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Should you trust online medical reviews?

By Dr. Brian Dixon

|Apr 26, 2019

I came into work Monday morning to a message from one of our patients asking if they could write a Google review for us because there are "very VERY bad reviews out there for you."

Our patients are awesome. While I appreciated the sentiment, free online reviews pose a grave danger to medical practice in general — and mental health in particular. A popular petition on Change.org sums up the underlying issues:

  1. Anyone can make an online medical review, for free, on any public review site. But HIPAA and medical privacy laws prohibit physicians from responding to those reviews, resulting in undefendable, one-sided stories that can literally sink medical businesses by fostering mistrust toward physicians.
  2. Doctors shouldn’t be motivated by earning positive (or deterring negative) online reviews. We should be concerned and motivated by providing quality medical care.

But according to the 2018 ReviewTrackers Online Reviews Survey, 53% of consumers expect businesses to reply to negative reviews within a week. In an era when 6 out of 10 people check online reviews before making a purchase, the stakes just got even higher for physicians practicing medicine in 2019.

Running a medical practice in the digital age

I'm a terrible employee. It took me a long time (and lots of tears) to realize I don't do well with people telling me what to do. So I started my own private practice.

There have been so many pros — like kids getting A's after being treated for ADHD — as well as some cons such as not making payroll and sacrificing my own paycheck to cover my staff.

But the pros and cons average out to one happy median: I love what I do.

Running a private psychiatry practice has been one of the best, and most difficult, experiences of my life. Over the last 5 years, Progressive Psychiatry has grown from one psychiatrist to five. Most of us were on the edge of burnout before trying the direct patient care (i.e no insurance) model. Before we got here, each of us was worn down and morally injured by the impossible bureaucracy of insurance-based medicine at large conglomerate hospitals and medical systems.

The differences are anything but subtle. For one thing, by avoiding insurance, my rates can be (and are) utterly transparent. My patients don’t have to agonize or guess what their copay will be. Zero surprise billing.

Direct patient care also gives me the time to truly invest in my patients and craft individualized treatment plans for each person, most of them to good effect.

This brings me back to my first point. My metrics for measuring success are not — and should never become — striving toward positive online reviews. Reviews represent the extremes, the outlier cases on either side of the spectrum.

Please don't confuse your Google Search with my Medical Degree

In fact, I’d go so far as to say that, in medical practice, online reviews are incredibly dangerous.

Here’s why:

Good reviews

  • Could inspire false hope
  • Suggest that change is easy
  • Hint that one psychiatrist is "better" than another, as opposed to conveying that a good psychiatrist for one person might not be a good fit for another
  • Imply that one mental health practice is "better" than another based on the arbitrary experience of a single individual with nuanced medical needs

Bad reviews

  • Instill a fear of doctors / the entire mental health profession
  • Propagate stigma because they never tell the whole story
  • Imply that change is impossible
  • Perpetuate malicious and retaliatory behaviors

My role as a psychiatrist is not to nudge you toward positive reviews. It’s to help you solve a specific problem that is unique to you. Treatments that work for one person’s mental health could be harmful for others and vice versa.

Instead, I measure success by patient improvement. When the goals I have set with the patient are met and they fall off my schedule, that’s a win.

The review economy hurts small medical practices

The rate of physician burnout is 40% among all working physicians and 50% among women. The largest reported source of burnout is too many bureaucratic tasks (59% of respondents), followed by spending too many hours at work (34%) which are hallmarks of work at major hospitals.

You’d think such statistics would result in a growing number of private practicing physicians. Yet, the private practice model is under fire, with pressure to work in large hospitals growing every year.

On one hand, the internet makes it easier for private practicing physicians to reach those in need of our services. On the other hand, doctors face the new challenge of navigating public reviews that are more easily found than their practices.

Speaking from experience with my own private practice, Progressive Psychiatry has a particular methodology and ethos that differs from other practices. For instance, we try really hard to prioritize other interventions before we prescribe medications to our patients, although SSRIs and other psychiatric drugs are tools at our disposal should the patient need them.

There’s a lot in a medical practice that simply isn’t communicated in online reviews:

  • We're not the best fit for everyone (but we do refer to other clinicians who may be).
  • We're a patient-leaning partnership; we can't work harder for you than you do.
  • We rely heavily on technology; our HIPAA patient portal and our phone tree allow us to reach the largest number in need as efficiently as possible.
  • If there was a drug for happiness, we'd put everyone on it. But it doesn't exist so we support you in doing therapeutic work.

Each staff member and physician is human. We get sick. We have kids. Our driver’s licenses expire forcing us to sit in line at the DMV. We work diligently to keep our lives from affecting the trajectory of our patients and we're very proud of the result.

Online advertising versus online reviews

On one hand, both have been instrumental in helping us market who we are. We pay for online advertising (via search engine optimization algorithms) as part of our business marketing budget. We tried print ads but got zero return on the investment. Our paid advertising has worked as intended and we get lots of referrals from all over the northern half of the state.

A private medical practice is a balance between business and clinical practice.

As a business, we want corporate accountability. Don't like our response time? Let me know. Doctor was rude to you? Email me about it directly. Feel like fees are too high? Let's walk through the cost of providing care.

As a clinical practice, we want clinical accountability. Don't feel well after the session? Let me know. Doctor didn't listen? Email me about it directly. Feel like the therapeutic investment isn't helpful? Let's walk through how to get the most out of your experience.

Online reviews give NONE of the nuance of that balance. As the New York Times puts it, “Reviews are subjective, and the tiny subset of people who leave them aren’t average… What’s more, reviews are often capricious and circumstantial.”

Physicians are already overseen by strong regulatory boards. Physicians who are guilty of malpractice can be disciplined or have their licenses suspended or revoked. Online reviews, therefore, only add to the insurmountable confusion already inherent in the U.S. medical system.

What is the solution? Allow medical practices the right to be forgotten on free online review sites. It’s that simple.

It’ll be better for patients, better for physicians, and easier than writing blogs like this to explain the unrealistic picture that public reviews paint of medical practices.

With physicians creating new modalites to take care of you (e.g. virtual visits, direct primary care, bundled services, medical tourism, concierge, etc), you can find physicians that meet your needs. See a physician, judge for yourself, and skip the online reviews.

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About the author

Dr. Brian J. Dixon

With accolades spanning my career as a child psychiatrist, entrepreneur, writer, and public speaker, I advocate for a more sensible U.S. healthcare solution that appeals across all party lines. I am a Texan, born and raised. My psychiatry practice, Progressive Psychiatry, is based in Fort Worth.

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