Wednesday, May 30, 2012

An Open Letter to HealthGrades: Are Online Doctor Reviews Always Valid?

I Googled myself recently to discover a one-star rating of my practice on HealthGrades.  The rating wasn't just a rating on the HealthGrades site, it showed up on the top of the first page of search results, a public announcement to anyone who Googles me.  

I contacted HealthGrades and asked them to please investigate as I did not believe this was a review from one of my patients.  Because the facts in the review were simply inaccurate, the one-star review of all aspects of my practice seemed to be vindictive, not an accurate assessment of my psychiatric practice. 

On our Clinical Psychiatry News website, I  will discuss in more detail what happened transpired when I asked HealthGrades to investigate.  To those who hate waiting for end of the story: They took it down.  
Here, I want to tell HealthGrades why I don't believe this was posted by any of my patients.  Below is my open letter to the HealthGrades leadership team

Dear HealthGrades:

You've taken the liberty of listing me on your site without my permission.  You've put up my name, an incorrect address with a click-on map providing directions to my previous office, my age (which this week, I'm feeling a bit touchy about), medical training, an inaccurate list of insurance companies which you claim I participate with,  and you've provided a venue for any human being with Internet access to post a review and write comments about me. There is nothing to assure that a review wasn't written by a neighbor who is  angry that my dog got into their yard, by one of the 47 commenters who has asserted that I'm an idiot for writing a Baltimore Sun op-ed piece in opposition to medical marijuana legislation,  by  someone who disagrees with something I have to say here on Shrink Rap (where we do periodically host some discord),  or by a patient who is displeased that I won't prescribe an addictive medication that is not indicated for their condition. There is also nothing to prevent me from posting 5 star reviews of myself.

Many patients Google doctors before they see them, and whether or not you believe a single review (there is only one) has any weight, at some level, people see it and process it.  I Google my doctors before I schedule a first appointment, and I might not go to someone with a one-star review.  All in all, I feel violated that you've posted this information and have permitted an unchecked venue for all commenters.   The one-star appearance on my Google search page may damage my professional reputation and may have financial repercussions for me.  Certainly there are bad doctors out there, but I am not one of them, and allowing an unverified reviewer to say that every aspect of my practice is unacceptably poor, constitutes slander.

I don't believe that the review was written by one of my patients, and let me go through each of my one-star items and tell you why I think this was an internet hater and not someone who knows me.

I've copied and pasted the HealthGrades categories you've established for doctors to be rated on.  For each of these categories, I was rated one-star out of a possible five stars.
Scheduling Appointments:
Ease of scheduling urgent appointments when you feel ill:
-----Any established patient who calls and says their problem is an emergency is seen that day or the next. Every patient is given my cell and home phone numbers before our first meeting, I respond to calls and texts within the day, sooner if they are urgent, and I do my own scheduling.  It generally takes days, and not weeks, to get an appointment, even on a non-urgent basis.

Office Environment:
Office environment (cleanliness, comfort, lighting, temperature, location):
----- These are individual taste issues.  The office was built out to my specifications, with neutral decor and a fair amount of attention to the environmental factors that I can control.  It is in a professional building, in a safe part of town, surrounded by shops and restaurants, and a janitorial service cleans the suite on a daily basis.   

Office Friendliness:                                                       
Friendliness and courtesy of the office staff:
----- I don't have office staff, but I wish I did.

Wait Time:
Once you arrive for a scheduled appointment, how long do you have to wait (including waiting room and exam room) before you see this provider:
----- In 20 years, I have never run 45 minutes late.  I can count on one hand the number of times I have run 10 minutes late. I start almost every session within 5 minutes of the scheduled appointment time.

response:Over 45 Minutes

About Dr. Dinah

Level of Trust:
Do you trust your provider to make decisions / recommendations that are in your best interests?
--- I can't fully address this-- trust is something that happens inside an individual's head.  I certainly believe that I have my patient's best interests in mind when I make a recommendation, people often tell me they trust me, and no one has ever said that they don't trust me.

Helps Patients Understand Their Condition:
Does the provider help you understand your medical condition(s)?
---  I believe I'm actually pretty good at articulating psychiatric conditions, I've had a bit of practice over the years.  

Listens and Answers Questions:
Does the provider listen to you and answer your questions?
--- I always ask new patients if they have any questions.  I  invite people to call or text me if they have concerns between sessions. I practice psychotherapy, so by definition, I listen.

Time Spent with Patient:
Do you feel the provider spends an appropriate amount of time with you?
-- I spend two hours on the first evaluation  and 50-55 minutes with each subsequent therapy session, unless a patient specifically wants a half hour session.  I'm happy to schedule longer appointments with anyone who'd like them, but no one has ever asked.

The response I got from HealthGrades, which I'm perplexed by, but not completely  displeased with, is that because I'm in the mental health field, they will take the review down.  They did not attempt to reach the reviewer.

If you are a mental health professional and want those bad reviews to vanish, remember to check your profile daily, and remember to request to have those ratings removed.  Funny, they don't publish this policy anywhere, so I'm taking the liberty of doing it for them.  If you're a patient looking for a good psychiatrist, remember that those with good reviews aren't going to ask to have them removed, so the ratings are biased in favor of the clinician.  From what I can tell, this site serves no one well.

HealthGrades' email address and a contact form are easily found on their website, and if that doesn't work, their phone number is 303-716-0041.  I got to a live person fairly easily and there was no wait.

Addendum: I wrote to their public relations person and asked them to remove my profile, and it was removed this morning. 

For more about my interactions with HealthGrades, see the Clinical Psychiatry New article Here.


rob lindeman said...

A better question is: Are online doctor reviews EVER valid?

Sunny CA said...

I have reviewed my psychiatrist several times over the last few years (5 stars), just trying to make sure he has the online rating he deserves. He seems to not care about online presence, but I totally disagree with him on that. The public does look and reads reviews.

I totally agree with you. The system is AWFUL. You really have stuck your neck out with the blog, book, comments on MJ, and so may well have many non-patient enemies. I am glad they responded to your request.

I just looked at a book on Amazon for a new book called "My Father's Name" by Jackson. The author is a black professor and has written thoughtfully about researching his family back to his slave ancestors, which I plan to buy and read this summer. He had only one review, which was a 1-star review written by a "hater". I flagged the review for offense language, not knowing what else to do. Things like this are totally unfair.

Sunny CA said...

The system works! I flagged the "hate review" on Amazon for offensive language yesterday and today it is gone! There is some justice at work.

Dinah said...


The day we appeared on NPR, our book got a one star review with a comment that we were just more drug company shills. At least Amazon has space for comments and reviews of the reviews. The book had become available that day, my copy arrived from Amazon an hour before I left the house, so I didn't believe the reviewer read the book. Several people came on and said "I heard these docs on NPR and they sounded reasonable and they didn't talk about drugs."
I do believe the review hurt our sales. I think people heard us, clicked on and saw a single star review as the only review, and clicked off.
I eventually went on and asked the reviewer to remove the review if he/she had not read the book. She took it down.
You can't remove a review from a doctor rating site.
There is a way for the doctor to comment, but they must register to belong to the site, and I want nothing to do with them.

I believe there should be some mechanism to assure that the reviews aren't falsely glowing or the result of vindictiveness.
And why the confidentiality? If a doc gets a bad online reputation, why shouldn't they be allowed to contact the reviewer, learn what troubled them, make changes, apologize, offer to fix it ("I didn't explain your condition well, Please write down your questions and I'll try to do better"). Why do you get to blast someone's reputation and income online anonymously with no possible means for fixing it.

There are bad docs. This system allows them to stay bad and justify that it's just a crank. Why not use the system to help fix things. And as long as your ex-lovers can blast you, it's not about forcing docs to give good care for fear of bad reviews.

George Dawson, MD, DFAPA said...

I think it is good to look at consumer doctor grades in the context of official doctor report cards that have been suggested (and in some cases implemented) by certain health plans and agencies. Those "report cards" claim to compare doctors on certain metrics that allow for "objective" comparisons.

In fact, there are no valid comparisons. Even the behind the scenes financial report cards that health care companies keep on doctors are inconsistent and lack validity.

The problem is that we have gone from any semblance of science in these rating systems to either a purely subjective system that is no better than a beauty contest or a system that is similar to financial analytics and consists of pulling a few variables out of thousands and claiming that those variables are the ones that count.

Consumer ratings have their problems but the real dirty little secret is that the proposed government and managed care ratings are no better.

Laura said...

I don't know about healthgrades but the vitals site does not require contact information from the reviewer. Doctors can opt to require reviewers supply an email address in order to post.

I understand your frustration however this post bothers me. As easily as you were able to have your review removed, so too will the inappropriate and unethical psychiatrist I saw 5 years ago. You may have a better online presence, but her future patients will not be warned. I don't have a solution, but it's a two way problem.

Elizabeth said...

When I was in need of a new psychiatrist, my therapist suggested one of the doctors in the agency she works for. I Googled the guy, and he did have one extremely unflattering review from a few years ago - we're talking major ethics violation. He didn't have any disciplinary action against him in this state, where he's been practicing for many years. I went ahead and saw him anyway, and he's kind and positively brilliant - not at all like the review portrayed.

Usually a therapist who has been working in an area for atleast a year or two can tell you who to see or not see. I trust the judgment of people in the field more than strangers on the Internet with an agenda. I will check for legal issues from a state website, sure, but Healthgrades? No chance in Hell.

Jane said...

I was you still work at a free clinic? You have mentioned before that sometimes you work in a clinic setting where you do med management only, followups every 3 months, and a therapist handles the talk therapy aspect.

It occurred to me that it could have been one of your patients from there. That would make a lot more sense. I don't even know that you would challenge that they get substandard care. The office staff probably does take a long time to get them in to see you, and the wait time in the clinic is probably awful, and you don't always get enough time to answer all the questions that they wanted to ask.

coolkid said...

I thought about that. I work in a clinic where all the patients have medicare/medicaid, and there are many situations there beyond my control. But I've been seeing the same patients forever, I see 2 patients an hour, rarely more, often less if someone doesn't show. Very very few of these patients have internet access, and the sessions, while not rushed therapy sessions, don't feel rushed. I make a point of asking people if they have questions, and of asking if there is anything important they need to tell me. Sometimes people come hours early and they do wait, and sometimes people come very late, and I squeeze them in as best as I can (it's hard for folks to get to their appointments, often several buses, so I don't take a punitive "you're late, out of luck"). The address was for my old private office, so assumed it wasn't a clinic patient. Mostly, those patients talk with their feet.

jesse said...

I totally agree ith Rob and George. What is meant by "valid"? An anonymous "review" by someone who might never have been a patient, with no screening whatsoever for any relevant factors.

A few years ago our local paper published an article on doctors who had multiple lawsuits. Incompetent docs, right? Except that the doctor with by far the greatest number was the chairman of a major surgical department at Hopkins. He saw the most difficult patients. It was clear that there would be a high number of less-than-perfect results but there were, of course, a very high number of brilliant results. Were the lawsuits a result of poor bedside manner, inflated expectations, solicitations from certain lawyers?

Use TripAdvisor if you are looking for a hotel, but don't choose your doctor that way.

Sarebear said...

I searched for my first psychiatrist on there, and found him. I can't remember if he had any reviews or not.

What I DID find was reference to a disciplinary thing that had gone on in the couple months before; the decision came down sometime around the time I was looking, and they gave him a month or two to find someone to cover his practice before he had to go on suspension.

This didn't scare me off, however; the reasons I could glean listed for the complaint, when I searched public utah records on the matter, did NOT match up with who he seemed to be. Can anyone ever really no for sure? Except him? Maybe not, but the person who referred me to him, had worked with him for her daughter for years, I knew did not believe he was the type of person who would do what the complaint alleged.

So I went on her judgement for awhile, until I had enough experience with him to form my own. He did howeve have a . . . very aggressive, Type A personality, approach to dealing with patients. He had a pile of files sitting over by a file cabinet, to which he'd point and say, if you don't like it (his manner, etc.) then you can join those patients who've chosen to go elsewhere.

Like I say, he didn't pull any punches.

I did end up thinking he had problems listening sometimes, but the times we worked best together, it was like two parts becoming more trhan the sum of their parts; it worked really well. When it didn't work, though, it kinda sucked.

My first female shrink was actually the one who covered during his suspension; I saw her twice. She didn't bite my head off like my current one does.

Anyway, the complaint was even from a former patient that he'd run into a couple years later, the complaint was from a couple years later; It's my guess she misconstrued something, either that or she was pissed off at his manner, treatment of her psychiatrically. I don't buy the complaint at all. I'm glad I knew agbout it though, because it helped me be more understanding when in the subsequent months, he seemed to be having a bit of a hard time in dealing with what had happened. Yeah, I'd prefer he had kept him being unsettled out of treatment; he never brought it up, actually. But he ACTED unsettled. Shrinks aren't robots.

Altho maybe Dinah is. ;^p

Jane said...

It's hard for folks to get to their appointments, often several buses, so I don't take a punitive "you're late, out of luck").

Thank you so much for understanding that Dinah. I also have MediCal and MediCare. And I do take buses everywhere. Unfortunately, the buses do not run every 15 minutes where I am from. They run every hour and a half and stop running around 5 or 6 at night. They also do not run at all on holidays and are on a limited schedule during the weekends.

Under my father, I have private insurance. Today, for the first time ever, I missed an appointment with a doctor. It was my psychiatrist. The bus was an hour and 20 minutes late. I could have walked to his office in that amount of time. But SoCal heat is blazing so it would have been rough. I called the bus company while I waited. I was told it broke down, but a replacement bus was being sent out and the bus was 30 minutes behind schedule. Okay. I can handle that. I was gonna show up at his office an hour early (because of the limited scheduling, so this means I would be 30 minutes early. When it started getting late and I realized the bus simply wasn't coming (I called the bus company again but they were worthless), I called the shrink's office and told them what happened. The receptionist told me to wait another ten minutes to see if the bus would come, and that they would be unable to get me in later that day. No luck. I called her back and asked how much I owed the doctor. She told me there would be no charge for the missed appointment, and they understood that it wasn't my fault. Phew!

I'm so glad that they didn't charge me, because I'm broke. When my grandma was alive, she was allowed to call the bus to come pick her up as part of a special program for disabled and elderly people. It's like a taxi service, only I think it was free or really cheap. She called to have them drive her to doctor appointment. The bus driver got lost and never showed up. Her doctor charged her for the full cost of the visit. My Dad ended up just driving her to her appointments.

It's nice to hear about doctors who have sympathy for people who have to take buses.

Anonymous said...

my post taking the opposite (or at least alternative) view was taken down.... how come? there was nothing impolite or inappropriate, just an additional perspective, from the patient end. it was up for a day and then came down so it didn't just get eaten by blogger......

Anonymous said...

Agree with everything said about the weakness of Healthgrades sites. But there is another perspective: patient as consumer. Some years ago I was referred to a psychiatrist who glared at me in disgust, refused to make eye contact or address me by name, and snickered at my discomfort. She was just a bully, really. After each appointment I felt physically ill, and after only three appointments I ended the relationship. Eventually I did make an ethics complaint, but the conduct was impossible to prove, and in any case regulators would not be interested in that type of misconduct. So the complaint was rejected. I did not use the Healthgrades procedures, but in retrospect I often wish I had--how else could an otherwise powerless and frustrated ex-patient obtain any redress, or any feeling that professional standards can be enforced?

Anonymous said...

Interesting that a psychiatric patient can't post on Healthgrades--the old stigmatization continues. That person can go online and rate movies, books, restaurants, plumbers, realtors, and car repair shops--but when it comes to his or her experience with a psychiatrist, well, you can't believe a word those nutcases might say.

Dinah said...

I saw a post by "Laura" and went to respond to it, but couldn't find it. I did not remove it. The ways of blogger are sometimes beyond me.

I'm going to post on this topic again.

Linda said...

I work in a psychiatric office and have another perspective. We had a patient who came in who wanted a medical marijuana prescription so his insurance would cover it. He was a healthy young man. He did not meet the criteria for that prescription, and the Dr. told him so very kindly. The few times he came in, he was treated with respect and concern, and the Dr., assuming he was there for real help, was trying to offer him counsel and resources. When he didn't get the RX, he went straight out the door to Google reviews and wrote a scathing, mean-spirited, personal attack on the Dr. It felt like blackmail. Our office called Google to have it removed, but they would not. (Also, he wrote under a pseudonym). In that case, the Dr. did know who the young man was, because of the timing and situational aspects of the review, so he made a personal call to him and the client removed it. However, we knew, from that point, how vulnerable providers are to this pseudo-blackmail. There are a number of controlled substances that "drug-seekers" desire, and it would be all too easy to use the threat of bad internet reviews. The doctors have little recourse, especially when they use a pseudonym. They also have to respect Dr/Patient privacy laws. Here's another negative aspect of it: when we called Google, their solution was to "pay" for the page so that we could control it and help move negative reviews to the bottom where they can't be seen. Their "wonderful deal" price was $200-$1000 per MONTH. Online reviews are a scam by these companies who know providers will want to pay to have some level of response and control. It really is like blackmail. I can't think of a better word for it. If they're going to allow these types of sites to continue, the client should have to use their name and suspend all privacy considerations so that the provider can respond in full. Otherwise, it's nothing more than slander. My provider has never had a lawsuit and has been practicing and helping patients for over 25 years. It's very sad to think anyone off the street with a grudge can ruin a reputation he has worked painstakingly his whole life to build.