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Doctors Are Giving Out More Drugs to Improve Their Online Ratings

With funding and patients on the line, docs are ordering more drugs and unnecessary tests to appease online reviewers.

The threat of negative reviews and their consequences for doctors (and their wallets) has led to some ugly unintended consequences. New research shows that drugs and tests are flowing more freely than ever, as docs chase good scores from patients.

Everyone hates being rated online. My friends in the service industry complain when they're mentioned on Yelp, academics live in fear of "Rate My Professor," and, indeed, now even doctors are under the five-star gun.

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First off, according to the Canadian Medical Protective Association, doctors are dealing with this new ratings landscape like you'd expect them to. "Physicians tend to get very upset with (online) criticism," Dr. Douglas Bell, associate executive director of the CMPA, told Postmedia News.

The CMPA, the largest malpractice insurer in Canada, is advising defensive doctors to view the scores "as objectively as possible," and "take measured steps to deal with these reviews."

The MD backlash is not just because doctors can be raving egomaniacs, either. Kevin Pho, writing for USA Today, reports that "two-thirds of physician pay incentives are based on patient satisfaction scores." In the US, Medicare reimbursement rates are based in part on satisfaction survey results, so doctors and hospitals have a very real financial interest in getting good ratings.

Meanwhile, evidence suggests that satisfaction surveys are a widely used metric by the public as well. A study published in the journal Pediatrics found that more than a quarter of parents used physician-rating websites to help them choose a pediatrician.

You'd think that doctors being somewhat beholden to their patients' opinions would be a good thing, and arguably it has improved some aspects of their work. Zlati Meyer, writing about Michigan's Providence Park Hospital for the Detroit Free Press, found that, with money on the line, the hospital was a quieter and more patient-centric place.

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Nearly half of physicians "said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics"

"Special air-blowing vests keep patients warm pre-surgery," Meyer reported. "Private rooms are the norm. Staffers regularly check in with patients to anticipate their toilet and showering needs to cut down on call-light usage. Patients are given clear discharge instructions. Cleaning is no longer done at night."

These are small changes that may not affect medical outcomes, but certainly will affect the patient's experience and, therefore, the rating. It might not be entirely fair, but there's nothing to keep patients from giving ratings based on things like comfort with just the same weight as those based on their ultimate health results.

But, weirdly, there's also a downside. Pho referenced a survey by the South Carolina Medical Association that found nearly half of physicians "said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics." Doctors have also admitted to ordering tests they don't deem necessary just to improve their rating.

These are things that might boost scores, but don't improve patient outcomes.

Obviously there's a line here between treating your patients with compassion and just giving them whatever they want to keep your own rating high. It's a loaded topic because people already feel like their doctors don't listen to them, and feel like rating sites are finally their way of striking back.

As one letter writer to the Montreal Gazette explained, "Any one who has had the misfortune of dealing with physicians who need to be reprimanded by their peers has no choice but to go to RateMDs to vent their frustration."

So what's a doctor to do? First off, it's important to remember that most ratings are already positive. In one study published in 2010, researchers studying 33 physician-rating websites for reviews of 300 randomly-selected Boston doctors found that 88 percent were positive.

And for those that aren't? Over at the CMPA,Bell advises doctors to look at their ratings "to see if there is something going on that you might not be aware of, or that you might be aware of but it's more problematic than you thought." You know, look for constructive criticism.

And we all know how constructive criticism goes on the internet. If worse comes to worse, while the CMPA won't sue websites on behalf of doctors, it does have a handy prepared form letter that doctors can send to sites to demand that they take down defamatory comments.