Healthcare is increasingly becoming a ‘commodity’, subject to the same market forces as your favourite restaurant or hairdresser. Does that mean it’s appropriate to review your doctor online? If so, what regulations are in place to prevent a five-star review from simply becoming an ad?
Until recent years, healthcare had largely avoided the ubiquitous comparison-website movement. Whitecoat.com.au changed all this in 2013, when insurance provider NIB launched the new website. The healthcare directory and customer review site allows patients to rate and comment on allied health professionals such as dentists, physiotherapists and optometrists. Clinicians are able to review comments before they are posted, and respond if they want.
A similar website, patientopinion.org.au, originated in the UK in 2006 and started in Australia in 2012. Patient Opinion encourages patients to review their experiences with Australia’s local health services. The aim is to facilitate “honest and meaningful conversations between patients and health services” to help improve the quality of healthcare. Patients can leave comments about their experiences, but the website doesn’t allow people to rate a hospital or individual doctor. The comments are shared with the healthcare professionals, who also have the opportunity to respond.
The spread of these review-style websites is a sign that there is a market for this kind of information. The modern patient is more involved in their health treatment choices than ever before and the nature of the doctor-patient relationship is changing. As a general rule, patients are better informed and actively seek out information about doctors and treatment; the days of ‘doctor knows best’ are over.
The effectiveness of the UK version of Patientopinion.org.au was assessed in 2009. The research found that around 50 per cent of comments received a response, although positive comments were more likely to get one. Anonymity was seen as helpful, and around 30 per cent of participants felt that the site was filling a feedback gap. Many were glad that their experience had been ‘heard’.
There can be some benefit in providing feedback online and through an intermediary — it allows patients to take a step back and think about what happened. Anonymity can also help in giving honest feedback.
A key variable is how the clinicians themselves respond to comments. While it would be great to think that healthcare organisations are responsive and act on negative patient feedback, it’s not something that patients (or review sites) can actually control. However, if the websites do help to improve the quality of healthcare, all the better.
There is some merit in the argument that a good bedside manner doesn't always correlate with good clinical outcomes. There is, however, a strong correlation between bad communication and an unsatisfied patient… the kind of patient who is likely to make a complaint about the care they received. Therefore, these kinds of website rating systems can be a little skewed — people who have negative experiences are far more likely to post comments than those who have good ones.
The 2009 UK study of the Patient Opinion website found that despite the anonymity, many people said they were hesitant to complain about a service that they may have to visit in the future. The research also found that organisations remain concerned about litigation if they provide honest answers. Perhaps most importantly, the research found little evidence to suggest the site was leading to improvements in systems and outcomes.
Is it advertising?
Your online comments, whether about a doctor or local cafe, are generally written in good faith. But how do you know that every review you see is honest and independent, and not just someone trying to drum up business? The Australian Health Practitioner Regulation Agency (AHPRA) has strict guidelines around the advertising of health services, including comments on social media and public websites.
The confusion around healthcare reviews highlights the often complicated relationship between medicine and commerce. Doctors are entitled to make a living from their profession and many are running businesses; positive feedback on social media could be useful for them. However, medical treatment obviously has a broader social importance and can be a personal, invasive and risky undertaking, which could be overlooked if the treatment becomes too commercialised. Without regulation, the combination of advertising, reviews and ratings could be open to abuse and potential patients could be unduly influenced.
In 2014, doctors and other health professionals faced fines of as much as $5000 under revised guidelines if their patients made positive comments — deemed ‘testimonials’, which are banned — about them online. If a doctor became aware of such comments, they would have had to take ‘reasonable steps’ to have the comments removed.
A backlash from the medical community forced AHPRA to take a second look. Only a week after the guidelines were released, it announced that unsolicited comments on social media or review sites would no longer breach the guidelines, saying they did not expect doctors to monitor the internet for comments about them. However, national law still prohibits the use of testimonials in health practitioners’ advertising.
Open communication is always a good thing, particularly when things go wrong, and the ability to facilitate conversations between patients and health professionals is one reason why medical review websites have proved popular. However, it’s important to remember that online comments and ratings are unsubstantiated. We are being exposed to more information and advertising than ever before, so a degree of regulation is necessary to gain and retain trust in these sites.
Tom Ballantyne is a senior associate in Maurice Blackburn's Melbourne office.