Online ratings for doctors are flawed, but “not going anywhere”
===================================================================

* Paul Webster

Clinician–researchers in Europe and the United States who study online patient reviews of doctors have been closely watching a German lawsuit against Jameda, an online platform with ratings for 280 000 German physicians. A dermatologist had demanded that the company remove references that could injure her reputation.

Although Jameda deleted some of the material that prompted the lawsuit, it had defended its right to provide patients with comprehensive information about physicians. The website is also an effective feedback channel to drive improvements in patient care, claimed the company. In the end, however, Germany’s Federal Court of Justice [ordered Jameda to remove information](http://m.dw.com/en/german-doctor-wins-right-to-remove-name-from-rating-website/a-42654605?xtref=https%3A%2F%2Fwww.google.de%2F) about the plain-tiff, stating that the website failed to provide data about physicians in a neutral manner.

Physician fears over online ratings may be overblown anyway, according to Stuart McLennan, a medical bio-ethicist at Universität Basel in Switzerland. “Research from around the world shows physician ratings published online are overwhelmingly positive,” said McLennan. “These websites are part of a wider movement toward transparency around the quality of medical care, and doctors can use them to improve their practices.”

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/190/10/E305/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/190/10/E305/F1)

Doctors who Google their names are likely to see a physician-rating website among the top results.

Image courtesy of Steve Debenport/iStock

In [a recent paper](http://www.jmir.org/2017/11/e387), McLennan and colleagues concluded that recommendations from friends and family members, as well as referrals from other physicians, remain far more important than online ratings. Recent American studies, however, suggest that worries about the quality of online physician ratings may be warranted.

Dr. Joshua Harris, an orthopedic surgeon in Texas, contributed to [a 2017 meta-analysis](https://www.ncbi.nlm.nih.gov/pubmed/28853024) of rating websites for physicians in his field. The analysis found that surgeons with less than 10 years of experience were accumulating reviews at a significantly higher rate than older peers. This may be because younger surgeons are encouraging patients to go online and leave positive ratings.

“They are learning how to game these ratings,” said Harris.

The websites also fail to “accurately reflect physician quality,” concluded [a 2017 study](https://www.ncbi.nlm.nih.gov/pubmed/28838868) that compared online ratings for doctors who performed hernia surgeries with hernia-specific quality metrics. Patients could make better decisions about their health care if they were instead provided with “specialty-specific, risk-adjusted quality measures,” the authors suggested.

According to [a paper](https://academic.oup.com/jamia/advance-article-abstract/doi/10.1093/jamia/ocx083/4107665) published last year in the *Journal of the American Informatics Association*, online ratings appear to be based on a patient’s general experience, reflecting physician friendliness and overall atmosphere, but fail to provide objective measures of quality of care. “Online consumer ratings should not be used in isolation to select physicians, given their poor association with clinical performance,” the authors concluded.

A [recent study](http://www.jmir.org/2017/8/e254/) of online ratings for California physicians on probation for professional misconduct found that their scores were lower than peers but the “absolute difference was quite small,” making them “imperfect proxies” for clinical competence.

“These ratings do have value, and they’re not going anywhere,” said Dr. Benjamin Breyer, a professor of urology at the University of California, San Francisco, and a coauthor of the study. “But they need to be taken with a pinch of salt. There is a lot of grade inflation, so to speak.”

With respect to the lawsuit in Germany, another concern raised is that Jameda allows doctors to buy premium memberships. [Some doctors accuse](http://www.dw.com/en/german-doctor-sues-for-right-to-be-removed-from-review-website-jameda/a-42265981) the company of promoting doctors who pay and hiding their negative reviews, making the platform more of an advertising scheme than a neutral source of physician reviews.

## Footnotes

*   Posted on [cmajnews.com](http://cmajnews.com) on Feb. 22, 2018.