Online feedback falters when topic is health

A large percentage of health care decisions made in the U.S. are based on information found on the Internet. But recent studies have found that much of that information may not be an accurate representation of patient feelings.

A PwC report published April 9 found that 48% of patients have consulted online reviews, but only about 25% have written one. Of those who consult reviews, 68% said they have used the information to select a doctor, a hospital or, to a lesser degree, a health plan.

“Obviously, when there are less data points, the data become skewed,” said Vaughn Kauffman, PwC's health care payer advisory leader. “So certainly if there are more and more reviews submitted — and this is true of any sort of example even outside of health care — that this will be a more reliable source to leverage.”

Kauffman said these reviews will become increasingly important to patients as they keep paying more out of pocket — as various annual surveys note they do — and are presented with more options. The quality of this information also is important to physicians now that Medicare payments will be linked partially to physician reviews, he said.

The more people who participate in reviews, the more reliable those reviews will become, said Rosemary Thackeray, PhD, MPH, associate professor at Brigham Young University's Dept. of Health Science in Utah. She was lead author of a study posted online Jan. 16 in the Journal of Medical Internet Research. The study also found that a large percentage of Internet users consult online information while making health-related decisions, but very few contribute information.

Thackeray's research, based on telephone surveys of 1,745 adults, found that more than 41% said they consult online rankings or reviews, but less than 10% have posted a review. She said people likely to write reviews tend to post either really good things — or bad things. Not much comes from the middle.

Kauffman and Thackeray said the findings show that doctors should talk to patients about what they see online and encourage them to be more than lurkers.

“It's important for the industry to encourage the feedback,” Kauffman said. It's “similar to how the retail companies are very proactive, even at the point of service. When the receipt is printed, [customers] are pointed to a link they can go to provide feedback. To the degree the [health care] industry adopts a similar process … we'll see more data available that will add to the credibility of the information.”

What patients seek online

Thackeray's research found that although many patients go online for reviews, almost as many look for health information. She found that 32% use social networking sites, including blogs, patient support sites, and Facebook and Twitter, to seek health-related information. Only 15% post comments, questions or information on those sites.

“I definitely think that one of the downsides of more people not contributing is that it may not be representative of everybody's experience,” Thackeray said. “Maybe you're not going to get the spectrum.”

Internist Richard Kravitz, MD, professor and co-vice chair of research in the Dept. of Internal Medicine, University of California, Davis, is a proponent of patients seeking online information about their health. He published research in May 2012 that found distrust of physicians was not a motivating factor for patients going online. He said he often learns new things from patients bringing in results of Internet searches.

He agrees that the best information comes when more people contribute to the knowledge base. Despite the relative lack of patient posting, Dr. Kravitz said, physicians should not caution patients against going online.

“It's really important for physicians to be aware that these sites are out there and that patients are getting information from them, and that the information they get might be skewed,” Dr. Kravitz said. “And they have to be prepared to tell their patients, 'The information is perhaps worth looking at but may not be applicable to you, and let's try to figure out why or why not.' ”

Thackeray said such conversations could allow doctors to help patients be more savvy online. “In terms of being a wise health care consumer, you have to be informed when you are looking for health information online,” Thackeray said. Whether information comes from a social media site or elsewhere, patients need to determine whether it is reliable, she said. Getting good information may mean looking at multiple sites and sources of information. Thackeray said she would like to see physicians encourage patients to contribute more to online conversations, but she realizes this may be a challenge because of the stigma associated with some illnesses.

Dr. Kravitz said he wouldn't discourage patients from posting online, but he wouldn't go so far as encouraging them to contribute.

“I think a better use of people's time, if they are really going to contribute to the production of knowledge, is to participate in clinical research, including practice-based research and other kinds of valid studies,” he said.