Society for Participatory Medicine
e-patients.net blog
CNN has recently published an article about what to look for in a doctor rating website. Unfortunately, they repeat some misconceptions and errors about these services.
The most serious error is the claim that the greater volume a website has of doctor ratings, the more reliable or statistically valid it will become.
It’s a matter of statistics: The more reviews you read, the more likely you are to get an accurate assessment. “I would check a lot of different Web sites,” says Carol Cronin, executive director of the Informed Patient Institute. “Look across them, not just within one.”
Speaking of volume, a common concern about doctor rating sites is that one angry patient can make multiple nasty comments, using a different name each time (or, conversely, that the physician herself could go on and make multiple glowing comments).
But Martin Schneider, chairman of the Informed Patient Institute, says these sites have ways of detecting when one person is making several comments under different names. Back in the 1990s, Schneider was president of a now-defunct doctor rating site called thehealthpages.com. “Even back then, we had to the technology to stop that from happening,” he says.
These claims are commonly made, but they are largely incorrect. Here’s why…
In survey research (which is basically what a doctor rating site is trying to be), you need a sample that is both large and randomized. That is, you do not go out and post an announcement saying, “Take our survey if you think you have depression” if you’re looking for an unbiased data sample on depression in the general population. You need to have a group of people that both have and don’t have depression in order to obtain generalizable results.
The same is true with ratings sites. They may get the volumes needed, but none of these sites have any way of addressing the biased sample problem. People who rate their doctors are likely to fall into one of two categories — they either had a horrible experience with them and want others to know, or they had a wonderful experience with them and want others to know. But most people who fall in between these two extremes and have run-of-the-mill experiences with the doctor will likely never rate, because they have little incentive to do so.
You will also need a humongous number of patients rating each doctor — at least 20 to 30% of their entire patient list — in order to for the ratings to start gaining enough power to be reliable and valid (notwithstanding the population sample bias issue).
CNN admits as much later on in the same article quoting Dr. Robert Wachter:
While patient reviews might be useful, they have several clear drawbacks, our experts say. First, many doctors have just a few reviews or none at all. Second, even if a doctor has 20, 30, 50 or 100 reviews, that’s still only a small fraction of his entire patient population — and a warped fraction at that.
“The person most likely to write is the one who’s most enthralled with the doctor, or the one who’s most pissed,” Wachter says. “You’re getting a skewed view.”
The other advice — decide what’s important to you, look for patterns in the ratings, look for specifics in people’s ratings of their doctor and put more weight onto detailed reviews rather than general comments, and consult objective data already available — is generally solid, but still doesn’t address the foundational statistical problems with these types of online ratings systems. All the business people gloss over these problems, but if a rating isn’t scientific, its value is diminished substantially.
And honestly, Martin Schneider is a bit naive if he thinks it isn’t a simple thing to rate one doctor multiple times on all of these sites. Simply by clearing one’s cookies, using a few webmail addresses and using a Web proxy, you can register as many accounts as you would like on any of these services in a matter of minutes.
John M. Grohol, Psy.D. is one of the pioneers in online mental health and support groups, getting his start on the Internet in 1992 with depression support groups and advocacy efforts. He is a writer, researcher, and is the publisher (and founder) of the Internet's leading mental health and psychology network, 
I couldn’t agree more. I know here on this blog we’ve considered the topic of “rate your doctor” sites but I don’t think it’s comparable to the value of Consumer Reports car ratings.
I hadn’t thought about the randomization issue. I had, otoh, thought about the broader issue of self-selection bias: flaming idiots (and upset people) might be far more likely to post a rating than others, or not – who can tell.
Completely agreed re repeat raters. Didn’t I hear that TV talent shows gave up and now let you vote as often as you want? Otherwise, the vote would be biased in favor of more devious citizens – just as you suggest about doctor ratings. Not good.
Consumers need to take back control of their patient satisfaction, and as in other industries, only the consumer can effect change. So in the case of MyDocHub.com, patients rate their doctor based on waiting room times, total wait time including the time in the patient room with the doctor, and a simple rating of 1 to 5, 5 being the highest on how satisfied they were with that appointment. The doctor ratings are averaged out, so one poor score does not hurt the doctor, but on the other hand, various poor ratings may indicate poor performance by the doctor, since the wisdom of crowds determine a more accurate assessment of the doctor.
The only site I found to have more detailed physician information (including physician ratings) would be http://www.mdnationwide.org. I used several other “free” services, however information generic, and I never did find his rating until I ordered a report from this site mdnationwide.org. The report also showed two malpractice judgments, which I never found anywhere else.
I think consumers should browse the Internet and not solely rely on free information, after all – you get what you pay for.
the mydochub.com post above has also been posted on another discussion board under a different name> ignore it.
John, I think you are missing the point. Rating web sites are not about generating scientific data. People don’t care about unbiased scientific data unfortunately. They care about what other people say, good or bad, but not neutral. You hire or don’t hire people based on recommendations from friends. You buy a food items because your buddy says he likes it. You avoid or try a vacation spot because your neighbour said she did or didn’t have a good time there. It’s all about the social connection and the weight it carries with people. People don’t want to listen to neutral ratings. What’s the point of that? Yawn.
In the restaurant industry, they say that one satisfied customer tells 3 friends, and 1 unsatisfied customer tells 7 friends. The neutral customer generally doesn’t tell anyone. It’s word of mouth marketing mostly for restaurants, so you have to make sure to prevent unsatisfied customers.
Sorry to disappoint you if it isn’t scientific, but that is just the way people think. These sites do have value, but not the value you think.
Judge tosses Duluth doctor’s suit against patient’s family
By Mark Stodghill, April 28, 2011, Duluth News Tribune
A judge threw out a lawsuit today filed by a Duluth physician who said he was defamed by a man who publicly criticized his bedside manner.
Dr. David McKee, a neurologist with Northland Neurology and Myology, alleged that Dennis Laurion of Duluth defamed him and interfered with his business by making false statements to the American Academy of Neurology, the American Neurological Association, two physicians in Duluth, the St. Louis County Public Health and Human Services Advisory Committee and St. Luke’s hospital, among others.
Laurion was critical of the treatment his father, Kenneth, received from McKee after suffering a hemorrhagic stroke and spending four days at St. Luke’s hospital from April 17-21 last year. Kenneth Laurion recovered from his condition.
Dennis Laurion claimed that any statements he made about the doctor were true and that he was immune from any liability to the plaintiff.
In his 18-page order dismissing the suit, Sixth Judicial District Judge Eric Hylden wrote that looking at Laurion’s “statements as a whole, the court does not find defamatory meaning, but rather a sometimes emotional discussion of the issues.”
Hylden addressed the fact that Laurion posted some of his criticisms of McKee on websites. “In modern society, there needs to be some give and take, some ability for parties to air their differences,” the judge wrote. “Today, those disagreements may take place on various Internet sources. Because the medium has changed, however, does not make statements of this sort any more or less defamatory.”
Hylden concluded his order by stating that there wasn’t enough objective information provided to justify asking a jury to decide the matter.
Laurion was relieved by the court’s ruling.
“My parents, who are now 86, my wife and I have found this process very stressful for the past year, since my father’s stroke. There was never just one defendant,” he said. “We’re grateful that Judge Hylden found no need for a trial.”
In his suit, McKee alleged that Laurion made false statements including that McKee “seemed upset” that Kenneth Laurion had been transferred from the Intensive Care Unit to a ward room; that McKee told the Laurion family that he had to “spend time finding out if [the patient] had been transferred or died;” that McKee told the Laurions that 44 percent of hemorrhagic stroke victims die within 30 days; that McKee told the patient that he didn’t need therapy; that McKee said it didn’t matter that the patient’s gown was hanging from his neck with his backside exposed; that McKee blamed the patient for the loss of his time; and that McKee didn’t treat his patient with dignity.
According to the Minnesota Board of Medical Practice website, McKee has had no disciplinary actions brought against him.
“I’m very disappointed by this court’s decision because as far as I can see the only avenue that I can see that I had to respond to this overwhelming attack was through the courts, and for the time being it appears that avenue has been closed without me ever getting a chance to present my evidence,” McKee said.
McKee said he hadn’t had a chance to confer with Marshall Tanick, his Minneapolis attorney. He said he will do so before he decides whether to appeal the decision. Tanick told the News Tribune he had not yet seen the decision and couldn’t comment on it.
“Dennis Laurion is a liar and a bully and a coward,” McKee said.
More: http://www.duluthnewstribune.com/event/article/id/197679/publisher_ID/36
Ruling: http://www.onpointnews.com/docs/Mckee-v-Laurion.pdf
Doctor rating site online defamation case scheduled for appellate court hearing
Source:
http://macsnc.courts.state.mn.us/ctrack/view/publicCaseMaintenance.do?csNameID=71108
(case # 111154)
The Minnesota Court Of Appeals has scheduled the online defamation case of David McKee MD v Dennis Laurion for a hearing by a panel of three judges. The oral hearing will be November 10, 2011, at 10:00 AM in the Sixth District Court House of Duluth.
Sources:
http://www.duluthnewstribune.com/event/article/id/202704/
http://minnesota.cbslocal.com/2011/06/25/duluth-doctor-appeals-judges-decision/
Dr. David McKee, a neurologist with Northland Neurology and Myology, said he is still being targeted in online attacks related to the lawsuit he filed in June 2010 against Dennis Laurion.
McKee, who treated Laurion’s father after he suffered a hemorrhagic stroke, alleges that Laurion made false statements about him to neurological associations, other physicians, St. Luke’s Hospital and the St. Louis County Public Health and Human Services Advisory Committee, among others. He is seeking more than $50,000 in damages.
Dennis Laurion claimed that any statements he made about the doctor were true and that he was immune from any liability to the plaintiff.
McKee said a sudden concentration of unfavorable critiques about him cropped up online before Sixth District Judge Eric Hylden dismissed the suit.
“It appears that Mr. Laurion made over 100 adverse postings on the Internet once he became aware that he was going to receive a favorable decision on the motion for summary judgment,” McKee said. “Appealing seems to me the only way to curb the activities of this malicious person.”
Laurion said he has not posted anything on the Internet about McKee since the lawsuit was filed last June. He said his lawyer advised him not to. But, because the case was thrown out, technically he could if he wanted to, he said.
Laurion said he was aware there was an influx of Internet chatter about McKee after a link to a story about McKee appeared on the high-traffic website reddit.com.
Kenneth Laurion spent four days at St. Luke’s hospital in April 2010. John Kelly, Dennis Laurion’s lawyer, told the News Tribune last summer they didn’t feel McKee acted appropriately toward their father, and they reported it to the hospital and Board of Medical Practice.
Hylden wrote in his 18-page order dismissing the suit that the court did not find Laurion’s statements about McKee defamatory, “but rather a sometimes emotional discussion of the issues.”
Hylden addressed the fact that Laurion posted some of his criticisms of McKee on websites. “In modern society, there needs to be some give and take, some ability for parties to air their differences,” the judge wrote. “Today, those disagreements may take place on various Internet sources. Because the medium has changed, however, does not make statements of this sort any more or less defamatory.”
Hylden concluded his order by stating that there wasn’t enough objective information provided to justify asking a jury to decide the matter.
In his suit, McKee alleged that Laurion made false statements including that McKee “seemed upset” that Kenneth Laurion had been transferred from the Intensive Care Unit to a ward room; that McKee told the Laurion family that he had to “spend time finding out if [the patient] had been transferred or died;” that McKee told the Laurions that 44 percent of hemorrhagic stroke victims die within 30 days; that McKee told the patient that he didn’t need therapy; that McKee said it didn’t matter that the patient’s gown was hanging from his neck with his backside exposed; that McKee blamed the patient for the loss of his time; and that McKee didn’t treat his patient with dignity.
According to the Minnesota Board of Medical Practice website, McKee has had no disciplinary actions brought against him.
“I’m very disappointed by this court’s decision because as far as I can see the only avenue that I can see that I had to respond to this overwhelming attack was through the courts, and for the time being it appears that avenue has been closed without me ever getting a chance to present my evidence,” McKee said.
“Dennis Laurion is a liar and a bully and a coward,” McKee said. “He knowingly made false and malicious statements about me to a total of 19 different professional and medical organizations, regulatory agencies and websites.”
Laurion’s attorney John Kelly was critical of McKee’s reaction to the decision. “I think it’s regrettable that somebody would choose language of that kind in commenting on a court decision,” Kelly said. “Secondly, this case has always been about Mr. Laurion’s reaction to what he perceived to be poor conduct on the doctor’s part in relation to his interaction with his father. And he stood up and said something about that and the judge has agreed that what he said was within the bounds that are permissible under our law.”
References:
http://boards.medscape.com/forums?128@659.iVYfaQ7qwue@.2a0e380e!comment=1
http://www.techdirt.com/articles/20110629/03411314906/doctor-plans-to-appeal-ruling-that-said-complaining-about-his-bedside-manner-was-not-defamation.shtml#comments
http://jonathanturley.org/2011/05/16/minnesota-doctor-loses-effort-to-sue-patients-son-for-defamation-about-his-allegedly-poor-bedside-manners/
http://www.onpointnews.com/NEWS/Judge-Dismisses-Suit-Over-Bad-Review-of-Doctor-s-Work.html