A growing number of websites in Switzerland can be used to give an opinion about services provided by a medical professional. And that is affecting the patient-physician relationship.
Choose, book and comment. Having grown up with TripAdvisor, Booking.com and Digitec, young people are used to doing everything online via their smartphone, instead of actually talking to someone. So why should medical care be any different? Symbolising this new habit, Medicosearch.ch saw its traffic double from July 2017 to July 2018 and now has over 600,000 users a year.
The website has information on more than 20,000 doctors and specialists in Switzerland. Patients can not only make an appointment online, but also rate the service and leave a comment after the appointment. Behind the scenes, retired doctors act as moderators and filter reviews.
Online reviews are also being left on non-specialised websites such as Facebook and Google, but without moderators. Any grudges are out for everyone to see. Here is an example of what you can read about hospitals in French-speaking Switzerland and their staff: “You’re in critical condition, and the first thing they ask for is your insurance card…. no compassion, just money!”, “The chief of service informed me about my diagnosis (cancer) over the phone,” or “We’re not mannequins or holograms, sometimes we’re really having difficulty not being able to talk. And for you, dear healthcare staff, if we don’t make any demands, we don’t exist!”
The creation of healthcare rating sites at the end of the 2000s initially caused an uproar in Switzerland. The Federation of Swiss Physicians (FMH) took the case to the federal government, stating that they were formally against online comments. “In accordance with Article 28 of the Swiss Civil Code, hospitals and medical practices can file a complaint for an attack on character when their reputation is on the line,” the FMH’s spokesperson told the press. “They can even file criminal charges if it involves libel.” But the law is more effective at putting pressure on Swiss websites than on companies based in the United States, such as Facebook or Google. Even when hospitals and medical practices manage to have defamatory remarks removed from the websites of tech giants, these companies can be slow to act, and a medical professional’s e-reputation can be lastingly tarnished.
Even the Swiss consumer association (FRC) refused to join a new project to develop a rating platform. “We usually favour sites that include reviews,” says Valérie Muster, head of FRC Conseil. “We only remind consumers to add a weighting. But we believe healthcare is different.” The legal expert feels that the criteria for telling the difference between a good doctor and a bad doctor are less tangible than for a restaurant or hotel. “It’s as hard as saying what makes a good parent. The notion of trust and the human factor play a role that is too important.”
The FRC opted to publish a little guide for the informed patient called La Boussole du patient (The patient’s compass). The guide suggests questions patients could ask a general practitioner during the first appointment. “Patients have to form their own opinion, to see if there’s a connection. Our book helps build the patient’s trust to share needs, experiences, observations and concerns.” And nothing is better than recommendations from other healthcare professionals, or word of mouth among friends and family, Ms Muster says.
“You’re better off listening to the opinion of a friend than of Joe Bloggs on social media.”
Healthcare professionals are required to inform patients about their practices, points out Dr Jean Gabriel Jeannot, an expert in internal medicine and author on Medicalinfo.ch, an informational website on digital health. “At the very least, the doctor or therapist must indicate online who they are, what they do and what type of approaches they take or don’t take. Providing a brief online presentation or even a short video by the practitioner is very reassuring for patients.”
Dr Jeannot feels that online reviews about the quality of healthcare professionals could even have some value. “But few sites can be used to determine which healthcare professional is good and which is not. This is partly due to bias.” He refers to a 2016 American study published in the Journal of Medical Internet Research which showed that online reviews did not correlate with the physicians’ actual medical skills. “The patient has a number of objective criteria – waiting time before an appointment, how well the doctor listens, the clarity of explanations, etc. – but they are not enough to judge all aspects of the quality of care.”
The AdopteUnEGynéco initiative sets a prime example. Designed by a feminist group in Lausanne, the website lists “compassionate” gynaecologists. “It’s a positive site that only lists best practices to help patients find medical care with respect for women,” Dr Jeannot says. “The concept should be extended to other areas of specialised medicine.”
So what can be done when reviews are already all over the web and on less ethical sites? Dr Jeannot thinks that doctors should be aware of their online reputation.
“Healthcare professionals should care what is being posted about them on Google. They should regain control by requesting the removal of negative information and, more importantly, by forging a positive online reputation.”
“For example, they can create a website, release their publications, participate in press articles, etc.” He adds that it is not rare for patients to come to his practice after reading information about him on a search engine.
Large university hospitals in Switzerland monitor what is said about them and their staff online. They even hire communications experts to respond to dissatisfied users. For instance, Lausanne University Hospital (CHUV) encourages people who post negative reviews on Google to contact the Espace Patients&Proches (Patients & Loved Ones) service. “When a healthcare professional or department is singled out in a comment, the author is asked to contact us,” says one of the service’s mediators, Thierry Currat. He recalls a doctor who, after being criticised on Google, immediately went to see him. “He was outraged and hurt. And the patient felt betrayed and angry. They opted to meet, which helped each side understand what motivated the review.” The author ended up changing the remarks.
Conflict management experts like Thierry Currat do not typically support online reviews. “It’s similar to an argument at a bar. These comments are a form of excessive violence and differ from a conflict between two individuals that can be resolved via mediation.” Criticism should be expressed, but in more appropriate spaces than the web. Public organisations have several constructive channels for checking and receiving complaints (see inset). “Online reviews leave no chance for a relationship, and a relationship is a key component for treatment to work. In fact, we keep a totally anonymous record of what is said, both positive and negative, and we can gain a better understanding of what patients want at CHUV. It’s useful for everyone.”
The mediator points out that a university hospital is different from a bad restaurant. “Patients can’t decide not to go back to CHUV. They have to be able to go back if they need to. To do that, trust must be re-established between physician and patient, and between institution and patient.” The Espace Patients&Proches service handled 544 cases in 2017, and far from the web.
At hospitals in French-speaking Switzerland, patients have lots of ways to express their opinion about medical care, whether it is in the form of thanks, a positive review, a request or a complaint. Here are some of the channels available:
– filling out an evaluation questionnaire on the quality of care;
– writing to the management of the department(s) concerned;
– meeting a mediator (from the Espace Patients&Proches service at CHUV).
Created in 2009, medicosearch.ch really began to take off with the introduction of online appointments. “Automatically synced with the doctor or specialist’s calendar, the platform saves time and reduces errors,” says its Chairman and CEO, Beat Burger. Healthcare professionals set the game rules. Do they want to have a designated space for reviews? What information do they want to provide? After the appointment, patients can rate the service in a questionnaire.
“I had two abortions, but I didn’t feel judged,” is an example of a comment about a Vaud-based gynaecologist on AdopteUnEGynéco. Following the example of the “white lists” established by the Women’s Liberation Movement in the 1970s, the website was created to promote “compassionate gynaecological care”. At first, the women’s group collected questionnaires from people who wanted to share their opinion about the gynaecologists they saw for care. It then published an information profile for each specialist, including their approach and anonymous positive comments posted. However, practitioners are discouraged from promoting their services on the site and can ask not to appear on the list. As of August 2018, nearly two years since the website came online, 70 “safe” gynaecologists have been listed.