What do patients say about their physicians? An analysis of 3000 narrative comments posted on a German physician rating website
Introduction
In many health care systems, quality deficits [1], [2], [3] as well as remarkable variability in quality of care across health care providers can be observed [4], [5], [6], [7]. However, patients are generally not likely to be aware of those quality differences [8], [9]. One reason for this is the limited amount of publicly reported quality information on health care providers [10]. It thus has become a major challenge to create more transparency regarding the quality of health care providers [10], [11]. In this context, public reporting (PR) is supposed to have an impact on increasing overall quality by steering patients to better performing health care providers [12], [13] and by motivating providers to seek quality improvements [9], [14].
One instrument, which has been gaining in importance among patients when seeking a physician, is physician-rating websites (PRWs) [15], [16]. The primary objective of these sites is to rate and discuss the physician's standards by using user-generated data [16], [17]. Emmert et al. examined this issue by conducting a cross-sectional study in Germany in January 2013, surveying an online sample of participants [18]. According to their results, 32% of all respondents have heard of German PRWs and about one quarter (25.3%) have already used a website when searching for a physician. Furthermore, every ninth interviewee (11%) has already posted a rating on a PRW. But even more important, approximately 65% of PRW users have consulted a particular physician based on the ratings shown on the websites; in contrast, 52% have been negatively influenced by the ratings they have seen. This clearly demonstrates that neither physicians nor health policy makers (e.g., statutory health funds, website providers) should underestimate the influence of PRWs.
Usually, the rating systems on PRWs include a scaled survey to assess the treatment received from a physician [16], [19], [20]. In addition, patients generally have the opportunity to write commentary on PRWs (narrative comments) [19]. Currently, there is a controversial discussion about whether narrative comments are useful. On the one hand, patients can elaborate upon their rating with additional comments and provide personal experiences and impressions that cannot be covered by the scaled rating system [16]. Additionally, the information provided can help physicians gain a better understanding of patient concerns [21]. On the other hand, narrative comments might provide the opportunity for doctor bashing, defamation, etc. For this reason, no option for commenting in narratives has been implemented on the German PRW, Weisse Liste [22].
While most PRW related research has focused on the scaled survey rating results [11], [15], [16], [19], [21], less research has been carried out to assess the content and nature of narrative comments in order to explore in greater detail the concerns of patients. In this context, this paper adds to the literature by presenting an analysis of 3000 narrative comments posted on the German PRW, jameda, in 2012. The results show the most frequently mentioned patient concerns but also demonstrate which concerns physicians should address in order to enhance patient satisfaction. Thereby, we take into account characteristics of both patients and physicians.
Section snippets
Methods
This paper presents an analysis of 3000 narrative comments, which were posted on the German PRW, jameda, in 2012. Data were provided by jameda, containing 127,192 physician ratings of 53,585 physicians from 107,148 patients. It contained the medical specialty and gender of the physician, as well as the gender, age and health insurance status of the patient [23]. Additionally, the results of the physician ratings for five mandatory and 13 optional questions were provided. In addition, a
Results
In total, four articles could be identified which addressed narrative comments on PRWs and also applied a categorization approach. Regarding comments on US websites, Alemi and colleagues conducted a sentiment analysis and focused on nine categories [29]: physician-related concerns, staff-related issues, getting in to be seen, wait-related issues, cost-related issues, nurse-related concerns, facility-related concerns, privacy-related concerns, and other. Furthermore, López et al. distinguished
Discussion
Our analysis of 3000 narrative comments revealed that the majority (80%) of all comments were positive, 4% neutral, and 16% negative. This finding is in line with evidence from the US; Lagu et al. found that for a sample of 300 Boston physicians, 89% of patients’ narratives were positive, while the remaining 11% were negative [11]. Ellimoottil et al. determined that slightly more than half of the patients’ comments (53%) were favorable, while one out of four narrative comments regarding 80
Conflict of interest
The authors declare that there is no conflict of interest.
Acknowledgments
The authors would like to thank Dr. Phillip Goos and Ms. Elke Ruppert from jameda for the provision of the data.
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