permit incompetent physicians to be admitted or remain on their staffs Patients should check the hospital affiliations of doctors and ask where they admit patients. There are outstanding teaching hospitals here with medical schools and they are well known nationally. Selecting a doctor at one of these institutions does not guarantee anything and doctors at other hospitals may also be excellent but you increase your odds of having a good doctor and a good outcome substantially by selecting one at, say, New York-Presbyterian, Mt. Sinai or NYU-Langone or Memorial for cancer. All doctors know this.

Transferring care to a better institution is probably a prognostic variable. Really sick, not savvy and otherwise disadvantaged patients do not do well in this economy

I had a truly horrible experience with a new doctor whose practice and office was a complete disaster and so I wrote a detailed review only to have it buried. I emailed Yelp and asked why my review was buried (none of my countless others good/bad have ever been) and they never responded. To this day it bugs me that I couldn't warn others.

Unfortunately, Yelp favors frequent reviewers and those with a presence on social media sites. Thus, the occasional reviewer who has something very positive or negative to say about a doctor or facility will usually find their review consigned to the grayed-out area below the accepted reviews--and those are often the most useful reviews (like Amazon's one star write-ups).

This is really an excellent article.

Unfortunately the ratemds.com website mentioned was sold within the last few years, and the new owners wrecked the user interface, so it is almost unusable compared to its highly useful previous state.

Um, the "free market" has been working exceedingly well in health care, just not to the benefit of the patient.

This is a fantastic opportunity for the Department of Veterans Affairs to "buy in" by utilizing peer support to improve engagement and positive outcomes in primary care for veterans, though the use of the lived experience and "stories" of positive care at the VA. Furthermore, by having active engagement with the veteran, a reduction in acute medical conditions that require hospitalization are reduced, thus providing a substantial cost savings to the taxpayer while creating increased funding for other services at the VA. Let's get this done! Contact your Congressman and advocate for improving care for our Veterans.

When I was a student, I had to fill out course evaluations. I realized it made no sense to give a single number to summarize different aspects of 'treatment'. Eventually I realized I could summarize much using two scores: Were they competent as an instructor? And were they a decent human being, who treated their students with respect?

The last doctor I ditched may have been competent as a doctor, but failed miserably as a human being.

What this means in reality is not improved patient care. It means doctors have to perform well in popularity contests in order to get paid. Guess what happens when there is bad news to deliver?
Part of the mission of being a doctor is a duty to be as honest as possible with the patient and be there to help guide them through their reactions.
Being professional in medicine is much more important than being likable. Being your "best friend" belongs in some other profession.
I should know. I am a physician who, like the other 55% of physicians, is burned out by this inappropriate trend in medicine. We are scientists, not prom queens or football heroes.

I always check Yelp reviews before choosing a doctor, dentist or other health care professional. The strongest predictor of whether you will like something -- be it a hotel, restaurant or doctor -- is whether people before you have liked it. The only problem with Yelp is that not every doctor is reviewed by a sufficient number of people for me to gather a clear perception of them. I would love to see us ditch the narrowly focused HCAHPS for a full-on Yelp offensive.

Patients should be offered two opportunities to describe their satisfaction with medical and surgical care. The first should come at or near hospital discharge. The second should come much later, maybe six months after discharge, and would contain blunt questions, like "still happy with that new metal knee?"

From my experience, and that of several friends, the one thing which might improve patient satisfaction is for the v arious doctors to TALK with one another. Writing notes and memos which take days to transit a hallway is no substitute for face-to-fac e discussion of a mutual patient's condition and needs, and those of the family. This is nothing new, of course. Turf wars. have been going on forever. But if medicine is to truly become patient-centered and not disease-centered, people need to talk to other people.

I had a steel cage match with a Brookings guy last year over the value of patient reviews of healthcare services (full 411: https://www.brookings.edu/blog/techtank/2015/07/09/patient-reviews-of-ph.... We wound up agreeing that healthcare, as a system, can learn more from real-time reviews from patients and family/caregivers than from all the HCAHPS and Press-Ganey high-priced, 90-days-later surveys.

Press-Ganey and HCAHPS seem like antiques from a different epoch, given that real-time surveys could be deployed as part of the discharge and/or care delivery process ... IF the wallahs in the C-suites are willing to stop doing the same thing, over and over, expecting better patient satisfaction metrics.

The most useful reviews, of course, are actual constructive comments which are later read by a discriminating human with the power to make things change, if needed. But that doesn't come up with a numerical score, which can be easily tabulated into a chart or line graph.

However, it does seem appropriate that we could separate comments (or scores) concerning clinically relevant observations from those that are perhaps logistical or even aesthetic. Surely it is more important to know how many patients acquire infections that it is to know how many patients like the music playing in the lobby or the design of the new chairs. And yet the latter may be what people complain about.

Yelp! is a valuable tool for choosing doctors, however one must take into consideration the efforts of lawyers to remove negative reviews of their doctor clients. I received such a "cease and desist" letter when I posted a negative review of a doctor I had seen. The doctor's office responded on Yelp! with my personal medical information and THEN I received a threatening letter from an attorney, basically calling me a liar. So I'd say Yelp!er beware.

My health care provider sends me surveys. The surveys make me a little furious. They ask if it was hard to find a parking place. I don't drive, and walking to their door from the bus stop is murder. They ask if I thought the place was clean. They don't ask whether I got a sufficient explanation for what's wrong, and what to do about it. They don't ask about the black hole in their phone system. They don't ask how I feel about going through two levels of bureaucracy before I can visit the lab for a blood test. They don't even ask how I feel about being forced to listen to muzak. Is my health being treated appropriately? Probably. Am I happy? Not so much.

Mr. Carroll begins by stating that patient satisfaction scores 'aren't necessarily aligned with outcomes'. He never references the New England Journal of Medicine article that ties higher satisfaction scores to higher mortality. The fact is that I'm frequently at my best when I put satisfaction at risk; no you can't go out for a cigarette; no you cannot eat the McDonald's your family brought in, ...
He goes on to write that the health care system assumes it has figured out the best way to measure patient satisfaction. No one believes this. In fact, you'll notice that he doesn't identify true quality markers. Otherwise, why would we even be talking about Yelp! I love it when an academic explains how the "real world works" particularly by citing the value of checking with "other family members" because "they focus on safety in a way that patients may not be able to". Sure, the lightly informed, should be our guide. Nonsense.

"“It’s still unclear how people are getting the information to choose the hospitals"

Most people don't "choose" hospitals. They get sick and they go to the nearest Emergency Room. Whatever information they do get about hospital quality and safety is likely to come from the local hospital's PR machine.

I find Yelp of no value in reviewing doctors. Negative information is scrubbed or made less visible. Nearly all of these review sites are vulnerable to "Reputation" defending efforts by doctors tha make sure negative information is kept from the public.

Interesting, you don't mention vitals.com. I went to a lousy doctor who got top ratings on vitals, but when I checked Yelp later, they were in line with my experience. Yelp must be doing something right. Something is really wrong at vitals, and nobody should depend on their ratings.

Medicine's into marketing. After spending some 5 hours in the emergency room recently, received a survey in the mail that asked me to rate various interactions with staff. Seems instead of being a patient, I am now a CUSTOMER. But found myself appreciating the ability to give feedback and did so about a nurse who was a bit snotty and also was rather aggressive in giving an inoculation.

I am still looking at how to use and value Yelp. I use Yelp for a variety of purposes but the value of the reviews is questionable. When I read a review by a known reviewer I can take into account what I know of the reviewer. It is a more complex analysis, I am able to judge the review by what I know of the reviewer. On Yelp I don't know these reviewers and I cannot judge from their review the value of their opinion. Restaurants are a good indication. I mostly do not agree with the Yelp reviews of restaurants that I know. Which brings into question the ratings of restaurants that I do not know. To depend on Yelp for a review of health care seems especially tenuous except for maybe judging bedside manner of some doctors. My personal GP would fail the bedside manner test but his knowledge of medicine and my ability to talk and sometimes argue with him about my treatment makes him a valuable healthcare provider for me. My wife and my children cannot deal with his rigorous and authoritarian manner. They have their own GP. My GP's practice also has some of the more difficult patients with more and greater medical and health issues. So, the value of a Yelp survey might be questionable. Though, I see that if you give more reviews you are a more valuable Yelp reviewer. Maybe some way to judge the expertise of the reviewers would help to validate Yelp reviews immensely.

Here's the healthcare universe I see. The doctor is now the middleman and fall guy for all that's "wrong."
We are being down-cycled to data entry experts in 15 minutes, preferably less. Formularies make treatment a no-brainer because there is little choice.
To judge people's recovery (and doctor's performance) by a diagnostic category is specious, anyway. Hillary's recovery will be different from another woman her age with pneumonia. Sorry, G-d did not create Adams and Eves so that we could apply our statistics.
Anyone with significant health problems knows their choices of treatments and doctors have been curtailed, along with their rights to confidentiality and freedom to refuse suggested treatments. Electronic health records along with ongoing threat of productivity ratings will force doctors to take less complicated cases. Even Hillary may have trouble finding a doctor.
What we are signing and signing away? Our benefit or to save a buck?
Insurance and government work well together in limiting costs, sometimes with macabre consequences. Psychiatrists are NOW required by law to ask and have admitted inpatients with dementia, psychosis and suicidal depression SIGN what they want for resuscitation on each admission. Three choices: 1. No resuscitation. 2.No resuscitation with limited support like hydration, 3.limited resuscitation.

What's missing? Full Resuscitation!
Doctors won't be important.
Law, Insurance and Big pharm are.

We went out for a family dinner last night. I asked what was the reason for the choosing of this restaurant. The family member said that she based it on Yelp! reviews. She said it has to have at least 500 reviews and 90% positive well-thought of comments. The later part struck me. Food, like healthcare, is personal. Taste is also subjective. Like healthcare, it involves some form of socialization. Like the healthcare surveys, it's also not often about just the cuisine being served, but experience remembered.

Here's the distinction. I use Yelp whenever I want to explore the Mom-n-Pop restaurants, the Hole-in-the-Wall types, the Locals' Favorites type. Why? Because here it is also art and science, not just economics. Yes, you need the money to keep it going, but the operations are very efficient, often small businesses relying on family members and long time workers who are often overworked without pay. Their end game is better food to provide for the family. Yes, some will expand, licensed to be a chained brand, but most are barely just making it. The Yelp review is their only free marketing.

Healthcare used to be like that - small-businesses. Not anymore. I don't know if it's ever going to go back. They want growth, expansion, mergers and acquisitions, exorbitant middlemen pay and bonuses, and eventually record-breaking deals in selling the company. The current metrics being used are very rudimentary and do not advance the art and science of medicine other than for selling.

wouldn't mind if reviews/format was impartial; there's considerable risk of bias. First learned I had a terrible YELP review from colleague who'd referred a patient who returned saying, "Why would you ever refer someone to him?" One of only two reviews was a lengthy, diatribe ending in, "run don't walk from this doctor!" It implied I hastily misdiagnosed only to over medicate, to make money off prescriptions. Details provided didn't resemble any case I'd seen. I typically take 3-5 hours for a comprehensive intake, making great effort to reach the best diagnosis I can. I make no money from prescriptions, but I do deal with complex regimens for many unstable bipolar patients.
Reviewer stated that I heavily dosed Valium, a medication I don't even use.

YELP has no avenue to refute reviews, warning don't soliciting + reviews because they'll suspect and remove them. After my negative review I got several calls from a YELP agent suggesting I place adds with them.

I've seen many grateful and satisfied patients over 20+ years of practice, but it simply doesn't cross minds to submit positive reviews.

Whether from a parent who wanted unwarranted antibiotics for a child or a psychiatric patient rejecting a difficult diagnosis, the risk of negative reviews can hold a practitioner hostage, even influence treatment. Fortunately, for established doctors it's less impactful, but for a freshly minted doctor trying to establish himself, such negative reviews can be catastrophic.

Narrow networks are the result of "perverse incentives" that pervade the financial industry. Keep in mind that health insurance is strictly a financial industry and not health care.

It is ironic that we actually pay for this disservice:
Medicare overhead is about 3%.
Insurers' overhead is exactly 30%, by law.

Medicare for all.

Narrow networks are a deliberate strategy by the health insurance industry in order to steer high-cost insureds to plans with wider networks and higher costs... Stated by senior leadership where I work.

Narrow networks can then cause problems for individuals insured under ACA when there are NO specialists in-network for specific issues. A friend ended up at a local "free" hospital because of a career-threatening injury when her BCBS insurer didn't have anyone in-network.

Medicare for all, or else Congress needs to do their job and improve ACA.

"In other words, this may be an area of health care where the free market is working. When allowed to choose, patients seem able to discern quality — as they define it — and gravitate toward it. It’s not clear that we need to be forcing the issue with measurement and reimbursement." (Aaron E. Carroll). Yelp reviews as the author argues helps patients to discern quality (5 stars = highest quality!) and enables patients to choose. However, in the real world, not all patients are wealthy and can be the pure disciples of the free market. Low income patients with limited geographical mobility will not be able to choose a 5 star hospital 4,000 miles away. Also, the author fails to mention that CMS has already started giving out stars for hospitals. Unfortunately, there is a strong correlation between 1 - 2 star hospitals and low income patients who may suffer from frequent re-admissions because of the lack of care after discharge. The stars fail to account for the socio-economic status of the patients and blame is unfairly placed on the hospitals. So yes, we do need to go beyond Yelp reviews and stories that higher income patients write about and we do need to do a better job with reimbursement.

The choices for Medicare beneficiaries is quite large. Not a week goes by without a flyer from this or that Advantage Plan, or a Secondary Medicare insurance provider.
There is choice in plans, and depending on what your choose, greater choice in providers.

Excellent analysis. Thank you. In addition to consumer reviews of providers and hospitals, I would love to see someone start "rateyourinsurance.com" with the chance for both providers and patients to voice their opinions.

Americans want quality health care when they need health care. Narrow networks, surprise bills, limited access, and doctors who do not accept any insurance because they can't stand dealing with the health insurance industry have curtailed our ability to get the care we need from doctors who are good. Imagine a CEO being told that he/she cannot go to a recommended specialist because that specialist isn't part of the network the health insurance company set up. The CEO will probably be able to pay the out of pocket costs for the doctor. Yet his employees, who are subjected to the same plan will not even if that doctor is the best one for their medical condition.

What this country needs to do is ensure that people have access to the care they need at a price they can afford (even if means single payor universal access) when they are in need of medical care. It's not health insurance if we can't afford to get care after we pay the premiums or if there is a long waiting list or all providers in that specialty are booked and not taking new patients, or when there isn't continuity of care. It's a patchwork system set up to benefit everyone and everything but the patients.

I have actively avoided seeing doctors in the last 10 years unless I'm so ill that it's clear to me that I need to see one. That usually means I'm running a fever, have a racking cough, and will remain weak for quite awhile. The problems we have with health care pre-date the ACA. Fix them.