Online Physicians Research Articles

Knowledge and attitudes on implementing cardiovascular pharmacogenomic testing.

Pharmacogenomics has the potential to inform drug dosing and selection, reduce adverse events, and improve medication efficacy; however, provider knowledge of pharmacogenomic testing varies across provider types and specialties. Given that many actionable pharmacogenomic genes are implicated in cardiovascular medication response variability, this study aimed to evaluate cardiology providers' knowledge and attitudes on implementing clinical pharmacogenomic testing. Sixty-one providers responded to an online survey, including pharmacists (46%), physicians (31%), genetic counselors (15%), and nurses (8%). Most respondents (94%) reported previous genetics education; however, only 52% felt their genetics education prepared them to order a clinical pharmacogenomic test. In addition, most respondents (66%) were familiar with pharmacogenomics, with genetic counselors being most likely to be familiar (p < 0.001). Only 15% of respondents had previously ordered a clinical pharmacogenomic test and a total of 36% indicated they are likely to order a pharmacogenomic test in the future; however, the vast majority of respondents (89%) were interested in pharmacogenomic testing being incorporated into diagnostic cardiovascular genetic tests. Moreover, 84% of providers preferred pharmacogenomic panel testing compared to 16% who preferred single gene testing. Half of the providers reported being comfortable discussing pharmacogenomic results with their patients, but the majority (60%) expressed discomfort with the logistics of test ordering. Reported barriers to implementation included uncertainty about the clinical utility and difficulty choosing an appropriate test. Taken together, cardiology providers have moderate familiarity with pharmacogenomics and limited experience with test ordering; however, they are interested in incorporating pharmacogenomics into diagnostic genetic tests and ordering pharmacogenomic panels.

Exploring the Effects of Online Physician Voice Pitch Range and Filled Pauses on Patient Satisfaction in Mobile Health Communication

ABSTRACT The convenience of mobile devices has driven the widespread use of voice technology in mobile health communication, significantly improving the timeliness of online service. However, the issue of listening to therapeutic content, which requires great cognitive effort and may exceed the patient’s information processing capacity (i.e., information overload), is of concern. Based on information processing theory, this study reports how online physicians’ voice characteristics (pitch range and filled pauses) affect patient satisfaction. We obtained 10,585 mobile voice consultation records of 1,416 doctors from China’s largest mHealth platform and analyzed them using audio mining and empirical methods. Results showed that pitch range (β = 0.0539, p < .01) and filled pauses (β = 0.0365, p < .01) in doctors’ voice positively influenced online patient satisfaction. However, the effect of filled pauses becomes weaker for patients with higher health literacy and higher disease risk. This suggests that there is heterogeneity in the way different patients process audio information. This study provides important insights for guiding online physician behaviors, enhancing patient satisfaction, and improving mobile health platform management.

Attitudes of Healthcare Professionals to Extremism and Treatment Options

In view of the cruelty of acts of terrorism and violent extremism, it is often inconceivable what the underlying motives are. Analyzes of the attacks in Ansbach (2016), Halle (2019) and Hanau (2020) showed a picture of different psychological conspicuities among the perpetrators, which highlights the need to involve health care professionals in the prevention of extremism. Against this background, the treatment of people with extremist attitudes appears to be crucial in order to prevent negative consequences for those affected, but also for society. Within the framework of an anonymous online survey, physicians and psychological psychotherapists were asked about previous experiences, attitudes and wishes regarding the treatment of patients with extremist attitudes. Furthermore, data on their own work was collected. A total of 364 physicians (18%), psychological psychotherapists (72%) and participants with other job descriptions (10%) took part in the study. Only one fifth state that they felt well trained in the subject. About half of the respondents would offer a place in therapy (if they could decide on the patients themselves), likewise about half have already dealt with the topic of extremism and the majority see a need to deal with the topic more in the future and indicate a need for further training. The analyses show that physicians have so far dealt with the topic somewhat more than those with psychological psychotherapeutic training, and professionals in private practive are more likely to see a connection between extremism and psychiatric illnesses than professionals in hospitals, but would be less willing to offer patients with extremist attitudes a place in therapy. Physicians and psychotherapists need further training on extremisms and should be better prepared fo the challenges of treating patients in this context. In order to increase the chances of providing adequate care for mentally ill people with extremist attitutdes, health professionals should be better prepared for the topic in the future, for example through further training or opportunities for cooperation.

Physicians' Online Writing Language Style and Patient Satisfaction: The Mediator of Depth of Physician-Patient Interactions.

Online health counseling (OHC) is increasingly important in modern healthcare. This development has attracted considerable attention from researchers. However, the reality of the lack of physician-patient communication and dissatisfaction with online health services remains prevalent, and more research is needed to raise awareness about important issues related to OHC services, especially in terms of patient satisfaction and depth of interaction (i.e., the product of the number of interactions and the relevance of the content). This study constructs an empirical model to explore the relationship between physicians' online writing language style (inclusive language and emojis), depth of physician-patient interactions, and patient satisfaction. The study obtained 5064 online health counseling records from 337 pediatricians and analyzed them using text mining and empirical methods. The results showed that physicians' inclusive language (β = 0.3198, p < 0.05) and emojis (β = 0.6059, p < 0.01) had a positive impact on patient satisfaction. In addition, the depth of the physician-patient interaction partially mediated this effect. This study promotes a better understanding of the mechanisms of physician-patient interactions in online settings and has important implications for how online physicians and platforms can better provide online healthcare services.

Effect of the Announcement of Human-to-Human Transmission on Telemedicine Services in China During COVID-19.

Telemedicine enables patients to communicate with physicians effectively, especially during the coronavirus disease (COVID-19) pandemic. However, few studies have explored the use of online health care platforms for a comprehensive range of specialties during the COVID-19 pandemic. This study aimed to investigate how telemedicine services were affected by the announcement of human-to-human transmission in China. Telemedicine data from haodf.com in China were collected. A difference-in-differences analysis compared the number of telemedicine use and the number of active online physicians for different specialties in 2020 with the numbers in 2019, before and after the announcement of human-to-human transmission. Data from 2 473 734 telemedicine use during the same calendar time in 2020 and 2019 were collected. Telemedicine use in 2020 increased by 349.9% after the announcement of human-to-human transmission in China, and the number of active online physicians increased by 23.2%. The difference-in-differences analysis indicated that the announcement had statistically significant positive effects on the numbers of telemedicine use for almost all specialties, except cosmetic dermatology, pathology, occupational diseases, sports medicine, burn, medical imaging, and interventional medicine. Telemedicine services increased significantly after the announcement of human-to-human transmission of COVID-19. Online activities of most specialties increased, except where providers had to conduct in-person testing and provide bedside therapies.

Artificial intelligence-assisted remote detection of ST-elevation myocardial infarction using a mini-12-lead electrocardiogram device in prehospital ambulance care.

ObjectiveTo implement an all-day online artificial intelligence (AI)-assisted detection of ST-elevation myocardial infarction (STEMI) by prehospital 12-lead electrocardiograms (ECGs) to facilitate patient triage for timely reperfusion therapy.MethodsThe proposed AI model combines a convolutional neural network and long short-term memory (CNN-LSTM) to predict STEMI on prehospital 12-lead ECGs obtained from mini-12-lead ECG devices equipped in ambulance vehicles in Central Taiwan. Emergency medical technicians (EMTs) from the 14 AI-implemented fire stations performed the on-site 12-lead ECG examinations using the mini portable device. The 12-lead ECG signals were transmitted to the AI center of China Medical University Hospital to classify the recordings as “STEMI” or “Not STEMI”. In 11 non-AI fire stations, the ECG data were transmitted to a secure network and read by available on-line emergency physicians. The response time was defined as the time interval between the ECG transmission and ECG interpretation feedback.ResultsBetween July 17, 2021, and March 26, 2022, the AI model classified 362 prehospital 12-lead ECGs obtained from 275 consecutive patients who had called the 119 dispatch centers of fire stations in Central Taiwan for symptoms of chest pain or shortness of breath. The AI's response time to the EMTs in ambulance vehicles was 37.2 ± 11.3 s, which was shorter than the online physicians' response time from 11 other fire stations with no AI implementation (113.2 ± 369.4 s, P < 0.001) after analyzing another set of 335 prehospital 12-lead ECGs. The evaluation metrics including accuracy, precision, specificity, recall, area under the receiver operating characteristic curve, and F1 score to assess the overall AI performance in the remote detection of STEMI were 0.992, 0.889, 0.994, 0.941, 0.997, and 0.914, respectively. During the study period, the AI model promptly identified 10 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) with a median contact-to-door time of 18.5 (IQR: 16–20.8) minutes.ConclusionImplementation of an all-day real-time AI-assisted remote detection of STEMI on prehospital 12-lead ECGs in the field is feasible with a high diagnostic accuracy rate. This approach may help minimize preventable delays in contact-to-treatment times for STEMI patients who require PPCI.

Virtual Teaching and Training Models in Pediatric Oncology: A Retrospective Study from an LMIC

Abstract Introduction A multidisciplinary approach is essential for success in pediatric oncology treatment. Updated protocols, quality nursing care, psychosocial support, safe and standardized preparation of chemotherapy, infection control, and effective data management are key shareholders for the effective management of childhood cancer. The Department of Pediatric Oncology at Indus Hospital and Health Network (IHHN) initiated consistent teaching and trainings with the help of the My Child Matters Grant from Sanofi Espoir Foundation. These courses were conducted in person starting in 2019 and had to be postponed and restructured due to coronavirus (COVID-19) pandemic in early 2020. Objectives The aim of this study was to determine the impact of virtual teaching models for healthcare workers employed in pediatric hematology/oncology departments in low-resource settings. Materials and Methods After in-person courses in 2019, courses for all six disciplines (physicians, nursing, infection control, pharmacy, psychosocial care, and cancer registry) were conducted virtually starting December 2020, open to all and free of cost. A total of 878 registrations were obtained and 267 certifications given. Lectures with Q&amp;A sessions were conducted via zoom and recordings shared through email. Each course was conducted by the relevant department at IHHN with pre- and postassessment conducted through Google Forms. Session feedback was taken through zoom polls and a comprehensive course feedback conducted after completion; e-certificates were awarded to successful participants according to a predetermined criterion. Results A total of 434 physicians' registrations were done from around Pakistan and countries like Saudi Arabia, Malaysia, Jordan, and Canada for the online physicians' course, of which 110 received certifications after completing post-test and attendance criteria of 55%. Pharmacy, infection control, psychosocial care, and cancer registry courses saw participation and certification of 51, 41, 24, and 14 participants, respectively. Online sessions received positive feedback in terms of instructors, course content, convenience, and access from over 90% participants. Conclusion Due to the ease in coordinating hectic schedules and cost-effectiveness of online lectures, this virtual teaching model will persist despite the trajectory of the COVID-19 pandemic. Similar ventures aimed at pediatric oncology teaching and training are needed in a widespread manner to improve outcomes of childhood cancer.

Will Natural Media Make Online Physicians More Trustworthy? The Effect of Media Naturalness on Patients' Intention to Use HIT.

Although previous studies have recognized the important role of patients' trust in promoting their intention to use health information technologies (HIT), most of those studies were under the “risk-benefit” theoretical framework. To deepen the understanding of patients' online consultation decisions, this paper develops a dual-path model investigating how patients develop trust beliefs toward online physicians from the perspective of communication. Drawing on media naturalness theory, we propose that HIT media naturalness will improve patients' perception of communication effort from online physicians and decrease communication ambiguity between patients and online physicians. This improved communication will further strengthen patients' trust in online physicians and promote their intention to use HIT. Based on a two-wave time-lagged survey from 361 participants, the empirical results demonstrated that the relationship between HIT media naturalness and patients' intention to use HIT is individually and serially mediated by two chains, including (1) perceived communication effort and patients' trust and (2) perceived communication ambiguity and patients' trust. We thus contribute to the related literature and provide practical implications.

The effect of technical and functional quality on online physician selection: Moderation effect of competition intensity

In this study, we use a hybrid sentiment analysis approach to identify and assess service quality dimensions (i.e., technical and functional quality) in unstructured textual reviews and employ econometric methods to theorize and test the impact of these service quality signals on online physician selection. By analyzing a data set with 246,294 reviews based on 5,452 physicians in 8 disease markets from an online health consultation platform, this study reports that technical and functional quality cues are important market signals used by patients to select online physicians. More importantly, this study provides strong evidence that the effects of these signals on online physician selection are substantially contingent on disease market competition intensity. Furthermore, this market competition effect is moderated by the level of disease risk. This study contributes insight into patients' physician choice behavior by introducing the role of market-level characteristics. It also guides online health consultation platforms in developing operational strategies to increase patient engagement.

Extracting Additional Influences From Physician Profiles With Topic Modeling: Impact on Ratings and Page Views in Online Healthcare Communities.

How physicians can get better ratings and more page views in online healthcare communities is an important issue. Based on 38,457 physicians' profiles from a popular online healthcare community in China, we used Latent Dirichlet Allocation model, which is a common topic model, to analyze the non-English text to obtain more doctor's latent characteristics. We found five of the most frequently mentioned topics. In addition to the first topic (doctor's academic rank and practice name), “research ability,” “foreign experience,” “committee position,” and “clinical experience” were included as unstructured descriptions in the doctor's profile. Inferences about physician ratings and page views could be improved if these themes were set as characteristics of physicians. Specifically, in our findings, Physicians' mentions of their “research ability” and “foreign experience” had a significant positive impact on physician ratings. Surprisingly, physicians mentioning more “clinical experience” had a significant negative impact on physician ratings. Moreover, while descriptions about “foreign experience” and “committee position” had a significant positive impact on page views, physician mentions of “research ability” had a significant negative impact on page views. These results provide new insights into the ways in which online healthcare community managers or physicians create their personal online profiles.

What Influences Physicians' Online Knowledge Sharing? A Stimulus-Response Perspective.

During the COVID-19 pandemic, online health platforms and physicians’ online knowledge sharing played an important role in public health crisis management and disease prevention. What influences physicians’ online knowledge sharing? From the psychological perspective of stimulus–response, this study aims to explore how patients’ visit and patients’ consultation influence physicians’ online knowledge sharing considering the contingent roles of physicians’ online expertise and online knowledge sharing experience. Based on 6-month panel data of 45,449 physician–month observations from an online health platform in China, the results indicate that both patients’ visit and patients’ consultation are positive related to physicians’ online knowledge sharing. Online expertise weakens the positive effect of patients’ consultation on physicians’ online knowledge sharing. Online knowledge sharing experience weakens the positive relationship between visit of patient and physicians’ online knowledge sharing, and enhances the positive relationship between patients’ consultation and physicians’ online knowledge sharing. This study contributes to the literatures about stimulus–response in psychology and knowledge sharing, and provides implications for practice.

Pacific Regional Infectious Disease Association (PRIDA): capacity-building for microbiology and infectious disease across the Pacific

PRIDA is an Australian based network of medical and scientific specialists, combining expertise in microbiology laboratory development, infection control, management of infectious diseases and antimicrobial stewardship. PRIDA focuses on grassroots support for Pacific and Southeast Asian sites through the establishment of long-term mentoring relationships with front line health care workers. With an emphasis on bench level training for scientists and bedside development for clinicians, PRIDA has advanced testing capacity, infection control and antimicrobial stewardship in the Solomon Islands, Timor-Leste, and PNG. Understanding the need to upskill HCWs in the Pacific, PRIDA has expanded into areas of formal education opportunities with development of online microbiology diplomas, for pathologists, physicians, and scientists. Concurrent design of multidisciplinary virtual video conferenced microbiology rounds provides teaching opportunities in real time and improvement in daily patient care. From its origin of volunteerism, PRIDA has attracted funding through partnership with larger organisations and are currently involved in sponsored AMR projects in the Pacific.

Affordances and Constraints of Virtual Healthcare: Students' Experiences Accessing Online Physician

Background: Students at a community college in Alberta were invited to participate in this project that offered access to virtual healthcare. Prior to inception of this project, the government medical insurance did not cover virtual healthcare for its members. However, at the end of this project, virtual healthcare was considered for coverage due to challenges created by COVID-19 pandemic. The main purpose of this study was to explore the affordances and constraints of a virtual healthcare platform as reported by the students who used the online primary healthcare services. Methods: Students enrolled in the fall 2019 and winter 2020 term at the community college were invited to enrol in the project and given access to the virtual healthcare services provided by a Canadian company. Over 15,000 emails were send to the students at the college. Students who consented and volunteered to participate were enrolled to access the online physicians through the virtual healthcare company’s platform. 430 participants registered to be enrolled for the project. A total of 142 consultations were made. Participants completed a survey on their experiences soon after their consultations. Results: The findings from the survey show that the students found the platform to be convenient, especially given the circumstances created by the COVID-19 pandemic. The students’ average satisfaction with the virtual healthcare services was 4.8 out of 5 stars. Students found the platform to be user friendly, convenient to students in rural areas and newcomers to Canada, and better than visiting clinics. However, students indicated that they will only access online physicians outside the project if insurance providers cover the services. Conclusions: Findings suggest that virtual healthcare is convenient to patients especially given the healthcare access challenges that were a result of COVID-19 pandemic. The virtual healthcare will also reduce inequalities in health access of people who reside in rural and remote areas where clinics are at a distance.

Video or Telephone? A Natural Experiment on the Added Value of Video Communication in Community Paramedic Responses

The objective of this study was to determine the effect of video versus telephonic communication between community paramedics and online medical control physicians on odds of patient transport to a hospital emergency department (ED). This was a retrospective analysis of data from a telemedicine-capable community paramedicine program operating within an advanced illness management program that provides home-based primary care to approximately 2,000 housebound patients per year who have advanced medical illness, multiple chronic conditions, activities of daily living dependencies, and past-year hospitalizations. Primary outcome was difference in odds of ED transport between community paramedicine responses with video communication versus those with telephonic communication. Secondary outcomes were physicians' perception of whether video enhanced clinical evaluation and whether perceived enhancement affected ED transport. Of 1,707 community paramedicine responses between 2015 and 2017, 899 (53%) successfully used video; 808 (47%) used telephonic communication. Overall, 290 patients (17%) were transported to a hospital ED. In the adjusted regression model, video availability was not associated with a significant difference in the odds of ED transport (odds ratio 0.80; 95% confidence interval 0.62 to 1.03). Online medical control physicians reported that video enhanced clinical evaluation 85% of the time, but this perception was not associated with odds of ED transport. We found support that video is considered an enhancement by physicians overseeing a community paramedicine response, but is not associated with a statistically significant difference in transport to the ED compared with telephonic communication in this nonrandom sample. These results have implications for new models of out-of-hospital care that allow patients to be evaluated and treated in the home.

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study

BackgroundTelemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions.MethodsThis retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014–2017. The consultations were analyzed for factors that may have affected the online physicians’ decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians’ decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation.The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety.ResultsThe first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians’ means for ensuring high patient safety – by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions.ConclusionsThe results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians’ ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings – with the aim of ensuring patient safety.

The Impact of Joining a Team on the Initial Trust in Online Physicians.

Introduction: Trust is a major challenge for the online market and this is especially the case for e-consultation platforms. Research that promotes online physician trust is highly desirable. In this study, we focus on whether joining a team led by a well-known physician will increase physician trust and what team characteristics will affect this trust. Materials and Methods: Brand extension theory is applied to the healthcare context to explain the impact of joining a team on physician trust. Specifically, both team strength and team similarity are hypothesized to have the main effects. In addition, team size is hypothesized to have a moderating effect. A 2 × 2 × 2 experiment was conducted to test the proposed research model. Results: The results indicated that joining a team would significantly increase physician trust (p < 0.001). Both team strength (p < 0.001) and team similarity (p < 0.001) had positive impacts on physician trust. In addition, a larger team size resulted in a reduced positive effect of team strength on physician trust (p < 0.001). Conclusions: Joining a physician team is an effective and low-cost method to address the initial trust problem of unknown online physicians.

The Medical Oncology resident mentor: situation and workload

PurposeThe Spanish Society for Medical Oncology (SEOM, for its acronym in Spanish) and the National Commission for the Specialty of Medical Oncology seek to highlight the important workload and unrecognized dedication entailed in working as a Medical Oncology (MO) resident mentor, as well as its relevance for the quality of teaching units and the future of the specialty.Materials and methodsThe current situation and opinion regarding the activity of MO resident mentors was analyzed by reviewing the standing national and autonomic community regulations and via an online survey targeting mentors, residents, and physicians who are not MO mentors. The project was supervised by a specially designated group that agreed on a proposal containing recommendations for improvement.ResultsOf the MO mentors, 90% stated that they did not have enough time to perform their mentoring duties. An estimated 172 h/year on average was dedicated to mentoring, which represents 10.1% of the total time. MO mentors dedicate an average of 6.9 h/month to these duties outside their workday. Forty-five percent of the mentors feel that their role is scantly recognized, if at all.ConclusionsThe study reveals the substantial dedication and growing complexity of MO resident mentoring. A series of recommendations are issued to improve the conditions in which it is carried out, including the design of systems that adapt to the professional activity in those departments that have time set aside for mentoring tasks.

A Theory of Information Biases on Healthcare Platforms

Online healthcare has emerged as an appealing new channel for healthcare in recent years. A fundamental but unanswered question is whether the classical physician-patient agency problem in the healthcare market can be alleviated, especially with the healthcare platform as a new market player. We address the question by developing a game-theoretic model. Given that physicians want to build the reputation as a provider of accurate diagnostic information (medical reports) in the online healthcare market, we find: the private information that originates from the expertise of the physicians would induce a bias in diagnostic reports, i.e., exaggerating the likelihood of being in an unhealthy condition, and suggesting patients to do more than necessary tests. This information bias would further influence the demand for online healthcare services in two ways. First, the more skeptical the rational patients are towards the potentially biased diagnostic information, the less likely their decision would rely on the diagnostic reports generated by the physicians. Second, the information bias would make certain types of diagnosis come up more often than others. We also find that the private information gives online physicians more incentive to bias their reports if their return of career concern depends on the reputation of being providers of accurate diagnostic information. However, the healthcare platform could reduce the bias by restricting the discretion allowed to physicians. The platform’s profit will be increased if more bias is allowed. We also present a variety of empirical predictions.

A Quantitative Study on Anonymity and Professionalism within an Online Free Open Access Medical Education Community.

The increasing use of social media to share knowledge in medical education has led to concerns about the professionalism of online medical learners and physicians. However, there is a lack of research on the behavior of professionals within open online discussions. In 2013, the Academic Life in Emergency Medicine website (ALiEM.com) launched a series of moderated online case discussions that provided an opportunity to explore the relationship between anonymity and professionalism.Comments from 12 case discussions conducted over a one-year period were analyzed using modified scales of anonymity and professionalism derived by Kilner and Hoadley. Descriptive statistics and Spearman calculations were conducted for the professionalism score, anonymity score, and level of participation. No correlation was found between professionalism and anonymity scores (rho = -0.004, p = 0.97). However, the number of comments (rho = 0.35, p < 0.01) and number of cases contributed to (rho = 0.26, p < 0.05) correlated positively with clear identification.Our results differed from previous literature, the majority of which found anonymity associated with unprofessionalism. We believe that this may be a result of the fostering of a professional environment through the use of a website with a positive reputation, the modelling of respectful behaviour by the moderators, the norms of the broader online community, and the pre-specified objectives for each discussion.

Rating a Sports Medicine Surgeon’s “Quality” in the Modern Era: an Analysis of Popular Physician Online Rating Websites

Consumer-driven healthcare and an increasing emphasis on quality metrics have encouraged patient engagement in the rating of healthcare. As such, online physician rating websites have become mainstream and may play a potential role in future healthcare policy. The purpose of this study was to evaluate online patient ratings for US sports medicine surgeons, determine predictors of positive ratings and analyze for inter-website scoring correlation. The American Orthopedic Society for Sports Medicine (AOSSM) member directory was sampled. Surgeon demographic and rating data were searched on three online physicians rating websites: HealthGrades.com (HG), RateMDs.com (RM) and Vitals.com (V). Written rating comments were categorized as relating to the following: surgeon competence, surgeon affability and process of care. Bivariate linear regression, Pearson correlation and multivariable analyses were used to determine factors associated with positive ratings. Two hundred seventy-five sports medicine surgeons were included. Two hundred seventy-one (99%) had ratings on at least one of the three websites. Sports surgeons were rated highly across all three websites (mean >4.0/5); however, there was only a low to moderate degree of correlation among websites. On HG, female surgeons and surgeons in academia were more likely to receive higher overall ratings. Across all three websites, increased number of years in practice inversely correlated with ratings; this relationship neared significance for HG and was significant for RM. A surgeon's online presence or geographic location was not associated with higher ratings. In multivariable regression analysis for ratings on HG, female sex was the only significant predictor of higher ratings. Two thousand three hundred forty-one written comments were analyzed: perceived surgeon competence and communication influenced the direction of ratings for the top and bottom tier surgeons. There was a low degree of correlation among online websites for surgeon ratings. Female surgeons and those with fewer years in practice appear to have higher ratings on these websites; comment content analysis suggests that high and low ratings are influenced by perceived surgeon competence and affability.