One of the naive missteps I took shortly after transitioning from trainee into an attending role was to sign up for Google to alert me whenever one of my patients posted a review. Despite getting mostly good reviews (my criteria at the time was 4 stars or higher), it was negative reviews that took a toll. In time, I realized such online reviews, good or bad, had started to influence my professional personality. Before I deviated from the objectivity of practicing evidence-based medicine, I unsubscribed myself and made a point of not looking at online reviews.
It’s not just me, either. In the health care profession, it’s not uncommon for friends and family members to ask for a recommendation for a clinical professional. Upon hearing a name, their first reaction is to look up the clinician. ‘Oh, he doesn’t have good reviews!’ comes the reply. Or ‘She has amazing reviews! I’m calling right now for the appointment.’
This obsession with reviews led me to think about the impact of online review culture on clinician burnout and medicine in general. I conducted a small survey, reaching out to my medical school classmates from nearly two decades ago (now well-established practicing physicians), and my colleagues. I asked them to answer a four-question survey about their specialty, whether they had ever received a negative review, and whether they believed it contributed to physician burnout.
Sixty-five physicians from 20 states and 18 specialties responded. One-third of respondents reported never receiving a negative online review, yet 92% perceived or had experienced burnout related to the issue. Certainly, it was not a rigorous scientific study, but the results indicated that online reviews are front-of-mind for many clinicians. Not to mention that even the perceived risk of burnout should raise alarms and not be ignored.
Physicians are, by training, resilient and receptive to constructive criticism. A trainee physician constantly receives feedback from senior residents, fellows, attendings, other interns, medical students, and ancillary staff members. Clinical training is immersive with 360-degree feedback.
Why do online reviews carry such weight?
Online reviews are the internet-era incarnation of what used to be word-of-mouth information. Previously, if you enjoyed a restaurant, hair stylist, grocery store, cafe, or bookstore, you’d be sure to tell your friends. Nowadays, you write a review online. But many people, including myself, argue that health care is not, and should not be, equated to a customer service-based enterprise for several reasons.
The primary responsibility of health care is to make and keep patients healthy. Oftentimes, there’s a conflict between what makes patients happy and what keeps them healthy. On top of that, there are emotions involved. Expecting someone to write a review after receiving a terminal diagnosis, discussing cancer treatment, hearing about a complicated surgery for their suffering child, or being informed of crucial lifestyle changes is bewildering. Very few patients would be in a state of mind to review their experiences objectively.
Non-health care industries lean into the art of service and may suggest to customers that they write a review if they had a good experience. In health care, where we are dealing with suffering, dying, and death, exploiting emotions to squeeze out a good review is unethical.
There is an argument that online reviews provide patients with agency and empowerment. For all other industries, this might be the case, but not with health care. If your food isn’t made right, the restaurant will redo it or refund your money. Don’t like a product you purchased? You can return it. In these cases, the maxim “the customer is always right” applies. However, in the case of health care, the knowledge asymmetry between the patients and the clinicians makes it nearly impossible for the “customer” to always be right. Physicians undergo rigorous training to expertly and efficiently guide their patients through the best course of action for their afflictions. Of course, patients are welcome and encouraged to participate in care decisions with their clinicians. But to lump health care in with other service industries when it comes to patient satisfaction and online reviews is a disservice to the patients and unjust to their care team.
Furthermore, patients' experiences within the health care system are not solely driven by physicians but are significantly influenced by other players in the background, like insurance, pharmaceutical, and pharmacy benefit management industries. But physicians are still the face of a convoluted system and bear the undue burden for inefficiencies and profitability agendas of others.
This isn't to imply that all concerns by the patients are disingenuous. From my ‘review’ of online reviews of nearby practices, common complaints included long wait times, lags in responses to messages, overbooking, and feeling rushed during the appointments, which are all legitimate concerns. Previously, I had been part of such a practice where patients were herded through the facility like cattle. I’m not part of that practice anymore. However, online reviews haven’t stopped these practices from persisting. So, what purpose do these reviews serve if they aren’t prompting meaningful change – or put it in economic terms, if the market is not responding?
Online reviews may be affecting the younger generation of physicians more than older generations. My spouse, who is in hospital medicine, works frequently with internal medicine residents. Recently, she shared an anecdotal incident about her resident who entered the team room a bit annoyed. When asked what was wrong, the resident said, ‘I’m pretty sure patient x will give me a bad review.’ Upon further inquiry, the reason for such concern was that the trainee physician didn’t yield to the patient's demand to change the hospital diet order from a ‘low salt diabetic diet’ to a regular one.
My spouse was flabbergasted. Immediately, she sat down with the entire team of residents, interns, and medical students to highlight the contrast between practicing evidence-based instead of a customer service-oriented approach in clinical medicine.
In my specialty, we often get asked to order ultrasounds and check certain laboratory tests just because “it has been a while since it was last checked” or “I want ALL of my hormones checked” or, my most disliked, “I did my own research.” Such patient-pleasing clinical decision-making leads to the practice of defensive medicine, which studies have demonstrated to be unsafe for patients and increase the cost of health care.
Younger physicians tend to be more self-doubting. This can be a positive attribute, as it keeps up their drive to continue to learn, to be meticulous, and to continue to practice medicine based on sound scientific evidence – which is the hallmark of modern medicine. Contamination of that with the social pressure of avoiding bad reviews is poor for their morale and for the development of their clinical acumen. Eventually, this way of practicing could impact the collective competence of the clinical community.
Most physicians have enormous empathy for the patients, especially those in distress. But the current landscape of online reviews is neither helping patients, nor clinicians. This is draining the compassion out of physicians.
Online reviews reflect patients’ expectations and it’s crucial to reset those, especially as the landscape of health care changes. Modern medicine is becoming more interdisciplinary and collaborative than ever before. Today, physicians are just one part of a complex system. Unlike other services, health care is nuanced and cognitive. Even seemingly brief encounters via patient portals and phone messages require time and resources on behalf of the physicians.
Patients deserve to have their concerns heard and addressed with discretion and dignity. But physicians also deserve the opportunity to respond in the same manner, and the current system of online reviews is devoid of both elements. We live in a society that values instant gratification, but for better or worse, health care isn't “Amazon Prime.”
Neither fear nor social pressure should deter physicians from focusing on evidence-based medicine. To stray from this would be detrimental to patient health and wellbeing, and ultimately, come at the cost of lives. And no amount of glowing reviews is worth that trade-off.
Do you encourage online reviews from patients? Why or why not? Share in the comments!
Dr. Ameer Khowaja is an Endocrinologist based in San Antonio, TX. In addition to his clinical practice, he enjoys participating in population research, teaching internal medicine residents, community volunteer work, reading, writing, and spending time with his family. Dr. Khowaja is a 2024–2025 Doximity Op-Med Fellow.
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