Poor Patient Reviews Linked to Bad Customer Service

When a physician gets a poor review from a patient online, they may wonder what they could have done clinically to make the situation better.

New research, however, indicates that poor reviews and ratings from patients have little, if anything, to do with the physician's clinical expertise. Instead, they come from less than adequate customer service.

According to a recently published study in the Journal of Medical Practice Management, only 1 in 25 patients who rated their provider with two stars or fewer on a review website were unhappy with their physical examination, diagnosis, treatment, surgery, or health outcome. A whopping 96 percent said the complaints had to do poor communication, disorganization, and excessive delays in seeing the physician.

Physicians Practice talked with the lead author of this study, Ron Harman King, CEO of Vanguard Communications, a marketing and public relations firm for medical practices, to discuss the results in a two-part interview. Below are excerpts from part one.

Physicians Practice: What were the main conclusions of your study?

Ron Harman King: The surprise for us was not the conclusion we reached, but the degree to which that conclusion was reached. People are largely satisfied with their healthcare. When they are unhappy, they are unhappy about customer service issues. The customer service issues are entirely addressable. The surprise was that by a margin of 24 to 1, this is what people complain about the most when people complain online when they review doctors.  

There is another a-ha [moment] too that might even be more shocking. The a-ha is that they are not even that upset about being kept waiting. That's the stereotype of doctor complaints. They are really more bothered by not being fully informed. We hear this anecdotally too. People are fine with doctors running behind schedule overall when there is a legitimate reason communicated to them. The reason is typically that there is a more complicated case ahead of them. We understand that. We get that as healthcare consumers. There are surprises in healthcare, like in any profession. People are tolerant of that because they know that next time they may be the complicated case. They may require extra attention.

Bottom line, this is a hugely fixable complaint if staff in a practice or clinic or hospital can be more informative about a doctor running behind. Give some detail, not a lot, but enough to mollify the patient. Just let the patient know, this is not routine and it is not the desired objective. Otherwise, healthcare consumers assume, in the absence of additional information, that it's a sign of disrespect from the provider. That may be the wrong assumption but in the absence of any information, it's the conclusion they reach. The one true factor about human nature is that in the absence of information, people tend to assume the worst. It's no different here.

Another point I've heard … from doctors on online complaints [is false reviews]. I want to acknowledge they are not always fair, scientific, and they are not always from real patients. We've seen cases where competitive physicians appear to be dummying reviews to trash their competition.  Online reviews are not a scientific sample. A marketing researcher would say, 'This is not science.' It's more of a self-selecting population. It's only the people who want to review a physician. It's not all people who have seen a physician.

We accept that. However, you can't dismiss reviews for two reasons. One is when you look at 35,000 [reviews], it will give you some indication of what people are thinking. It's not necessarily scientific, but it's still a pretty good read on what patients think in the aggregate. The second reason, which is even more important, is that people go by them. The internet has changed everything. Doctors and hospitals and providers used to have all the information about healthcare and could direct patients how they wished. Today, much of that information is on the internet, including reports by other patients about their healthcare experience. So people are using these reports, fair or not, to make healthcare decisions and to decide which provider to give their care. From a pragmatic standpoint, providers have to pay attention to this. It will affect their business, one way or another.

PP: How did you conduct this study and come to your conclusions?

RHK: We were are able to develop software that goes out to the internet and it uses a technique called scraping. It gathers all the data on these review websites and information that's out there in the internet, including the names of the practice and the comments on the reviews. We then categorized the data, according to star rankings. So we put one-star reviews with their comments in one bucket and we put two-star reviews in one bucket. Then we used some other software to look at recurrence of phrases. It's called word cloud analysis. So we can see how many people used the same phrase repeatedly. From that, we were able to derive a somewhat objective interpretation. It's not terrible objective because we looked at a number of repetitions and drew conclusions from that. It's basically data interpretation.

PP: Why do you think the waiting room is so much more important to the patient experience than the exam room?

RHK: I can only answer that as a healthcare consumer myself. What we are seeing, healthcare consumers want the same standards of service from doctors they get everywhere else; from other professionals including attorneys, accountants, architects, and anyone else in the service profession. They want the same standard of courtesy they get in restaurants and hotels, which are also reviewed online.

I don't know why this should come as surprise to people in healthcare. A common response I hear from physicians is that this is demeaning to them. I say back to them, 'Are they willing to wait in a restaurant for a meal for over an hour without explanation?' I think that's demeaning to the patient to not give [an explanation]. Patients are lot more forgiving to physicians than they are to restaurants and hotels. Five-star reviews generated many more words in quantity than the one-star reviews. When people like their doctors, they are overwhelmingly in love. Seventy-four percent of these reviews were either 4 or 5 stars. Only a quarter of reviews are complaints. By a factor of three to one, people praise their doctors online. I wouldn’t even say online complaints are a huge problem for doctors, they are just an opportunity.

Editor's note: Stay tuned for part two of this interview with more insights from King.