Yikes, It's Yelp!

“I found you on Yelp,” said Erica. “You had the second most reviews.”

“Saw Dr. Rockoff and was extremely disappointed. … The first time I visited, I was put on a very aggressive treatment plan which ended up not helping my skin problems. When I went back for a follow up, he recommended the same products insisting that I had not tried them yet … when he himself had prescribed them to me 2 months earlier!” Kristen Z.

I looked at Kristen's chart. The “very aggressive” plan was benzoyl peroxide, clindamycin gel, and minocycline. She had used doxycycline, tretinoin, and adapalene for years. At her return visit, I added tazarotene. A month later, she called for refills.

Pretty sharp and accurate review, yes?

Other notices were more favorable. Here's one:

“I go to the Rockoff Center for all my facial needs. This is a dermatologist office, so it is much better than going to a spa.”

So, I guess all that medical school was worth it after all.

But Yelp doesn't limit itself to dermatologists, or even to physicians. You can also read reviews of restaurants, shopping, nightlife, and beauty and spas. In the last category, here's one for a tattoo parlor: “I was so happy with how it came out. It is really simple, just tracing my handwriting, but every day I am amazed at how authentic it looks!”

Sites like Yelp represent a larger cultural trend fostered by the Internet, which lets anyone anywhere say anything to everyone everywhere. In this respect, the Internet is a great leveler that sweeps away rank and privilege and lets professors and peons alike hold forth on history, medicine, or fast-food joints. Those who choose to can show the universe their picture; share their birthdays, hobbies, and preferences; and let the world read more about them.

The effects of this trend are still evolving, but they are likely to be profound and may have increasing relevance to physicians. Consumer Aware and Blue Cross Blue Shield of Minnesota have set up a Yelp-like site, www.thehealthcarescoop.com

“My daughter died of heart failure at the [XYZ] Heart Hospital. [She] had an aortic valve replacement. … She was 28 when she went in for her aftercare checkup with the surgeon, she died a day later in the hospital. The medical team assigned to her, as well as her surgeon, did not respond with any urgency even though there was an infection present, she was given no antibiotics. … Hindsight tells me that she would be alive today had the proper care been taken at the time she came in for her aftercare checkup.”

Here's another: “My wife was scheduled for her first colonoscopy so she was naturally nervous. The staff at the [ABC] Clinic made her feel very comfortable. They were very attentive during the recovery time and even followed up with a 'check-in' phone call after the procedure to see how she was doing. The [ABC] Clinic is great.”

Is XYZ Heart Hospital incompetent? Is ABC Clinic superb? “Reviews” like these give us no real idea. Those who write them are, of course, entitled to their opinions, and the nature of such opinions give us insight into the way real people—our patients—talk about us to their friends and family and judge how we've done.

But should society rate us on the basis of reviews of this kind? Will this become yet another flawed criterion that health insurers will use to implement pay for performance?

Maybe we should call our leaders and professional societies and do some yelping ourselves.

“I found you on Yelp,” said Erica. “You had the second most reviews.”

“Saw Dr. Rockoff and was extremely disappointed. … The first time I visited, I was put on a very aggressive treatment plan which ended up not helping my skin problems. When I went back for a follow up, he recommended the same products insisting that I had not tried them yet … when he himself had prescribed them to me 2 months earlier!” Kristen Z.

I looked at Kristen's chart. The “very aggressive” plan was benzoyl peroxide, clindamycin gel, and minocycline. She had used doxycycline, tretinoin, and adapalene for years. At her return visit, I added tazarotene. A month later, she called for refills.

Pretty sharp and accurate review, yes?

Other notices were more favorable. Here's one:

“I go to the Rockoff Center for all my facial needs. This is a dermatologist office, so it is much better than going to a spa.”

So, I guess all that medical school was worth it after all.

But Yelp doesn't limit itself to dermatologists, or even to physicians. You can also read reviews of restaurants, shopping, nightlife, and beauty and spas. In the last category, here's one for a tattoo parlor: “I was so happy with how it came out. It is really simple, just tracing my handwriting, but every day I am amazed at how authentic it looks!”

Sites like Yelp represent a larger cultural trend fostered by the Internet, which lets anyone anywhere say anything to everyone everywhere. In this respect, the Internet is a great leveler that sweeps away rank and privilege and lets professors and peons alike hold forth on history, medicine, or fast-food joints. Those who choose to can show the universe their picture; share their birthdays, hobbies, and preferences; and let the world read more about them.

The effects of this trend are still evolving, but they are likely to be profound and may have increasing relevance to physicians. Consumer Aware and Blue Cross Blue Shield of Minnesota have set up a Yelp-like site, www.thehealthcarescoop.com

“My daughter died of heart failure at the [XYZ] Heart Hospital. [She] had an aortic valve replacement. … She was 28 when she went in for her aftercare checkup with the surgeon, she died a day later in the hospital. The medical team assigned to her, as well as her surgeon, did not respond with any urgency even though there was an infection present, she was given no antibiotics. … Hindsight tells me that she would be alive today had the proper care been taken at the time she came in for her aftercare checkup.”

Here's another: “My wife was scheduled for her first colonoscopy so she was naturally nervous. The staff at the [ABC] Clinic made her feel very comfortable. They were very attentive during the recovery time and even followed up with a 'check-in' phone call after the procedure to see how she was doing. The [ABC] Clinic is great.”

Is XYZ Heart Hospital incompetent? Is ABC Clinic superb? “Reviews” like these give us no real idea. Those who write them are, of course, entitled to their opinions, and the nature of such opinions give us insight into the way real people—our patients—talk about us to their friends and family and judge how we've done.

But should society rate us on the basis of reviews of this kind? Will this become yet another flawed criterion that health insurers will use to implement pay for performance?

Maybe we should call our leaders and professional societies and do some yelping ourselves.

“I found you on Yelp,” said Erica. “You had the second most reviews.”

“Saw Dr. Rockoff and was extremely disappointed. … The first time I visited, I was put on a very aggressive treatment plan which ended up not helping my skin problems. When I went back for a follow up, he recommended the same products insisting that I had not tried them yet … when he himself had prescribed them to me 2 months earlier!” Kristen Z.

I looked at Kristen's chart. The “very aggressive” plan was benzoyl peroxide, clindamycin gel, and minocycline. She had used doxycycline, tretinoin, and adapalene for years. At her return visit, I added tazarotene. A month later, she called for refills.

Pretty sharp and accurate review, yes?

Other notices were more favorable. Here's one:

“I go to the Rockoff Center for all my facial needs. This is a dermatologist office, so it is much better than going to a spa.”

So, I guess all that medical school was worth it after all.

But Yelp doesn't limit itself to dermatologists, or even to physicians. You can also read reviews of restaurants, shopping, nightlife, and beauty and spas. In the last category, here's one for a tattoo parlor: “I was so happy with how it came out. It is really simple, just tracing my handwriting, but every day I am amazed at how authentic it looks!”

Sites like Yelp represent a larger cultural trend fostered by the Internet, which lets anyone anywhere say anything to everyone everywhere. In this respect, the Internet is a great leveler that sweeps away rank and privilege and lets professors and peons alike hold forth on history, medicine, or fast-food joints. Those who choose to can show the universe their picture; share their birthdays, hobbies, and preferences; and let the world read more about them.

The effects of this trend are still evolving, but they are likely to be profound and may have increasing relevance to physicians. Consumer Aware and Blue Cross Blue Shield of Minnesota have set up a Yelp-like site, www.thehealthcarescoop.com

“My daughter died of heart failure at the [XYZ] Heart Hospital. [She] had an aortic valve replacement. … She was 28 when she went in for her aftercare checkup with the surgeon, she died a day later in the hospital. The medical team assigned to her, as well as her surgeon, did not respond with any urgency even though there was an infection present, she was given no antibiotics. … Hindsight tells me that she would be alive today had the proper care been taken at the time she came in for her aftercare checkup.”

Here's another: “My wife was scheduled for her first colonoscopy so she was naturally nervous. The staff at the [ABC] Clinic made her feel very comfortable. They were very attentive during the recovery time and even followed up with a 'check-in' phone call after the procedure to see how she was doing. The [ABC] Clinic is great.”

Is XYZ Heart Hospital incompetent? Is ABC Clinic superb? “Reviews” like these give us no real idea. Those who write them are, of course, entitled to their opinions, and the nature of such opinions give us insight into the way real people—our patients—talk about us to their friends and family and judge how we've done.

But should society rate us on the basis of reviews of this kind? Will this become yet another flawed criterion that health insurers will use to implement pay for performance?

Maybe we should call our leaders and professional societies and do some yelping ourselves.