"How's My Doctoring?" Patient Feedback's Role in Assessing Physician Quality

A society-wide consumer revolution is underway with the rise of online user-generated review websites such as Yelp, Angie's List, and Zagat. Service provider reviews are now available with an intensity and scope that attracts increasing numbers of reviewers and readers. Health care providers are not exempt from this new consumer generated scrutiny though they have arrived relatively late to the party and as somewhat unwilling guests. The thesis of this article is that online patient feedback on physicians is relevant and valuable even though it is also uncomfortable for health care providers. This is because the modem physician-patient relationship is sufficiently commercial that physician reputation information is amenable to information sharing in this format. This is also because individual physician-patient feedback highlights the cooperative nature of modem health care delivery and consumption. In an era of chronic disease treatment, health outcome success is often based on the need for an ongoing responsive physician-patient relationship. This article begins by discussing the availability of online patient feedback on specific physicians and the vision of the modem role of patient that informs it. Next, this article makes the case that patient experience data is empirically relevant to service quality and efficiency. Part of this discussion concerns the interest commercial health insurance and government agencies are displaying in anecdotal patient experience information. Finally, this article considers both whether online anecdotal patient experience information is fair to physicians grappling with the * Visiting Assistant Professor, University of California, Hastings College of the Law. For comments on earlier drafts of this paper I thank Jasmine Abdel-Khalik, Karen Bovarnick, Steve Bovarnick, June Carbone, Brad DeLong, Kathleen Foote, MaryAnn McCormick, Charity Scott and Jonathan Todres. I thank Anita Pandhoh and Scott Sawyer for research assistance. This paper was selected for presentation at the 2011 Health Law Scholars Workshop, September 15-17, 2011, co-sponsored by the American Society of Law, Medicine & Ethics (ASLME) and the Saint Louis University Center for Health Law Studies. I particularly thank my readers at this workshop: Kathy Cerminara, Sharona Hoffman, Elizabeth Pendo, Sidney Watson and especially Rob Gatter for their generous and thoughtful feedback. All errors are my own. DEPAUL JOURNAL OF HEALTH CARE LAW [VOL. 14.2:361 problems of representative data, anonymous posting, practical and legal limitations on physician response, and the unlimited shelf life of on online data as well as whether it is fair to patients considering the risk of liability for online defamation and the enforceability of gag clauses and prospective copyright assignments for anecdotal reviews of physicians. Throughout, this paper takes the position that this kind of data universe can and should flourish in a way that is fair to all concerned while also producing a public good. Both the values of transparency and fairness can be advanced through the collection and dissemination of anecdotal patientgenerated physician reviews.