Irreverent opinions: Can I Yelp you?

August 17, 2015

If you don’t know what Yelp is — ask your next patient between the ages of 20 to 45. Chances are they not only know Yelp but have even “Yelped” some themselves. Have you been “Yelped?” Do you care?

Yelp is a crowd-sourced review site that has just joined the non-profit investigative news organization, ProPublica, to provide a feature called “About this Provider,” reviews. USA Today has the cold, hard facts: “As the healthcare industry experiences a digital boom, 77% of consumers begin their healthcare search online, and 45% read online reviews before booking an appointment, according 2015 Healthcare Consumer Trends survey.” 

I picked a big city, New York, at random, and just reviewed a doctor who scored an average of just 3.5 out of 5 with lots of reviews. I found the major categories of complaints fall into one of two areas – waiting time and disagreement with the doctor’s diagnosis. If a doctor buys into the patient’s diagnosis and is agreeable, the ratings are high. But if doctors dispute the patient’s theory – that’s going to get you “Yelped” every time. There are some ways around this that I’ll explain below – be patient. 

There are lots of reviewing procedures in addition to the internet consumer based ones.

A sample Press Ganey survey.The oldest is the Press Ganey survey used by hospitals and health organizations. In business for thirty years, these surveys are a bit more academic – the University of Utah provides some information and an example of the survey.

In querying a number of allergists, I picked up these comments:

“What we fail to understand is that medicine is driven by consumers now. “Cyber-chondriacs” are people who, disparaged by traditional medicine, seek their answers on the internet. They then become at odds with those of us who practice evidence-based medicine. Our reimbursement is compromised because of the few who are unhappy and who return their surveys knowing that they are affecting the physician’s pay.” 

“At my organization, I am now subject to a maximum five percent pay reduction if my Press Ganey surveys lag behind ALL of my colleagues! Not just allergists but also my friendly family medicine docs who have closed practices of patients who have selected them after years of attrition and doctor shopping. Not just pulmonologists but OB-GYNs who deliver healthy, smiling babies that enlighten the parents’ ideals.” 

“Under this scheme, even if I score an average of 90 out of 100, that puts me in the 15 percentile – sorry Bub, that’s not good enough. The curve is incredibly steep, literally rising 10 percent points per one point difference after a score of 93. But all it takes is one upset patient to hose you – one out of 100 surveys returned with grateful patients who gave you 9’s and 10’s and that one person gave you zeros.”

No one has translated what a bad Yelp will do for you, but it’s not good when people can anonymously vent. US News says that reviews for doctors on Yelp are "not valid."

Exacerbating this issue are the new efforts to have patients be able to treat themselves with over the counter medications. NPR is championing a movement called “self start” where women with histories of UTIs can manage themselves with antibiotics. It seems to conflict with efforts to minimize antibiotic use, but it’s an emerging trend of “power to the people.” The most intriguing patient power issue also reported by NPR are efforts for small companies or even people to home brew insulin — no kidding!

So what is a conscientious doctor to do in this minefield of public opinion? Here are my theories:

  1. Change your language: be agreeable
  2. Be proactive

Change your language to be politically correct and sensitive

You used to say: “These IGG blood tests aren’t any good.”
Now you would say: “These blood tests are interesting, but most allergists haven’t found a way to use them.” (And shut up – you are not going to change any minds with your scientific opinions – recognize your limits in today’s society.)

You used to say: “I don’t think you have any allergy.” (Which means “I can’t help you.”)
Now you would say: “Our testing is negative, but there are other options to consider.”

You used to say: “I am the doctor.”
Now you would say: “Let’s work together on this.” 

You used to say: “I don’t know what to do with you.”
Now you would say: “Let’s get another opinion.”

We have always had a paternalistic attitude about what’s best for the patient – realize that it is the patients right to make mistakes, and your job to provide options.

Be proactive

Construct your own survey. Loosen your tightwad approach and buy 1,000 stamped postcards with your address and with some personalized variety of the survey above. Give it personally to the patient and ask them to mail it in. Some people cheat and give it only to the patients they know are going to give them good ratings – you decide. But if you are ever challenged by an organization or carrier, you take your stack of postcards up and challenge their data. I have been doing this for years and have boxes of them. I am not about to roll over and let a couple of people hurt me with Medicare or a carrier. It works – I have done it. 

Why not let the patient fill out the email they get after every visit from some large clinics? Those things are irritating, and people are more likely to be motivated to report a bad experience rather than a good one. I like my urologist, and if he would hand it to me – I would do it. But I hate that inevitable email survey I get following the most casual of encounters. It’s irritating enough to want to give someone a bad report to see if they are listening. Health systems don’t care – doctors care, or not. 

Make sure it is part of every documented visit to ask the question: ‘”Do you have any questions?” And an encompassing question – “Is everything going OK?” Is everyone treating you well?” 

You are going to get Yelped or Propubica’d or Heathgraded – it’s part of the environment – plan for it.

Bobby Lanier MD, FACAAI, Executive Medical Director