Are Friendly and Competent the Same?

Abstract

More and more people regularly use physician rating websites to inform their choice of physicians. As physician rating websites attract more users, the number of such websites is expanding as well. Research on several German and English physician rating platforms has shown that despite similarities among the factors constituting ratings across platforms, there is no standardized set of such factors. The lack of a framework explaining how physicians are rated makes it difficult to compare how patients perceive and evaluate their doctor, and how physician ratings are calculated. As a step toward developing such a framework, this study identifies the factors influencing how satisfied patients are with their physician, and therefore how they rate them, assuming positive ratings on rating websites correlate with patient satisfaction. Past medical and healthcare-related research indicates that overall patient satisfaction is influenced by factors directly attributable to the physician, such as the quality of the medical treatment and the doctor-patient relationship, as well as by factors attributable to the administrative aspect of medical treatment services, such as waiting times, accessibility and the physical environment of the physician's office. This research focuses solely on the factors directly associated with the physician. The literature identifies two main determinants of patient satisfaction with the physician: the perceived competence of the physician and the interpersonal relationship between the doctor and the patient. The influence of perceived competence of the physician is a controversial construct among practitioners, who argue that in general most patients are laymen in the field of medical treatment and are not able to accurately assess treatment quality. In other words, this knowledge gap between patient and physician skews perceived competence. The second important determinant of patient satisfaction are interpersonal aspects such as how much the patient likes the physician, which influences the patient's perception of the physician's technical skills. This kind of satisfaction focuses on the short-term evaluation of the physician and does not consider medical treatment outcomes, which is often only possible after much more time has passed and, even then, may not necessarily be directly or solely attributed to the treatment. In this study, patients (n=115) in waiting rooms of five physicians in southern Germany were part of the quantitative data collection how satisfied they are with their physician and, therefore, how they would rate them. The data was evaluated using the partial least square method, and convergent validity, construct reliability and discriminant validity were tested. According to our results, the doctor-patient relationship and perceived competence are major determinants of satisfaction. More importantly, our findings indicate a strong influence of the doctor-patient relationship on perceived competence, supported by high cross-loadings of the two constructs. This finding indicates that patients who like their physician are likely to rate the physician's competence highly. This has important implications for the value of ratings as an information source. Patients may perceive ratings as an indicator of quality medical treatment, but the reviews and ratings on physician rating websites are a stronger indication of empathy, sympathy, amiability and likeability. The data also indicates that patients generally view their physicians positively, which is in line with previous research on physician ratings showing that patients ratings of physician rating websites usually favor their physician. This study fails to collect sufficient data about factors influencing patient dissatisfaction, since the sample had a heavy positive bias. In addition, this study does not measure rating behavior directly, but rather assumes strong correlation between high patient satisfaction and positive physician ratings. Further research will focus directly on the rating behavior on physician rating websites and the influence of treatment outcomes. To challenge the positive bias of patients, specialists should be chosen for the study, who are only visited few times by patients.