Two studies on surgeons published in the last month may be instructive on how patients find physicians. First, a report in JAMA Surgery from January by Ziemba et. al Consumers Preferences and Online Comparison tools used for selecting surgeons. The study looked at 25,000 households using a net based survey, with a median age of 50 and predominantly white (73%), female (63%) and 70% had at least one health issue. Let's start with some bad news, how often did they use a search tool to seek a physician? For a primary care physician, 21% of the time; for a surgeon, 7% of the time - that makes sense because we rarely seek surgery as our primary approach to a problem. But to put it into perspective these households searched for restaurants 50% of the time. So despite a push for web-based physician comparison sites in government policy and academic journals patients are not flocking to these sites for information they feel is important. And what criteria were important in their selection?
|
Accepts insurance |
51% |
|
Referral from primary care physician |
44% |
|
Physician reputation |
38% |
|
Hospital reputation |
28% |
|
Office location |
17% |
|
Family or friend recommendation |
10% |
|
Website |
6.7% |
As a physician it is disheartening to see, but who accepts insurance is the primary criterion for finding a physician. The referral from a primary care physician makes sense because you already have a trusting relationship with that individual. But I want to focus on websites because they are increasingly mentioned as an important source of information on physicians’ performance. So within websites who was the leader? Yelp. Yes, it’s true, Yelp leads the way at 12% followed by Healthgrades at 10%. I have rearranged their data a bit, here’s my take [1]:
|
Consumers |
18% |
|
Private aggregators |
16% |
|
Hospital and physician websites |
7% |
|
Insurance company sites |
7% |
|
Media sources |
12% |
|
Medicare.gov |
4% |
|
Pro publica |
0.6% |
Forty-four percent of these respondents felt that comments on the website about physicians were the most valuable information, followed by 35% looking for generally accepted metrics considered significant, like peer evaluations, case volume, and litigation and finally 29% were concerned about complications.
It would be easy to dismiss everything in this piece, Yelp, looking at patient comments, and relying on rating companies more than trusted sources until I saw this second article in JAMA Surgery from February Use of Unsolicited Patient Observations to Identify Surgeons with Increased Risk of Postoperative Complications. Unsolicited patient comments were identified for behavior that 1) might intimidate or deter communication or that was 2)disrespectful or rude to patients or staff. These observations were used to place physicians in four groups, from the fewest (0-4) to highest (14-60). The post-operative complications of these physicians were taken from the National Surgical Quality Improvement Program database, a very reliable source of clinical information that allows for reliable clinical risk adjustment. For those with the least number of these complaints, the complication rate was 9.6%, for the physicians with the highest number of complaints, 13.9%. So maybe, the consumers are right, the most useful information lies in the comments of their peers and not so much in the many measures (and costs) we are busily collecting on physicians. Maybe crowdsources, Yelp and Angie’s List have an under-recognized value - they did for me.
[1] Consumers-Yelp and Angie’s list; Private aggregators-Healthgrades, Vitals, RateMD, Consumers Checklist, UCompare;Media sources-Consumers Report, US News and World Report
