Blog | Monday, January 23, 2012

QD: News Every Day--Office staff drive positive reviews; bedside manner drives negative ones

More than 60% of online reviews of primary care physicians are positive, and the overall experience of the office visit influences positive reviews while bedside manner drives negative reviews, researchers found.

Study authors conducted qualitative content analysis of 712 online reviews from and, purposively sampling reviews of 445 internists and family practitioners from Atlanta, Chicago, New York and San Francisco. Results appeared in the Journal of General Internal Medicine.

Reviews were first categorized as positive or negative. The analysis then distinguished between global remarks and specific descriptions. Global remarks were those about the medical encounter or the doctor, while specific remarks included more detail insight into the medical encounter or the doctor. In short, if investigators could answer the question, “Why does the patient perceive this doctor positively or negatively?” then the review was defined as specific.

Most reviews (63%) were positive, recommending the physician. There was a major distinction between global reviews--"Dr. B is a great doctor"-- compared to specific descriptions, in which comments tended to be more positive (69% and 80%, respectively). For office-related issues related staff or wait times, results were more mixed (60% positive, 40% negative).

So what drives a positive review? Not the diplomas on the wall, the authors said; the prestige of the doctor's medical school or fellowship never came up. Instead, trust and confidence in the doctor, ease of appointment making and a good interpersonal relationship lead to patient satisfaction among Internet reviewers.

The authors wrote, "The subset of specific, negative reviews may be particularly useful for providers and health systems. First, negative interpersonal reviews underscore the importance of well-perceived bedside manner for a successful patient-physician interaction. In addition, our findings reaffirm that the care encounter extends beyond the patient-physician dyad; staff, access, and convenience all affect patient’s reviews of physicians. Such reviews could prompt efforts to make the office environment more patient-centered."

Further, they wrote, online reviews shift the balance of power in patient communication. Patients can write anonymous reviews in a public forum, and doctors can't respond without breaching patient confidentiality. This can impact a physician's career. Physicians have been driven to make patients sign promises not to criticize doctors online, and those clinicians who have sued haven't always been pleased with the outcomes.

"Although we cannot predict the exact effect, we do expect these reviews to influence trust and communication in the patient-physician relationship."