Ethical principles for physician rating sites.

Daniel Strech

doi:10.2196/jmir.1899

Abstract

During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians’ performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician–patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for physicians that can result from physician rating sites need to be contained without limiting the potential benefits for patients with respect to health, health literacy, and equity.

Highlights

Physician rating sites allow patients to evaluate their experience and satisfaction with their health care providers, similar to other service-oriented businesses
While this paper focuses on the preceding ethical discussion concerning the basic concept of physician rating sites, it does not analyze the wide range of issues surrounding the safety and validity of information provided by physician rating sites
The aforementioned basic conditions for a fair decision-making process are relevant under such conditions of normative complexity and insufficient evidence

Summary

Introduction

Physician rating sites allow patients to evaluate their experience and satisfaction with their health care providers, similar to other service-oriented businesses. The ratings are posted online and are intended as a source of information for people searching for a physician. In addition to the more than 30 private physician rating sites [1,2], more and more publicly hosted physician rating sites have gone online in the last 5 years. Service (NHS) in the United Kingdom launched the NHS Choices website, which allows patients to evaluate both physicians and hospitals. In the United States, the Hospital Compare site, maintained by the Centers for Medicare & Medicaid Services (CMS) and other publicly funded sites, provides information on the quality of care, but it does not yet permit patients to rate physicians [3]

Objectives

Conclusion