Abstract
BACKGROUND: Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. OBJECTIVE: To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. METHODS: In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. RESULTS: In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes of care were also judged to be very important, but both parties agreed that they would not be evaluable by health care consumers. CONCLUSIONS: Health care consumers in Switzerland show a high appraisal of the importance of physician-approved criteria for assessing health care performance and a moderate self-perception of how capable they are of assessing the quality and performance of a physician. This study supports that health care consumers are differentiating between aspects they perceive they would be able to evaluate after a visit to a physician (such as attributes of structure and the interpersonal skills of a doctor), and others that lay beyond their ability to make an accurate judgment about (such as technical skills of a physician and outcome of care).