Elsevier

Health Policy

Volume 118, Issue 1, October 2014, Pages 66-73
Health Policy

What do patients say about their physicians? An analysis of 3000 narrative comments posted on a German physician rating website

https://doi.org/10.1016/j.healthpol.2014.04.015Get rights and content

Abstract

Background

Physician rating websites (PRWs) could be shown to have an impact on physician choice making. However, little research has been carried out to assess the content and nature of narrative comments.

Objective

The aim of this study was to explore the concerns of patients who commented on physician care and to address and enhance patient satisfaction.

Methods

Content analysis of 3000 randomly selected narrative comments from the German PRW, jameda, from 2012. We therefore developed a theoretical categorization framework addressing physician, staff, and practice related patient concerns.

Findings

In total, 50 sub-categories addressing the physician (N = 20), the office staff (N = 13), and the practice (N = 17) were derived from the content of all comments. The most frequently mentioned concerns were assessing the professional competence of the physician (63%, N = 1874) and friendliness of the physician (38%, N = 1148). Thereby, 80% of all comments (mean length 45.3 words ±42.8) were classified as positive, 4% as neutral and 16% as negative.

Conclusion

Users of the German PRW, jameda, are mostly satisfied with their physicians. However, physicians should focus on the time spent with the patients, waiting time, as well as on taking the patients more seriously.

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.

References (48)

  • J. Hibbard et al.

    Best Practices in Public Reporting No. 1. How To Effectively Present Health Care Performance Data To Consumers. The Agency for Healthcare Research and Quality Publications No. 10-0082-EF

    (2010)
  • J.H. Hibbard

    What can we say about the impact of public reporting? Inconsistent execution yields variable results

    Annals of Internal Medicine

    (2008)
  • M.E. Porter et al.

    Chancen für das deutsche Gesundheitssystem

    (2012)
  • T. Lagu et al.

    Patients’ evaluations of health care providers in the era of social networking: an analysis of physician-rating websites

    Journal of General Internal Medicine

    (2010)
  • M. Faber et al.

    Public reporting in health care: how do consumers use quality-of-care information? A systematic review

    Medical Care

    (2009)
  • M. Emmert et al.

    [Public reporting in health care: the impact of publicly reported quality data on patient steerage]

    Gesundheitswesen (Bundesverband der Arzte des Öffentlichen Gesundheitsdienstes (Germany))

    (2012)
  • C.H. Fung et al.

    Systematic review: the evidence that publishing patient care performance data improves quality of care

    Annals of Internal Medicine

    (2008)
  • G.G. Gao et al.

    A changing landscape of physician quality reporting: analysis of patients’ online ratings of their physicians over a 5-year period

    Journal of Medical Internet Research

    (2012)
  • M. Emmert et al.

    Eight questions about physician-rating websites: a systematic review

    Journal of Medical Internet Research

    (2013)
  • M. Hardey

    Consuming professions user-review websites and health services

    Journal of Consumer Culture

    (2010)
  • M. Emmert et al.

    Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study

    Journal of Medical Internet Research

    (2013)
  • S. Reimann et al.

    The representation of patient experience and satisfaction in physician rating sites. a criteria-based analysis of English- and German-language sites

    BMC Health Services Research

    (2010)
  • M. Emmert et al.

    [Websites to assess quality of care: appropriate to identify good physicians?]

    Gesundheitswesen

    (2009)
  • B. Kadry et al.

    Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating

    Journal of Medical Internet Research

    (2011)
  • Cited by (96)

    • TripAdvisor of healthcare:Opportunities for value creation through patient feedback platforms

      2023, Technovation
      Citation Excerpt :

      As a complement to (and not a substitute for) traditional surveys, the recent emergence of digital review platforms in healthcare (hailed as the “TripAdvisors of health”) offers an opportunity for patients to express what might not have been captured in formal hospital surveys (James et al., 2017). For instance, a study of Physician rating websites (PRWs) exploring narrative comments about patients concerns, highlighted that patients are mostly satisfied with their physicians but physicians should focus on the time spent with the patients, waiting time, and take more attention to the patients (Emmert et al., 2014). The specificities of the patient feedback generated on these digital platforms are that the patient feedback is collected by an external third party (i.e., not the hospital), and they are open to the public (i.e., anyone can read them).

    • Preference access of users' cancer risk perception using disease-specific online medical inquiry texts

      2022, Information Processing and Management
      Citation Excerpt :

      Based on the increasing popularity of medical information platforms and online health communities as well as the booming of online medical texts, it has been found by many scholars that online medical texts can be recognized as important data sources to identify medical service topics from the user perspective (Luo et al., 2017; Korkontzelos et al., 2016). Emmert et al. (2014) conducted a quantitative analysis of the comments in 3000 texts on Ameda (a German doctor platform), and found that the foci of user comments are summarized as doctors, office staff and other related factors (such as waiting time, equipment, etc.). Jung et al. (2015) used text mining technology to identify the key factors of hospital services involved on the two health community platforms (Naver and Daum) in South Korea, including service, environment, professionalism, impression, process and popularity.

    View all citing articles on Scopus
    View full text