Physician rating sites deserve their own “Black Box Warning”

The Pediatric Insider

© 2017 Roy Benaroch, MD

When a drug is especially dangerous, or even potentially-maybe-especially dangerous, the FDA requires manufacturers to put a “Black Box Warning” on the product insert. (As it happens, many of these are misleading, inappropriate, or factually incorrect – but that’s a subject for another day.) A “Black Box Warning” is supposed to very explicitly say “BUYER BEWARE”, more than just the typical list of potential side effects mumbled by Mr. TalkFast at the end of a drug ad. The normal warnings look like “ThisDrugMayCauseDrowsinessTailGrowthAnalFlameDischargeAnUnpleasantMetallicTasteOrAnInexplicableInfatuationWithSenatorJonTester(D-Montana)”. It’s easy to ignore the wordy mumbling. The Black Box, that’s supposed to get your attention. It’s doesn’t mean the drug is a bad idea for everyone, but it does mean you’d better think before you take.

I’d like to see a Black Box warning on physician rating sites, too. They’re not always wrong, and they might just be useful once in a while. But you’d better think twice before taking them at face value, or using them to make decisions about whom to see for health care.

A few recent studies illustrate some of the problems. One looked at mortality rates for 614 heart surgeons scattered across 5 states, comparing those rates to their physician ratings on several well-known rating sites. There was no correlation at all. Physicians with high death rates often had great ratings; physicians with low death rates might have very good ratings. If your goal is to survive heart surgery, those physician rating sites tell you nothing. That should be in the Black Box warning.

Another study looked at physicians in California, comparing ratings on popular sites between 410 docs who had been put on disciplinary probation versus docs in those same Zip codes who hadn’t been sanctioned. Keep in mind that medical boards do not take probation lightly – docs who’ve been nailed by their board have probably done something fairly bad, and probably more than once (although there’s considerable variability, some luck, and politics involved. Good docs are sometimes trapped by their boards, too.) Although it varied by the reason for the probationary status, for many doctors disciplined for lack of professionalism, substance abuse, or sexual misconduct there was no correlation between ratings and probation status. Looking at the overall averages, docs on probation had an average score of 3.7, compared to 4.0 for docs who had behaved themselves. Very little difference, there.

There are several reasons that these doc rating sites not reflect genuine physician competence:

  • Only people who are motivated to write ratings do so. The vast majority of patients who have a reasonably positive experience do not bother to do rate their docs. I’ve called this property of internet postings “Exaggerating Freakiness”, and it pervades social media. The internet brings far more attention to the outliers than it does to ordinary stories, and that distorts the impression we get from just about every web site.
  • How people feel about the medical care they received doesn’t necessarily correlate with whether they got good care or not.
  • It’s pretty much impossible to tell if a public posting is true. There are many reasons people write both positive (friends, neighbors, well-wishers) and negative (competitors, those with specific agendas) reviews.

Some docs (and other businesses) are using litigation to aggressively fight back against negative reviews. But that’s not always fair, either. People are entitled to their opinions, and as long as they’re not just lying about what happened, I think it’s best if the lawyers stay out of this. Still, I get the frustration that business owners feel if they’ve been unfairly targeted.

Online rating sites are here to stay, and they’ll continue to rate doctors and hospitals, and people are going to continue to use them (Google just shoves the rating down your throat when you search. There’s no avoiding this.) Just remember the Black Box warning: physician rating sites may have some use, but they can have unintended side effects. They may mislead you into making a poor decision about your doctors, and that’s not good for your health.

Physician rating sites deserve their own “Black Box Warning”

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7 Comments on “Physician rating sites deserve their own “Black Box Warning””

  1. Jeanne Says:

    I love and agree with your article. Outliers get all the attention. I am a victim of medical malpractice as defined by a Dr ” deviating from standard medical practice.” This of course was not done by you! I’ve never made the first post against this Dr.

    But the question stands, “what should a person desiring a standard level of care do?” Tort reform in the state of GA has served only to create a haven for Drs who are careless and protect them from any meaningful or punitive consequence from the courts or their medical malpractice insurance companies who promoted the idea of tort reform to our legislature.

    As things stand in GA today, unless a Dr can be proven to create a large financial loss (via maiming, death, etc) there is no medical malpractice attorney in GA who will take their case. It costs those attorneys roughly $80k to take a case to court and that’s what they now have to plan for because the insurance companies take it all the way to trial. There is little to no settlement out of court now, as there was prior to tort reform.


  2. Cara Finn Says:

    So – beyond word of mouth – how does one find a good doctor?


  3. Dr. Roy Says:

    I’d probably start with a short list of docs who write their own blogs. They’s the best.

    This prior post has some other, better ideas:


  4. Angela Says:

    Most communities have a Facebook page nowadays. I’ve gone to our local one for recommendations, that’s how we found our current dentist.

    I did see a weird situation once, however. Someone was asking for recommendations for a pediatrician, and I recommended ours. Another mother said she had an awful experience with our pediatrician, but she wouldn’t give details. I even told her to send me a private message if she didn’t want to put it on the group page. She never responded. I was very curious, since he’s our doctor! I’ve always wondered about that.


  5. Sherry Says:

    Hospital ratings ought to have a warning, too. The number of people who told me “Don’t go there for maternity care, they have the highest c-section rate around.” Well, yeah, that hospital has the high-risk pregnancy center, and the only level-IV NICU around. If you know there’s a problem, you go there. So, they have a high c-section rate. Understanding statistics can mean thinking.

    Let alone, what’s wrong with having a c-section?


  6. Dr. Roy Says:

    Sherry, the lie that lower c-section rates = better care is unfortunately becoming entrenched as a new media myth:


  7. DT Says:

    It seems these days you throw a rock in an American hospital and you’ll pretty much be guaranteed to hit a doctor of Indian or Middle Eastern descent. What I want to know is why? What’s driving this?


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