‘Stay Far, Far Away’ and Other Things Gleaned From Yelp Health Reviews
This story was originally published by Pro Publica.
Dental patients really don't like Western Dental. Not its Anaheim, California clinic: "I hate this place!!!" one reviewer wrote on the rating site Yelp. Or one of its locations in Phoenix: "Learn from my terrible experience and stay far, far away."
In fact, the chain of low-cost dental clinics, which has more Yelp reviews than any other health provider, has been repeatedly, often brutally, panned in some 3,000 online critiques —379 include the word "horrible." Its average rating: 1.8 out of five stars.
Patients on Yelp aren't fans of the ubiquitous lab testing company Quest Diagnostics either. The word "rude" appeared in 13 percent of its 2,500 reviews (average 2.7 stars). "It's like the seventh level of hell," one reviewer wrote of a Quest lab in Greenbrae, California.
Indeed, doctors and health professionals everywhere could learn a valuable lesson from the archives of Yelp: Your officious personality or brusque office staff can sink your reputation even if your professional skills are just fine.
"Rudest office staff ever. Also incompetent. I will settle for rude & competent or polite & incompetent. But both rude & incompetent is unacceptable," wrote one Yelp reviewer of a New York internist.
ProPublica and Yelp recently agreed to a partnership, which will allow information from ProPublica's interactive health databases to begin appearing on Yelp's health provider pages. In addition to reading about consumers' experiences with hospitals, nursing homes and doctors, Yelp users will see objective data about how the providers' practice patterns compare to their peers.
As part of the relationship, ProPublica gets an unprecedented peek inside Yelp's vast trove of 1.3 million health reviews. To search and sort, we used RevEx, a tool built for us by the Department of Computer Science and Engineering at the NYU Polytechnic School of Engineering.
Though Yelp has become synonymous with restaurant and store reviews, an analysis of its health profiles shows some interesting trends. On the whole people are happy — there are far more five-star ratings than one star. But when they weren't, they let it be known. Providers with the most reviews generally had poorer ratings.
Of the top 10 most-reviewed health providers, only Elements Massage, a national chain, and LaserAway, a tattoo and laser hair removal company with locations in California and Arizona, had an average rating of at least four stars.
Western Dental did not return phone calls and emails seeking comment.
Dennis Moynihan, a spokesman for Madison, New Jersey-based Quest Diagnostics, said the company has more than 2,200 patient service centers around the country and had 51 million customer encounters last year. He said all feedback is valued.
"While one negative customer experience is one too many, we don't believe the numbers presented are representative of the service that a vast majority of our customers receive every day," he said.
For years, doctors have lamented the proliferation of online rating websites, saying patients simply aren't equipped to review their quality and expertise. Some have gone so far as to threaten — or even sue — consumers who posted negative feedback.
But such reviews have only grown in popularity as consumers increasingly challenge the notion that doctor knows best about everything. Though Yelp's health reviews date back to 2004, more than half of them were written in the past two years. They get millions of pageviews every month on Yelp's site alone.
In many ways, consumers on Yelp rate health providers in the same way they do restaurants: on how they feel they've been treated. Instead of calling out a doctor over botched care or a possible misdiagnosis (these certainly do happen), patients are far more likely to object to long wait times, the difficulty of securing an appointment, billing errors, a doctor's chilly bedside manner or the unprofessionalism of the office staff.
Health providers as a whole earned an average of four stars.
But sort by profession and the greater dissatisfaction with doctors stands out.
Doctors earned a lower proportion of five-star reviews than other health professionals, pushing their average review to the lowest of any large health profession, at 3.6. Acupuncturists, chiropractors and massage therapists did far better, with average ratings of 4.5 to 4.6.
Other providers, like dentists and physical therapists, are "actively seeking out customers to review them, whereas doctors have a lot of antipathy toward reviews and as a result have been trying to suppress reviews for many years," said Eric Goldman, a professor at Santa Clara University School of Law and co-director of its High Tech Law Institute. He has written extensively about physician review websites and physician arguments against them, but did not review the Yelp data.
Doctor visits also tend to be more complex than visits to the dentist or chiropractor. A typical dental visit is for a specific service—a teeth cleaning, a cavity filled or a root canal. In general, expectations are clear, and ways to gauge success are easier than with a doctor visit.
Healthgrades, a site which focuses solely on health providers, also sees slightly lower ratings for doctors than for dentists and other health providers, though the differences are smaller than those on Yelp.
Healthgrades, which says it has 6 million survey scores, has not allowed consumers to post comments. But Evan Marks, Healthgrades' chief strategy officer, said health rating systems are in their infancy. Soon, he said, patients could see different questions based on the type of doctor they see to provide far more useful feedback to those searching the site.
None of this has yet gained favor with physicians. The American Medical Association encourages patients to talk to their doctors if they have concerns, not post views anonymously. And those looking for doctors should be similarly skeptical, the group said. "Choosing a physician is more complicated than choosing a good restaurant, and patients owe it to themselves to use the best available resources when making this important decision."
The AMA has called on all those who profile physicians to give the doctors "the right to review and certify adequacy of the information prior to the profile being distributed, including being placed on the Internet."
In 2012, the group partnered with a company called Reputation.com to offer discounts to doctors for a service that monitors their online presence and tries to combat negative reviews.
Western Dental's average rating of 1.8 stars on Yelp is well below the average of four for all dentists nationwide. About 1,250 of its 3,000 reviews used the words "wait" or "waiting" and about 15 percent of them, the word "worst."
When patients leave angry comments, the chain's "social media response team" often replies, inviting patients to call or email and citing a federal patient privacy law known as HIPAA for not responding in more detail. "Thank you for reaching out and providing the opportunity to improve our services. We hope to speak with you soon," the notes say.
At least one patient gave a Yelp follow-up review of the social media response team's performance: "I responded to the info in their response twice and got no reply at all … they are just attempting to minimize the PR damage caused by undertrained and rude lazy staff."
Periodically doctors, dentists and other providers threaten or even file lawsuits against people who post negative reviews on Yelp or against the site itself. Their track record is poor: Courts have ruled in favor of the company and various consumers.
In June, New Jersey resident Christina Lipsky complained in a one-star review on Yelp that Brighter Dental Care had recommended $6,000 worth of work that a another dentist subsequently determined was unnecessary.
Within days, she received a letter from a lawyer who said he was retained by Brighter Dental "to pursue legal action against you and all others acting in concert with you." The letter was signed by Scott J. Singer, an attorney whose office is in the same building as a Brighter Dental clinic. A man named Scott Singer was also listed in 2012 as the non-clinical chief executive officer of Brighter Dental. Singer did not return a call or email seeking comment.
After Lipsky took her story to local media, Singer sent her a letter saying Brighter Dental was dropping its legal pursuit. In an email to ProPublica, Lipsky said: "People put a lot of trust into their healthcare providers, and if my review could help others make an informed decision regarding their treatment, then it was worth it."
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