labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, October 14, 2009

Online Reviews

So have you seen the latest commercial? I got a kick out of it, personally, but it got me thinking. Can we trust reviews of health care providers on websites? I know this question has come up plenty of times before on other sites and other forums, but...

The commercial shows a couple in the hospital, the woman very pregnant. A female voice over narrates the scenes. It goes something like this (I am ad-libbing this here, it's not verbatim):

My OB told me I needed to be induced by 41 weeks. So we went into the hospital and pitocin was started. I was told that I needed to get pushing by 1 o'clock because he had an important meeting at 2. But I wasn't dilating and ready to push before he had to leave. So he comes in to say goodbye wearing tennis gear! An hour later I was having a c-section with another doctor.
It's quite obvious, I think, to the general public that this narrative shows a poor customer service review (what Angieslist is providing) of this particular doctor. And, ya, this scenario was really shitty in terms of the important meeting being some tennis match. But what the underlying problem I have with this is that a 30 second commercial glosses over other aspects of potentially poor obstetrical care. And this is why online reviews make me a little nervous. Are we, as readers and potential customers of these providers, given the full picture behind the review?

Probably not.

There is so much missing from such a case as described above. Like, was there any evidenced based obstetrical care being provided? For instance, this woman was induced at 41 weeks. Was her cervix favorable? Multip or primip? And why the section? Of course a 30 second commercial can't wrap that up, but would an online review? I mean, how many times have I mentioned here that women, be it family, friends, or random strangers who learn what I do for a living, start telling me about their obstetrical care and birth experiences and don't seem to have a full grasp on the reasons behind the management of their care?

The other factor is that for people who have an ax to grind will write flaming reviews just because they are so angry, whether there is reason to be or not.

A problem I see with hate reviews is that sometimes a patient could be angry over something that would have been solved if there had been some open communication between patient and provider. And yes, patients can initiate that and demand that their provider make time for them to review and discuss their concerns. The flip side of that is a provider who brings in a patient to review their care plans, of which the patient is not following and therefore takes this as an attack when they are being called on the carpet for not following through.

The other thing to consider is that some providers just don't click with some patients; it doesn't make them a bad provider. I can tell you that in all my years in health care as a nurse and now a midwife, there are just some people I click with better than others. But all will get the same care out of me. Just because I don't bond as well with Jane as compared to Mary doesn't mean Mary gets better care. Mary's perception of me will obviously be better, and Jane would probably say I was just okay.

However, before you all go hating on me for sound all against online reviews of health care providers, I think they definitely have their place as well. If enough reviews about a provider are available, and a trend is obvious, then I think they can be useful in deciding if you would want that person or group caring for you. If specifics are being used to support the review, as opposed to "Dr or Midwife So and So are real asswipes and I wouldn't even send my neighbors dog to them", then they can be informative.


Anonymous said...

What's your opinion of The Birth Survey? It's been a while since I filled it out, but they did ask specific questions, like, "Where you told you could have X before going into labor, and then once in labor, the provider refused?" Granted, there could be extenuating circumstances that could have prevented X for good reason; but I've heard numerous stories of docs saying in prenatals, "Sure, no problem, you can have X, or you don't have to have Y"; and then it's like Dr. Jekyll and Mr. Hyde in labor -- they suddenly are required to have the IV (which they'd previously been told wasn't required); the "intermittent" monitoring becomes continuous from the start; etc. Sure, sometimes things happen requiring such changes, but in many of these stories, there is no explanation given for any change, and everything is just routine from the get-go.


Lct4j said...

I agree with you in part about online reviews of healthcare providers. With my last OB, I had a bad experience with him and the hospital (this is putting it mildly), but I didn't think an online review of his poor care was the best avenue. I recently found out that I could file a grievance against this doctor and hospital with my insurance, and so I did. That seemed to be a better option in my mind. I had tried discussing what went wrong with my doctor and the hospital, but after the insults and unreturned phone calls, I decided my insurance could look at my allegations and make their own decisions. This doctor, incidentally, is HIGHLY rated on those web sites. He just didn't work out for me.

Real said...

I would think that it's just like amazon. If you only have 10 reviews, it's hard to tell if you'll like a product or not. But when you have 500 reviews that are one star and all saying the same thing, you really start to see the pattern. So I think it all depends on how many reviews you have. Because you're right. There will be some people who aren't giving enough info, aren't being accurate, are biased, angry, what have you. And when you have just a few reviews, those will really skew things. But the more reviews you have, the more balanced it should be.

Taking Heart said...

There is obviously a gap in education and communication. I work in a hospital... I practice nursing in a medical setting. I have never heard of a doctor calling a section for failure to progress after one hour unless non reassuring fetal heart tones were present with no response to intervention.

Obviously there are women who are mislead and/or not understanding of the situations that occur. In OB we often act first, explain later because time is oxygen perfusion. We obviously can do way better in the "explaining later" aspect. For example, a new patient from out of state that I triaged recently told me that her old OB told her she had no placenta... but had double the amniotic fluid so that is what was sustaining her baby's life... a serious misunderstanding... something we can all learn from... how can we better teach and explain to our mothers what exactly is going on in order for them to understand/agree/or disagree with the care they are receiving?

Thanks for posting a great thought provoking entry...