Because I set up our Google advertising and business account several years ago (it’s since been handed over to one of our administrators) I still get notifications when patients leave us a review on Google. A few weeks ago, I received notification of the review below:
What am I supposed to do with “You suck”? Look, we clearly don’t get everything right and patient are rightfully unhappy about it. Sometimes we’re running late (ok, more than sometimes.) Sometimes we miss a referral or don’t return a patient call promptly enough. Those are areas where can improve and fair online criticism can help point us in the right direction on areas in which we need to improve. “You suck” isn’t helpful at all in this regard. If a patient leaves a legitimate criticism online our practice administrator will call them immediately and try to find out what happened so that we can be sure it doesn’t continue happening. “You suck” is not a legitimate criticism and thus doesn’t help us improve.
The bigger issue here is that “You suck” is just unfair and highlights the problem with online reviews in medicine: they give outsized importance to the unhappiest patients. First, patients are more likely to take the time to write a negative review than a positive one. The unhappy patients seem to have all the time to do so. Our happiest patients, the ones that actually have surgery, are back leading active lives and don’t take the time to leave an online review. In fact, we’ve had to take measures to ensure that our happy patients leave reviews to “dilute” the unfair negative ones. In other words, we must play the game. Thankfully we do excellent work so just about all our patients are thrilled with their care and don’t mind saying so online. Still though, the solicitation feels a bit slimy.
In addition to being more likely to write reviews, unhappy patients who write negative reviews do so with much more emotion and conviction. It makes them feel good to get revenge on their uncaring physician for their perceived poor treatment— “You suck” as a doctor! There are many reasons a patient may feel poorly treated. Maybe they’re unhappy to be seeing a PA or NP instead of me (even though the PAs and NPs on my team are better diagnosticians than I am!) Maybe they’ve had a bad surgical outcome elsewhere and are still upset about it. Maybe it’s because we won’t prescribe the opioids they’re looking for. Maybe they’re just pissed off at the world. I don’t know. What I do know, though, is that that none of the negative reviews are from patients who have surgery with us. All we did in the “You suck” case was, compassionately I should say, tell the patient that their problem wasn’t a neurosurgical one.
Inevitably the negative reviews will get more attention than the positive ones do. First, patients tend to put more weight in one negative review than a mountain of positive reviews. In fact, experts suggest that you need 10 positive reviews to cancel out the effects of one negative review. More concerning is that your physician pays more attention to these negative reviews too. Physicians today are expected to provide perfect, compassionate care 100% of the time. Because of this expectation, any positive feedback is often quite muted when the care goes as planned. When the care doesn’t go as planned (or even if the patient just has that perception) the negative feedback can be intense. This problem of asymmetric rewards in medicine haunts us from training through our careers and is one of the main causes of physician burnout in this country.
Thankfully I am confident enough in the care that I provide that at this point in my career I just find humor in reviews like “You suck.” I do think that online reviews can help patients make more informed decisions about their healthcare. Obviously, you should beware if a physician has way more negative reviews than positive ones. Otherwise, try to look past the reviews of a few bad apples and trust the many more positive ones the physician is likely to have.
Thanks for reading.
J. Alex Thomas, M.D.
Spinal (con)Fusion 