Online Ratings and Drug Seekers

[Technotronic]

🙂

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[sunlioness]

This is why I absolutely will not google myself. I just don't want to know.

I know how getting worked over is though. When I was just starting in my solo practice, I had a patient play me successfully for Xanax. She only came for the eval, no showed her subsequent appointments, and later had her methadone clinic call me to verify that her benzos were medically necessary when she had never disclosed to me a substance history let alone that she was on methadone. [The methadone clinic presented me with a signed release and I was more than overjoyed to tell them the scoop.] But for months after that, I was getting calls from patients who were referred from this patient and all wanting benzos.

 

[Sneezing]

1) Most everyone who turns to the internet is doing so to b itch. Most people understand this. Look at news articles, look at apartment ratings, etc. almost all negative.
2) People who are looking up their pscyhiatrist's ratings on the internet AND basing opinions off of them probably are the patients you don't want to see anyways. Consider it a good thing if there are any patients chosing to not see you because of the internet ratings.
3) Don't post your own rating. You are above that.
4) If you still really care, give patients a card with 3 main sites you want them to rate you at and have them pick one of their choice. At the end of each visit, hand them the card and ask to give feedback. Think of it like the bloody press ganey ED docs deal with or some of the others. Be greatful no paper pusher is thinking of tying it into your salary under the guise of 'measuring quality.'

 

[OldPsychDoc]

"I'd rather deal with negative online ratings than a DEA suspension of my license--or a malpractice suit from your survivors".

 

[whopper]

It's when they spend about an hour during an intake that they get ticked off if you refuse them a drug of abuse.

Steer them away before it gets there. Have your receptionists tell people who aren't yet your patients that you have a zero tolerance policy for people who seek to use drugs of abuse such as benzos (state the names because most people don't know what benzos are), or stimulants.

I do give out stimulants on occasion as mentioned in other threads-but only if the person has an EKG, a TOVA test suggesting they have ADHD and are not malingering (that test has a symptom exaggeration scale), does drug tests, and tries at least one medication for ADHD that does not have potential for abuse that failed. By that time, it's going to be at least 6 weeks. Most drugs abusers I figure will go elsewhere. I also use a system in the state I'm in where if I put in the patient's name, I can see any prior legal problems in the state, and every single prescription they've gotten in the last several years. Anyone getting anything of abuse that they didn't tell me about, or are arrested for anything substance-related or something not sounding kosher (e.g. something other than minor speeding/parking) ticket, they're automatically terminated, or I will continue their medication but no longer prescribe a substance of abuse.

 

[Manicsleep]

I recently started a new job in private practice in California. One thing I am noticing is that I am getting tested by a lot of benzo, stimulant seekers which I saw when I first started my previous job in the midwest but the patients there did not have the 'skills' that california patients have. I can usually pull out the groups/psychotherapy card which acts like kryptonite for most but some have been especially persistent until I have gotten old records and told them why I can't prescribe their drugs (diagnosis, drug history, constantly raising dose etc). I have lost count how many times the threat of bad online ratings has been used. It may be the area that I am practicing but these ratings are actually showing up when I google myself. Nobody ever rated me ever before and now in about a month, I have been rated several times, mostly negatively. I have pretty much decided that I am only going to a physician with bad online ratings and that positive ratings are probably the physician rating themselves.

Hurt ego, poor self esteem, get over it, no big deal or I should fall victim to this trap and start posting my own ratings or ask patients to rate me in this google everyone world. My coworkers say they don't care but for some reason I do.

Although you can't entirely discount the reality of the web, I would very little stock in sites like healthgrades and vitals as it is generally a place for people to moan. I am also exposed to press ganey on occasion so I know what that is like and it is just nonsense.

The customer/client/consumer is ALWAYS right.
The patient, especially one bereft of insight or blinded by misinformation, misunderstanding, addiction etc is sometimes wrong.

Clinical experience, education and most importantly, the patient, help the physician navigate the scenario and help the patient come to the right decision for themselves.

If the two can't come to the same decision and the patient has capacity/competence, they can get treatment elsewhere.To hell with the online ratings at that point.

 

[BobA]

You might try contacting www.reputation.com to see if their services can help.

 

[notdeadyet]

1) Most everyone who turns to the internet is doing so to b itch. Most people understand this. Look at news articles, look at apartment ratings, etc. almost all negative.
2) People who are looking up their pscyhiatrist's ratings on the internet AND basing opinions off of them probably are the patients you don't want to see anyways. Consider it a good thing if there are any patients chosing to not see you because of the internet ratings.

Wow, to be honest, these two ideas sound both condescending and misinformed.

Yes, some people turn to the Intenet to complain. But many also go online to sing praises. If you think feedback on review sites is "almost all negative," it makes me wonder what review sites you visit. Many people (myself included) use review sites for travel, eating out, purchases and services and find them very helpful.

Go to a trusted review site and you see both negative and positive reviews. Tripadvisor has complaining and praise about many locations. Lots of reviews and all positive = reassuring. Lots of reviews and all negative = troubling. This formula is pretty effective on most review sites.

I've used yelp.com to look at reviews of health care providers before going to see them or referring others. It's definitely not the only arrow in the quiver, but it's a helpful one. I've seen a couple physicians that had only negative reviews, but I've also seen physicians with only positive reviews. Most of the complaints (and praises) seemed valid. One physician had many complaints of having wait times of over an hour for most visits. Why go there? Another physician had multiple complaints that the nearest parking was ridiculously far away. All things being equal, this one isn't my first choice for the walker-bound geriatric.

I can't help but lots of the resistance to things like customer reviews has to do with physicians often having a kind of inflated self-worth. While medicine is incredibly important to the practitioner, it's usually not as important to the patient. At the end of the day, I'm very confident that your average patient spends a lot more time choosing a mechanic than physician. We can moan and wail how wrong this might be, but it doesn't change what is.

3) Don't post your own rating. You are above that.

Amen to that.

4) If you still really care, give patients a card with 3 main sites you want them to rate you at and have them pick one of their choice. At the end of each visit, hand them the card and ask to give feedback.

Sure. Or just deliver quality care and run a good practice and let the chips fall where they may.

Psychiatrists get interesting reviews and if you read them, it's fairly obvious that some of it is a representation of the patients attracted. But many comments are still very valid and can be extremely constructive. Running a medical practice while ignoring the tennents of basic business practices is why so many physicians do not do as well as they could.

 

[zenman]

I'm seeing a patient this afternoon for the first time who has been seeing a psychiatrist who will be back next week. Poor guy has run out of Xanax. After I hear the reason he's here, I'm going to pull out my state Rx Reporting Sytem sheet and ask him about the three different providers he's been getting Xanax from and why he has 11 months worth of Xanax in 7 months time. Should be interesting. Then I'm turfing him right back. 😍

 

[Manicsleep]

I am not sure if I would go on yelp for physician ratings, especially for psychiatry. I may sound condescending but I am not misinformed. The ability to judge a good physician is often times lost on patients. Usually they judge based on bedside manner and rapport. I posted earlier about a phsycian's practice we have recently taken over which is filled with benzo's, multiple antidepressants, hypnotics, 2 and 3 antipsychotics, often for a diagnosis such as DD NOS with no labs, vitals, informed consents etc.

Medically, this guy was a disaster. I am not sure how he survived so long and I am so happy his nursing staff convinced him to retire. He didn't think he needed to because he thought his patients loved him and that meant he was doing a great job. The truth is that although he was a horrible physician, his patients did (and still do) love him. They can't stop talking about how they would have great chats about his trips, his cats and their families. It seems they talked about everything except medicine! He has well over 100 ratings in aggregate on yelp, vitals and healthgrades and according to that he is God's gift to medicine. Contrarily, all the physicians who work with him and who have inherited his patients believe that although he was a very nice person, his skills as a physician had gone the way of the dodo.

 

[notdeadyet]

I am not sure if I would go on yelp for physician ratings, especially for psychiatry. I may sound condescending but I am not misinformed.

That was directed at the comment that almost all reviews online are negative and anyone who uses the Internet to search for a physician is a patient you don't want. I don't think those were your comments.

The ability to judge a good physician is often times lost on patients. Usually they judge based on bedside manner and rapport.

Agreed. I dont' spend hours poring over them, but most reviews I've seen aren't usually evaluating a physicians clinical judgment but how he runs his business. Is he constantly late? Is he rude or condescending? Is it hard to get an appointment? Is the office in a difficult location? Does he go the extra mile?

Very few people post that their physician lacks a fund of knowledge or doesn't practice evidence-based medicine. But those are not as big an issue for most patients as whether or not their physician is available and listens to them.

I wouldn't use yelp to guage how strong a practitioner's clinical skills are, but I think it's a pretty helpful tool to find out what kind of practice he runs. Dismissing patient evaluations and feedback, imho, is a mistake.

 

[digitlnoize]

As someone who scours the internet for reviews, I'd like to say a couple of things:

Reviews are not always negative. Just go look up a good book or product on Amazon.com and you'll see that a good product will get hundreds of good reviews (and always, a few negative ones).

The key lies in the number of reviews. Are you getting a large enough sample size to be reasonably sure it is a relatively random sample? If I am looking for a physician in my town, I would google them, and find that most of them have < 5 reviews. That's so few, that I might look at the reviews, but you can't really draw any conclusions from that, one way or the other.

The best response I've seen is to address it directly. Find the negative reviews and either explain why you were in the right (without violating HIPAA obviously) or offer to correct the problem. When I see one bad review where the physician/manufacturer/etc has actually taken the time to say, "look I'm sorry you feel this way, but we will fix the problem if we can." That goes miles, in my book. Otherwise, you can simply write a "review" of yourself, saying who you are, and explain that "as a physician, you sometimes have to make hard choices. In this case, the patient requested a form of treatment that was not appropriate for their condition. Obviously, they are unhappy with this outcome, but I will not compromise my patients' health for any reason."

Or something like that. It shows you care, and it lets any future review readers understand why that one person was unhappy with your care.

 

[Manicsleep]

That was directed at the comment that almost all reviews online are negative and anyone who uses the Internet to search for a physician is a patient you don't want. I don't think those were your comments.

My apologies.

Agreed. I dont' spend hours poring over them, but most reviews I've seen aren't usually evaluating a physicians clinical judgment but how he runs his business. Is he constantly late? Is he rude or condescending? Is it hard to get an appointment? Is the office in a difficult location? Does he go the extra mile?

Very few people post that their physician lacks a fund of knowledge or doesn't practice evidence-based medicine. But those are not as big an issue for most patients as whether or not their physician is available and listens to them.

I wouldn't use yelp to guage how strong a practitioner's clinical skills are, but I think it's a pretty helpful tool to find out what kind of practice he runs. Dismissing patient evaluations and feedback, imho, is a mistake.

Agreed, however for many physicians, they have almost no control over the business aspect of the practice. Overall, your point is well taken. As physicians, we must listen to our patients. However, after listening (or reading) we must then decide, possibly by consulting with our peers, how to address the issue but we should never let clinical judgment play second fiddle to 'client/consumer satisfaction'.

 

[Sneezing]

If you feel my comments were condescending so be it. My comments still stand. People are more likely to fill out a review to comment negatively rather than positively. I will sometimes go out of my way to give positive reviews, but I believe most don't. With the internet you just don't know who is giving the review. Is it an angry patient? Is it the doctor? Is it the business owner commenting on her own establishment... several times? Or is it a program that hacked it and slanted the reviews? I bet some one could find scripting for a program that does just that some place on the net.

In summary I believed it is dumb to turn to internet reviews. This is one arena that will still be dominated by word of mouth, formal organizations like consumer reports, or investigating it in person yourself. Until internet review sites have a transparency of who the raters are and what their qualifications are to give the feedback they aren't worth the hard drive space they take up.

 

[Manicsleep]

Until internet review sites have a transparency of who the raters are and what their qualifications are to give the feedback they aren't worth the hard drive space they take up.

👍

I can agree with that.

 

[notdeadyet]

As physicians, we must listen to our patients. However, after listening (or reading) we must then decide, possibly by consulting with our peers, how to address the issue but we should never let clinical judgment play second fiddle to 'client/consumer satisfaction'.

Couldn't agree with you more on this. I just that sometimes we need to remind ourselves that what we consider most important (like clinical judgment) is not necessarily what is most important to the patient. It affects whether or not they are likely to return (or even see you in the first place), so it ultimately affects patient care.

 

[notdeadyet]

People are more likely to fill out a review to comment negatively rather than positively.

Yeah, that seems like common sense, but if you pick a respected restaurant, service, or product and read reviews on help, amazon, or the like, you'll still find more positive reviews than negative for good entities and more negative reviews than positive reviews for bad entities. If it skews overall to the negative, it ain't by much.

With the internet you just don't know who is giving the review.

True, but anonymity is an absolute requirement for most customer-based market research. Few if any businesses want identifying information for feedback, whether it's a paper form, an online review, or a focus group.

In summary I believed it is dumb to turn to internet reviews. This is one arena that will still be dominated by word of mouth, formal organizations like consumer reports, or investigating it in person yourself.

Fair enough. To each their own. Keep in mind, though, that sources like the review sections on yelp et. al. are nothing more than electronic word-of-mouth. Most word-of-mouth is actually 2nd or more degrees, which makes it all but anonymous. Consumer reports as in Consumer Reports is a great resource if you're buying electronics or somesuch, but they have a pretty limited scope. Consumer reports in general don't mean much on their own, as most tend to have their own inherent bias.

I'm with you on first-hand experience being the best. And I agree with you that lacking that, turn to friends and family. But lacking that, you need to do your research. And consumer research can be a valuable mine.

Until internet review sites have a transparency of who the raters are and what their qualifications are to give the feedback they aren't worth the hard drive space they take up.

I understand what you're getting at, but you might be missing the intent of customer reviews: the entire point of customer feedback is that the only qualifications required is that they are a customer.

A physician who disregards patient feedback by saying, "well, he's just a janitor making $20K/year without any medical background..." or "what does a 70yo housewife know about healthcare?" is by definition not only being a snob but is also being an incredibly bad businessperson. If you don't care what your customer thinks, trust me, you'll find lots of competitors who will.

 

[whopper]

I got some family members pissed at me right now becuase I will not talk to them. The patient didn't sign a release, so guess what? I can't talk to them. I even think the family's right. In the case I'm talking about, the patient refused to continue her medication for bipolar and she's entering mania from what they told the office staff members.

I may sound condescending but I am not misinformed. The ability to judge a good physician is often times lost on patients.

Agree. People often times only judge on outcomes. Often times despite the best of treatment, the odds of a bad outcome are still high. They don't care if the treatment was good, they just care about the outcome.

 

[sunlioness]

I had a patient tell me today that because I was not honoring his request to prescribe Klonopin, I was thereby forcing him to seek treatment from less than ethical private providers "who will give me what I ask for.". And that furthermore, this was compromising treatment and overall mental health because said providers are "shady.". Therefore to avoid this, I should give him what he asked for.

The logic is astounding sometimes.

 

[Manicsleep]

I had a patient tell me today that because I was not honoring his request to prescribe Klonopin, I was thereby forcing him to seek treatment from less than ethical private providers "who will give me what I ask for.". And that furthermore, this was compromising treatment and overall mental health because said providers are "shady.". Therefore to avoid this, I should give him what he asked for.

The logic is astounding sometimes.

What was your reply?

 

[F0nzie]

I have a patient that says I'm the best psychiatrist they've ever had.

This is me riding the positive transference 😀

 

[notdeadyet]

My patient is only borderline if I'm on the bad side of the split.

 

[digitlnoize]

My patient is only borderline if I'm on the bad side of the split.

That deserves a ROFL-copter:

 

[whopper]

My wife works at a place where the psychiatrist, regularly, does what I believe are the worst treatment decisions in the world.

E.g. she had a patient with PTSD as a result of a rape. She saw her rapist in a store and had a panic attack. The psychiatrist, who has her on benzos galore, no SSRI, and no Prazosin, told her she needs to confront her rapist and only then will the PTSD go away. (Someone read any journal article showing this is the case?)

She just told me of a new case where the patient has one of the worst cases of borderline PD she ever saw, and she specializes in that. The same psychiatrist told the patient something to the effect of "You're feeling terrible. This is so bad that anything you want I'll prescribe it. Percocet? Xanax? I'll give it to you."

My wife was ticked. She has better knowledge of prescribing meds than this guy. (No I'm not advocating that other mental health fields should be able to prescribe, just that this guy shouldn't be.)

 

[Sneezing]

Then have her file a complaint with the board.

 

[sunlioness]

What was your reply?

The same old broken record about how I wasn't going to prescribe Klonopin, why I wasn't going to prescribe Klonopin and another plug for learning self-soothing techniques.

 

[billypilgrim37]

Not to kick a dead horse, but this seemed appropriate to this old thread:

http://xkcd.com/958/