Andrew Siegel MD 6/18/2022
Now that there are so many forums for posting public reviews and anything and anyone –ranging from Amazon products, to restaurants, to experiences with contractors, professors, etc. — can be reviewed, no one is immune from public scrutiny. Patient reviews of physicians is the topic for today’s entry.
Medicine has been corporatized and industrialized and the days of “mom and pop” medical practices are long gone. Most physicians now are employed by hospitals or large group practices. Clearly, something has been lost in this process and the times when doctors were revered by patients have gently slipped away. However, physicians are still reasonably respected, and a recent public opinion survey rated them #5 on a list of the most respected professions, surpassed only by firefighters, nurses, farmers, and members of the armed forces. Of note, on the very bottom of the list were car salespeople, members of the senate and congress, and owners of social media platforms.
Forums for Rating Doctors
There are numerous websites for rating physicians, including Healthgrades, Google, and Vitals, among others. A patient can rank their clinician ranging from one to five stars and has the option of writing a narrative to explain their ranking. If one does a Google search for a physician, e.g., John Smith MD, a ranking number from 1-5 (the total number of stars divided by the total number of reviews) will appear, followed by an image of that ranking using gold stars, followed by the number of reviews in parentheses.
5-Stars and 1-Star
I have found that most patients who have had an experience that meets their expectations are not motivated to write a review. Reviews are mostly written by patients who feel they have had an exceptional experience, whether exceptionally positive or exceptionally negative, and that is why many reviews are either 5-star or 1-star, with few intermediate ratings.
I recently appraised my reviews: Of 28 Healthgrade reviews, 23 were 5-star and 5 were 1-star. Of 14 Google reviews, 12 were 5-star, 1 was 4-star, and 1 was 1-star. Of 24 Vitals reviews, 16 were 5-star, 2 were 4-star, 2 were 3-star, and 4 were 1-star.
It is not surprising for doctors to receive some poor reviews since there are always going to be some patients who are unhappy with some aspect of their visit. In fact, some bad reviews serve to legitimize the good reviews, and anyone who garners exclusively 5-star reviews is not credible. In my humble opinion, a 1-star review without any written narrative to serve as an explanation for that ranking has little to no credibility. However, a 1-star review with a statement explaining the reason for the poor experience can serve as constructive criticism and an opportunity to improve shortcomings. No one is ever happy about a bad review — as it can lower a clinician’s rating — particularly when it is unwarranted. No one cares for a stain on their reputation that has been developed and honed over years in medical practice.
I choose not to comment on my 5-star reviews and am most appreciative of patients who take the time to post an excellent review and reinforce that with a narrative explaining their exceptional experience. I only scrutinized my 1-star reviews and analyzed the reasons for patient dissatisfaction.
In My Humble Opinion
One of the key problems with clinician reviews is that in many cases, the gripe is not with the clinician, but some aspect of office function or personnel that left the patient dissatisfied. Certainly, as physicians we are “captains of our ships” and are ultimately responsible for all aspects of office function, but complaints are often far removed from our one-on-one interaction with our patients. The litany of complaints can be highly variable and may include a negative interaction with a particular staff member, disappointment with insurance and payment policies, dissatisfaction with some physical aspect of the office — particularly crowded waiting rooms, time delays, annoyance regarding the time it takes to pre-certify imaging studies, communication difficulties with the office, etc.
Some of My 1-Star Reviews Paraphrased
A patient who was peeved when her minor office diagnostic procedure was cancelled by the anesthesiologist who genuinely feared that her significantly overweight status would make dealing with her airway in an office setting a risk to her health.
A patient who had a negative interaction with our front office staff and complained about telephone access to me.
A patient who felt rushed, unhappy about phone access, upset that I was unable to solve his problem, and felt that the only focus of our office was economics.
A patient with groin pain whom I could not detect any urological problems whose wife was upset because I did not order an imaging scan.
A woman who complained about our office staff because her father’s insurance company initially denied approving his MRI and it took a lengthy amount of time to appeal and finally get the approval.
A patient who had kind words about me but felt that our waiting room was overcrowded, had a negative interaction with front office staff and felt a nurse was rude to her. Furthermore, she thought that the bathrooms were not clean and was disenchanted with one bathroom’s use as a storage room.
Analysis and Solutions
Our practice is busy: 9 urologists, 2 nurse practitioners, a practice manager, several ultrasound technologists, lab personnel, many medical assistants, scribes, front office personnel responsible for checking in and checking out patients, an in-house call center to triage phone calls and make appointments, clinical personnel to help with lab call backs, scheduling personnel, billing and insurance department, imaging scheduling personnel, etc. It is quite a complex production with many moving parts.
Our waiting room is often crowded with typically two doctors working at any one time and rarely three. Although we do our best to stay on schedule, the nature of our practice is that we prioritize emergencies (blood in the urine, inability to urinate, painful kidney stones, infections, etc.) that can cause delays in patient flow. Cancer is a large part of urology practice (prostate, kidney, bladder, testes) and delays in patient flow can arise because of the consultations required to discuss these serious issues, often in the capacity of second opinions, which can take a variable amount of time. As much as we are always striving to improve scheduling and patient flow and stay on schedule, it is an imperfect science with many dynamic variables.
We are a service “business” and abide by the adage that “the customer always comes first.” Our hard-working office personnel try as much as possible to maintain a high-level “hospitality quotient,” but inevitably, some patient-office personnel interactions will be less favorable than others by virtue of the number of these interactions that occur on daily.
Telephone access to the office has surfaced as a complaint. Subsequently, we have revamped our call department that now consists of 6 people employed exclusively to answer the telephones, schedule appointments, and reply to voice mail messages on as timely a basis as possible. We also have 3 clinical triage personnel employed exclusively to do tasks including triaging emergency calls and getting emergency patients on the schedule, lab and imaging result callbacks to patients, responding to patient requests from our electronic medical system, prescription refills, etc.
Telephone access to physicians — including myself — has always had its challenges as the urologists in our practice are extremely engaged during office hours with barely time to get through our schedules, usually followed by a busy session in the operating room or ambulatory surgery center. As a solution, we now offer telemedicine visits as an alternative to an actual office visit.
The complaint of an untidy bathroom is certainly legitimate. If I was a patient in a doctor’s office and confronted a less-than-pristine bathroom I would be reluctant to return to that office. Our Maywood office is an older office, and while we make every effort at maintaining bathroom cleanliness, it is somewhat more challenging than for most other medical disciplines because of the nature of urology, with a tremendous volume of bathroom traffic as virtually all patients leave urine specimens many who are elderly. We have plans in the works to move to a larger and more modern facility, which hopefully will help this situation.
Conclusions
Like physician reviews that can be good and bad, my overall opinion of the concept of doctor reviews is that they are also good and bad. Excellent reviews reinforce what we are doing right and serve to encourage prospective patients to use us as their physicians. Poor reviews — when legitimate and when offering constructive criticism that can result in improving the patient experience — are clearly worthy. However, when undeserving complaints are leveled at issues that are beyond the ability of a physician’s office to control because of the nature of the practice of medicine, it results in an unnecessary soiling of a clinician’s reputation that does not improve the quality of our work or of a patient’s interaction with us.
Can we do better? The simple answer is “yes,” as warranted criticisms serve to motivate us to correct shortcomings and improve our practice. That stated, we have a superb practice manager and diligent and dedicated staff members who work really hard at trying to make the patient experience as professional, pleasant and streamlined as possible. Regardless of patient reviews, the physicians and leaders of our various office departments meet monthly after hours to discuss issues, problems and come up with solutions in an effort to further refine and evolve the practice and improve the patient experience.
Many patients are referred to our office by trusted sources, including their medical doctor, family member, or friend. Some find us via the Internet or from their insurance registries. Although reviews are important, I give future patients credit for having the savvy to sort through the reviews and put them in their proper perspective and context. “Everything with a grain of salt.”
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
Tags: Andrew Siegel MD, patient reviews
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