Online consumer reviews in 2022 are playing a bigger role in almost every consumer industry from travel to technology. Medicine is no exception. Physicians’ practices are being increasingly impacted by online comments, both good and bad. In a recent study, investigators at Harrisburg University of Science and Technology in Harrisburg, Pennsylvania, revealed gender bias in online reviews.
While bias may come in various forms, patients’ biases and perceptions have been understudied and may impact adherence to treatment, leading to unequal outcomes, according to the investigators. Online reviews of doctors are considered a naturalistic way to study gender bias. Their findings, published in Psychology of Language and Communication, suggest that both patients and physicians may need to increase their awareness of how their biases affect how they give and receive vital health information.
“There can be severe implications of gender bias on the overall patient outcome if patients allow stereotypes and biases to color their interaction with their physicians, potentially leading to an incomplete or improper course of treatment,” investigators Sonam Gupta, a doctoral candidate, and Kayla Jordan, PhD, an assistant professor of social analytics, wrote. “On the other hand, if doctors project gender bias towards their patients or allow their stereotypes to impact their interactions with patients, it can impact the overall patient care negatively.”
The investigators analyzed data from 2 different online patient review databases: RateMDs and ZocDoc. They used psychological text analysis to determine how patients reviewed male and female doctors and examined the informality, socio-emotional content, and gendered-ness in the text of the reviews.
In an interview, Gupta said, “Knowing that patients go to their doctors with preconceived notions based on the gender of the doctor and then judge them is mind-boggling. Such notions and biases can be an obstacle for the doctors to do their jobs. “We were surprised that female doctors were reviewed more on their interpersonal skills and not much on their technical competence, as well as how the reviews explicitly mentioned gender of the women surgeons and physicians.”
“Patient reviews should be carefully considered to determine which criticisms are true points for improvement, like spending more time talking with patients or explaining instructions in more understandable ways, and which reviews may be unreasonable or biased, like personal appearance,” Dr Jordan said.
“Online reviews provide physicians an opportunity to improve the social aspects of their craft, which could influence patient decisions when and where to seek care,” said Andrew M. Placona, of Virginia Commonwealth University in Richmond. “Unless something displaces them, I would say online reviews are likely here to stay in some form, such as Facebook, Healthgrades, etc. Whether they can be utilized to improve processes and outcomes will probably depend on the extent to which platforms get better at asking questions that could help healthcare providers to provide better care,” Placona said.
Patient online reviews can contain valuable information for gaining better insights into quality of care and the patient-doctor relationship, said Sophia C. Kamran, MD, an assistant professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts. Physicians can use patient feedback to learn about aspects of care they might not be aware of, she said.
It can be difficult to get honest feedback from patients. Patients might not want to tell doctors face-to-face what matters to them most, but would be willing to do so anonymously, she said.
On the one hand, Dr Kamran pointed out, patients may post online reviews containing biases that are out of physicians’ control, including about gender, appearance, race, and ethnicity. Unless online reviews are curated to remove those that clearly are biased in this way, they are not very helpful, she said.
On the other hand, thoughtful reviews can help a physician understand what works for patients and what does not. In some ways, the reviews can help improve physicians’ bedside manner, and this could translate improved patient adherence to treatment. “Physician reviews that are truly helpful may lead to decreased morbidity or mortality,” Dr Kamran said. “For example, if a review leads to a physician spending more time explaining details with a patient or talking with a patient in a more understandable manner, this may translate to improved patient compliance with treatment or recommendations, improved patient-doctor trust, and potentially decreased morbidity/mortality. This needs to be studied in greater detail.”
If online reviews contain frequent unhelpful or biased criticisms, physicians may not be able to tease out legitimate criticisms on which physicians could reflect in an effort to make improvements, she noted. Although online reviews may provide key information about whether the staff is courteous, they are not a reliable indicator of the overall quality of care in a medical practice, she said.