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Spring 2019 (Volume 29, Number 1)

Best Rheumatologist or Best-rated Rheumatologist?

By Philip A. Baer, MDCM, FRCPC, FACR

“I think people make way too much of ratings.”
– Walter Cronkite

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I’ve been mulling this topic for awhile. When RateMDs first appeared, I paid little attention, but my children did research it and offered to write me favourable reviews. What was more interesting was to see what was already there, without letting this external validation of sorts influence one’s mood too much, either positively or negatively. Overall, my ratings were good, reflecting (I think) that I see one patient at a time, try to run on time, emphasize to my office staff that we are running a customer service business, and try to be what the mindfulness gurus call “present” or “in the moment.” When I first started with an EMR, I had a negative comment about interacting too much with the computer. We solved that, at the cost of worse spinal posture, by rearranging my desk and computer monitors to better face the patient across my desk; no complaints since.

Another patient left enough clues in a negative review that I felt fairly confident I knew who had posted the entry. The main issue seemed to be that I had not found a diagnosable rheumatic disease. I carefully reviewed the information provided in the referral request, as well as the test results and my consult note, not uncovering any concerns. Validation came when the patient saw another rheumatologist, who ordered more investigations and copied me on their letter, also having found no significant disorder.

Dr. James Rosenbaum, an American rheumatologist and ophthalmologist, highlighted the importance of factors external to the physician’s competence in a doctor’s ratings.1 He practices in two clinics, one where he is highly-rated (rheumatology) and one where he is not (ophthalmology). Dr. Rosenbaum explored factors known to produce negative physician ratings in American hospital settings: being seen by a resident versus an attending physician; being seen at a teaching hospital; and the patient’s diagnosis, with fibromyalgia patients being less satisfied than those with other diagnoses. Patients who received tests and prescriptions which they wanted, even if those were medically inappropriate, were also more satisfied. With many American physicians having a portion of their pay based on patient satisfaction, these issues have become top of mind.

A study published recently in JAMA Internal Medicine confirmed this reality. This was a cross-sectional study of 1,141 adults making 1,319 office visits to 56 family physicians. Compared with fulfillment of the respective request type, denials of requests for referral, pain medication, other new medication, and laboratory tests were associated with worse patient satisfaction with the clinician.

In Canada, a recent CBC TV story3and a lead from a concerned Ontario rheumatology colleague led me to revisit RATEMDs.com. Amongst the interesting information online, I found out that the website is owned by Vertical-Scope Inc., which in turn is now owned by Torstar Corp., the parent of The Toronto Star newspaper, widely known to be no friend of physicians. The CBC story discussed what physicians with negative ratings could do to restore their reputations. This involved paying online “reputation management” firms, one of which is RATEMDs itself, a monthly fee to generate favourable reviews and hide unfavourable ones, or to push them lower onscreen and out of sight. The quoted RATEMDs fees for hiding up to three unfavourable comments range from $179 to $359 US per month. If you stopped paying the fees, the negative reviews would reappear. So this appears to be a smokescreen service, rather than a scrubbing service, with numerous ethical questions arising.

Meanwhile, back at my office, a rare patient mentions that they noted I had good online reviews, or that they wrote one about me. Most are oblivious, or at least not talking about the matter. Last time I looked, I was holding steady as either the #2 or #3 top-rated rheumatologist in Scarborough, for whatever that’s worth. As the #1 rated rheumatologist is sadly deceased, and likely not going to accumulate any negative reviews in future, the only direction my rating can realistically go is down.

References:

1. Rosenbaum JT. A Tale of 2 Physicians. The Rheumatologist, May 2014:8-9.

2. Jerant A et al. Association of Clinician Denial of Patient Requests With Patient Satisfaction. JAMA Intern Med 2018; 178(1):85-91. doi:10.1001/jamainternmed.2017.6611

3. Who's rating doctors on RateMDs? The invisible hand of 'reputation management.' Available at https://www.cbc.ca/news/health/ratemds-privacy-reputation-management-1.4880831. Accessed Oct. 31, 2018.

Philip A. Baer, MDCM, FRCPC, FACR
Editor-in-chief, CRAJ
Scarborough, Ontario

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