SALT LAKE CITY — The comment caught Dr. Robert Glasgow's eye. Reading it felt like a punch to the stomach.
“Prima donna," a patient had written about the University of Utah surgeon. "Great surgeon but flippant attitude... Just kind of, oh no big deal 'go live your life.'"
Comments like this used to be far more common at University of Utah Health Care a few years ago. In 2008, the U. was ranked in the bottom half of academic health systems for both patient satisfaction and quality.
So the university surprised everyone when, in late 2012, they became the first medical system in the U.S. to put the results of their patient satisfaction surveys online.
“We all kind of gasped and went, ‘What?’” said Amy Ranier, the senior director of patient experience at University of Pittsburgh Medical Center, who watched as the U. rolled out the initiative. "It really was a novel concept."
As more and more consumers turn to the Web to help them make decisions about which restaurant to try or which hotel to book, websites that rate doctors — often based on anonymous reviews — are also growing. But the trend is debated by some medical organizations and physicians who have questioned the validity of such reviews.
Regardless, said Evan Marks, chief strategy officer of the Denver-based web company Healthgrades, "It's the absolute way that everybody's doing it today."
At the University of Utah, each physician now has a profile where people can see dozens of comments from anonymous patients and an overall star rating. The results are culled from online surveys sent to each patient after each visit.
Even some of the biggest fans of the initiative admit the transition wasn’t easy.
Dr. Bernadette Kiraly (rating: 4.8 out of 5; specializes in women’s and refugee health; Nordic skiing enthusiast) recalls seeing colleagues crying after reading bad reviews.
“Providers take it seriously,” said Kiraly, who is a family physician and the medical director at the U.'s Sugar House Health Center.
Chrissy Daniels, the director of strategic initiatives at the university, said younger consumers are demanding transparency from their health care providers.
She sees it in the survey data. Greatest Generation patients tend to be "much more communally oriented, 'I don't mind waiting if everyone's waiting,' and there's a lot of respect for the authority of the physician," Daniels said. With them, she said, "We are the bomb. We are delighting them."
Baby boomers tend to be more focused on rankings and getting what is considered "the best" care, but they're still returning positive reviews, Daniels said.
But Gen X'ers and millenials tend to be more distrustful of doctors and more focused on convenience, according to Daniels. They don't just want doctors to give them orders — they want their doctors to develop a treatment plan with them. They aren't OK with waiting weeks to see a doctor — they'd rather go to an urgent care clinic.
"We are not meeting what they need from us. We can't outsmart our way out of an inconvenient system," Daniels said.
Researchers are still divided on whether public patient reviews lead to better or worse care.
In a 2012 study titled "The Cost of Satisfaction," researchers found that patients who reported higher satisfaction were also more likely to be hospitalized and had about 9 percent higher health care costs. They were also more likely to die.
The reason? Patients often want doctors to order prescriptions or tests that "are of little or no medical benefit," the researchers wrote. Doctors who cater to what patients want instead of what patients need may end up harming them by ordering inappropriate treatments.
A Salt Lake area primary care physician, speaking on the condition of anonymity, said he's lost business because of negative reviews on third-party review sites like Healthgrades, where he has a 1.1 out of 5. Many of those reviews, he said, are from patients who wanted treatments that were inappropriate, such as narcotics or antibiotics.
"When you read them, they say things like 'He doesn't give medicines' or 'He was rude,' 'He didn't listen to me,'" the doctor said. "What that translates to is 'I didn't agree with them."
Dr. Sharon Richens, an ophthalmologist in St. George, said reviewers on third-party sites tend to be at extremes. If you look up Richens, for example, patients tend to give her either 1s or 5s.
"Someone who is quite happy with your service is likely to tell you verbally, and we do get a fair number of cards and notes and candy," Richens said. "Someone who has negative things to say is not likely to come back and is more likely to vent."
The issue has intensified now that more insurers are talking about factoring in patient satisfaction scores to physician payments. Medicare started doing so in 2012 for hospitals.
The Utah Medical Association is so concerned that it plans to ask the the American Medical Association, the largest physicians association in the U.S., to ban third-party payers from using patient satisfaction ratings to determine physician payment.
“It can be an unfair way of cutting costs by underhandedly incentivizing a lower quality of care," said Utah Medical Association CEO Michelle McOmber.
But Daniels said the U. has seen dramatic improvement since 2008, when they first started sharing survey results with their physicians. Over the past six years, the hospital jumped from the 34th percentile in patient satisfaction to the 80th percentile.
In the same time period, the U.'s mortality, safety and efficiency scores improved. Meanwhile, costs have decreased and malpractice premiums have fallen. For the last six years, the university has ranked in the top 10 hospitals out of 118 academic medical centers around the nation.
"We could not get better at the rate we’re getting better without the comments," Daniels said. "It’s the engine that drives our whole system."
Madsen Internal Clinic director Dr. Hanadi Farrukh (rating: 4.8 out of 5) said better communication leads to better care.
Most of her reviews are glowing, but in some surveys, patients have said that Farrukh talked about issues she thought were important — like diabetes or high cholesterol — but missed what they actually wanted to talk about, like back pain.
"I brush over that, that shows up in the surveys and comments," Farrukh said.
Anonymous reviews can also impart some humbling lessons. During one bad month in 2014, after a death in the family, Kiraly reviewed her comments and was surprised to see that many said she seemed distracted.
Kiraly prizes her ability to “be present” for patients, so the comments came as a shock. But "it resonated as true,” Kiraly said.
If patients are human, then doctors are too.
“It’s still two people sitting in a room, sifting through human business, trying to get to the root of a prolem,” Kiraly said. “That will never change.”
Several other hospital systems like the Cleveland Clinic, Stanford Medicine and Duke Clinic have since reached out to the University of Utah for help putting their surveys online.
Last August, Intermountain Healthcare also made their physician reviews public. Administrators tapped pollsters Dan Jones & Associates to conduct the surveys over the phone, a decision that was "not inexpensive," said Susan DuBois, Intermountain's associate vice president of physician relations.
In March and November of last year, Intermountain collected nearly 131,000 completed surveys.
Marks, the Healthgrades executive, said consumers can expect hospital and doctor data to become increasingly detailed in coming years.
Healthgrades already publishes complication and mortality rates for each hospital. They also collect data on the number of procedures each surgeon completes and how many sanctions they have. These measures are far more important than a star rating, Marks said.
In the future, he plans to collect more meaningful data from patients.
Forget about whether it was easy to make an appointment. Marks wants to know: Was your diagnosis correct? Was it it made quickly? Now that you've had your knee replacement, how long did it take you to get back to work?
"Especially the younger doctors, this isn't the old days when you got your medical degree and you were able to drive away in your Cadillac," Marks said. "You've got to compete."
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