Don't even bother with Web-based doc-rating systems.

Health and medicine explained.
Nov. 28 2008 7:05 AM

Doctor, Doctor, Give Me Reviews

Don't even bother with Web-based doc-rating systems.

www.heathgrades.com screen capture.

An enduring seduction of the Internet is its ongoing invitation for you to rate—and learn what others think of—restaurants, hairstylists, car dealerships, your kids' school, DVD players, movies, college professors. Doctors are no exception: The Web is awash with sites eager to give you the inside dope on your physician. With a single click, you can find out how your internist or surgeon rates against colleagues in his field, what the patients are saying behind his back, if the office staff is chipper, whether malpractice lawyers have him in their sights. This seems the perfect way to resolve an age-old fear far more important than whether that HDTV cuts the mustard: Does my doctor actually suck?

Recently, I embarked on a mission to further the public good (and to determine whether my patients hate me) by visiting these rate-a-doc sites. One by one, I examined the examiners, spending hours—many, many hours, because the Web sites in question seem to run at dial-up-modem speed—checking out a carefully selected roster of a dozen doctors against the data available on the Internet sites, including checkMD.com, HealthGrades.com, RateMDs.com, Suggestadoctor.com, DrScore.com, UCompareHealthCare.com, RatePoint.com, Wellness.com, and Vitals.com. My sample of doctors—internists and surgeons, generalists and specialists—included me, my brother, friends, rivals, heroes, and, in the interest of nonpartisanship, a few docs near the Ohio home of Joe the Plumber.

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Here's what I found: zilch. The online doctor rating system has a shocking lack of useful information.

But don't take my word for it—join me on my tour. Let's start with the free sites (most of the rate-a-doc operations don't charge anything). To pay their bills, the freebie (and nonfreebie) sites are studded with ads—for cheap generic Viagra, fantasy football leagues, various walk-in clinics, weight-loss plans. Broadly speaking, all sites offered up two kinds of information. First is regulatory: licensure and any history of disciplinary action. These data are also easily obtained from state department of health Web sites—for New York, that's here and here. Everyone I looked into was licensed, none were running from the law, and—bonus feature—the sites provide e-maps to show you how to find the office.

The other info on the Web sites, and the real guts of the operation, is the promise that previous patients have spilled the beans about their doctors. This sounded exciting, but alas, few beans have been spilled—one site notes (without apology) that they have 137,832 listed doctors and 5,709 patient reviews. Only a few members of my sample had received any feedback at all—generally one or two mild complaints about outdated magazines in the waiting room or the temperature of the exam table. One site did have tons of comments—but none were directed at my panel of doctors. Rather, these commenters were laying into loads of obstetricians, plastic surgeons, and dermatologists, claiming they had done some real dirt. Reading the comments, though, wasn't that much fun—it came closer to listening in on unhinged talk radio.

The free sites were so lame that I figured the real juice was hidden behind a pay-as-you-go firewall. So I decided to blow some Slate bucks—$100 in all—starting with HealthGrades.com While some other pay sites have a la carte fee menus that were difficult to navigate, HealthGrades charges $12.95 per doctor inquiry. I looked myself up first. Surprise: I have a license and am certified to practice in my specialty. I have no disciplinary actions directed my way. And—disappointingly—no patient had written anything about me. As I moved from screen to screen, I found a curious offer. HealthGrades said that if I were Dr. Sepkowitz (of course they know doctors would be rummaging around their own sites), I could learn how, for no additional fee, to tell the 8,143,197 residents of New York City more about myself and my practice, including my philosophy of care (hold still, Plato, additional spinning is futile) as well as my history of publications and media coverage.

After paying for six additional HealthGrades searches to provide deep background on other members of my select group and finding nothing at all, I gave up. The paid sites appear every bit as lean as the freebies.

A confession before moving on: I was reviewed on one of the freebie sites, DrScore.com—and, um, someone out there doesn't like me. All of my measures fell short—my exam, timeliness, treatment, even my staff. So I did what any normal American male under e-assault would do. I stuffed the ballot box. I pretended to be a patient of mine and lied about my age, gender, how often I see me, and the reason I was seeing me. I talked up my friendly attitude and thoroughness, gushed over the oodles of time I spent examining me, and declared my overall treatment a success. Not to limit the kudos, I also gave high marks to parking availability by my office. Then I did the entire drill a few times more (changing my age and gender once or twice, natch).

With my unceasing selfishness campaign, I was able to hike my scores to levels that would make my mother and even my mother-in-law proud. I also peddled my influence upon one other site, Suggestadoctor, where my electioneering was particularly productive. The next day, I received an e-certificate in a gold frame announcing that patient Kent S. had rated me so favorably—he was particularly impressed by my "superhuman ability"—that I was now a "Suggested Doctor" though I didn't make it into the site's elite "Most Recommended Doctors" circle.

What can we make of a system that seemingly addresses a topic of such central importance yet remains 99.99 percent content-free (and so easily manipulated)? Compare the feckless rate-a-doc sites with eBay, with its well-maintained system of checks and balances. Thousands of comments from previous buyers accrue to eBay sellers, and if you've ever bought on eBay, you know the seller comes at you to fill in your evaluation! with the ferocity of a prison guard.

There's the difference. On eBay, each side of the equation—the buyer and the seller—wants to get the skinny on the other. In contrast, rate-a-doc sites have no clear constituency. Doctors aren't involved in policing the sites (unless they're padding their scores) and don't beg their patients to fill out the forms, and patients don't seem particularly itchy to click through sites that few have ever heard of (except, perhaps, the people who also call in to talk radio). And in the interest of fairness and self-aggrandizement, may I say that it is likely that the patient ratings skew south—probably only those with a serious ax to grind have any interest in hacking through the endless questionnaires. But if the doctor visit works out well, who would bother?

Even accounting for the inevitable bias, we are left to ask what value two, three, or even 10 or 20 comments about a doctor can have. The entire enterprise is yet another fine example of what happens when the lure of potential advertising dollars takes the lead and the content of interest (does your doctor suck?) is just along for show. No one at the sites is really worrying about your doctor—they're just concerned with keeping the sites afloat. So unless you're looking for a place to order a weight-loss shake, I suggest you click elsewhere.

Kent Sepkowitz is a physician in New York City who writes about medicine.

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