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The majority of physician rating websites (PRWs) provide users the option to leave narrative comments about their physicians. Narrative comments potentially provide richer insights into patients’ experiences and feelings that cannot be fully captured in predefined quantitative rating scales and are increasingly being examined. However, the content and nature of narrative comments on Swiss PRWs has not been examined to date.
This study aimed to examine (1) the types of issues raised in narrative comments on Swiss PRWs and (2) the evaluation tendencies of the narrative comments.
A random stratified sample of 966 physicians was generated from the regions of Zürich and Geneva. Every selected physician was searched for on 3 PRWs (OkDoc, DocApp, and Medicosearch) and Google, and narrative comments were collected. Narrative comments were analyzed and classified according to a theoretical categorization framework of physician-, staff-, and practice-related issues.
The selected physicians had a total of 849 comments. In total, 43 subcategories addressing the physician (n=21), staff (n=8), and practice (n=14) were identified. None of the PRWs’ comments covered all 43 subcategories of the categorization framework; comments on Google covered 86% (37/43) of the subcategories, Medicosearch covered 72% (31/43), DocApp covered 60% (26/43), and OkDoc covered 56% (24/43). In total, 2441 distinct issues were identified within the 43 subcategories of the categorization framework; 83.65% (2042/2441) of the issues related to the physician, 6.63% (162/2441) related to the staff, and 9.70% (237/2441) related to the practice. Overall, 95% (41/43) of the subcategories of the categorization framework and 81.60% (1992/2441) of the distinct issues identified were concerning aspects of performance (interpersonal skills of the physician and staff, infrastructure, and organization and management of the practice) that are considered assessable by patients. Overall, 83.0% (705/849) of comments were classified as positive, 2.5% (21/849) as neutral, and 14.5% (123/849) as negative. However, there were significant differences between PRWs, regions, and specialty regarding negative comments: 90.2% (111/123) of negative comments were on Google, 74.7% (92/123) were regarding physicians in Zurich, and 73.2% (90/123) were from specialists.
From the narrative comments analyzed, it can be reported that interpersonal issues make up nearly half of all negative issues identified, and it is recommended that physicians should focus on improving these issues. The current suppression of negative comments by Swiss PRWs is concerning, and there is a need for a consensus-based criterion to be developed to determine which comments should be published publicly. Finally, it would be helpful if Swiss patients are made aware of the current large differences between Swiss PRWs regarding the frequency and nature of ratings to help them determine which PRW will provide them with the most useful information.
Physician rating websites (PRWs) are a sign of the growing digitalization of the patient-health professional relationship, allowing patients to anonymously rate their physicians on the Web as a source of information for others [
In a recent systematic search of PRWs internationally, 143 different websites from 12 countries were analyzed [
Narrative comments potentially provide richer insights into patients’ experiences and feelings that cannot be fully captured in predefined quantitative rating scales and are increasingly being examined with content analysis [
Although the first PRWs in Switzerland, OkDoc and Medicosearch, were established in 2008 at the same time as many international PRWs, there has been a lack of research conducted on PRWs in Switzerland to date. However, a study recently examined, for the first time, the frequency of quantitative ratings and narrative comments on Swiss PRWs [
Although the content and nature of narrative comments on Swiss PRWs has not been examined to date, the controversial nature of negative comments on Swiss PRWs has received media attention in Switzerland [
A random stratified sample of 966 physicians was generated from the regions of Zürich and Geneva. Zürich is the largest city in Switzerland and is located in north-central Switzerland. Zürich has a total population of 402,762 (12/2016). Geneva is the second largest city in Switzerland and is located in south-western Switzerland. Geneva has a total population of 198,979 (12/2016). The regions of Zürich and Geneva were chosen because of language (German vs French) and a comparable number of total physician (Zürich 3254 physicians and Geneva 2780 physicians) considerations.
In November 2017, all physicians in these regions working in general practice, obstetrics and gynecology, pediatrics, and dermatology and venereology were searched for on the Swiss Medical Association’s medical registry (Ärzteverzeichnis). From each region, a random sample was generated for each specialty based on a 95% confidence level and 5% confidence interval. From Zürich, the random sample consisted of 254 of 747 general practice physicians, 85 of 109 obstetrics and gynecology physicians, 74 of 92 pediatric physicians, and 53 of 61 dermatology and venereology physicians. Therefore, the Zürich sample of 466 physicians represents 46.18% of a total of 1009 physicians. From Geneva, the random sample consisted of 272 of 930 general practice physicians, 86 of 111 obstetrics and gynecology physicians, 96 of 128 pediatric physicians, and 46 of 52 dermatology and venereology physicians. Therefore, the Geneva sample of 500 physicians represents 40.95% of a total of 1221 physicians (see
Physician samples per region.
Specialty | Zurich | Geneva | Total | |||
Total physicians found, N | Physicians selected for sample, n (%) | Total physicians found, N | Physicians selected for sample, n (%) | Total physicians found, N | Physicians selected for sample, n (%) | |
General practitioners | 747 | 254 (34.0) | 930 | 272 (29.2) | 1677 | 526 (31.36) |
Obstetrics and gynecology | 109 | 85 (77.9) | 111 | 86 (77.5) | 220 | 171 (77.7) |
Pediatrics | 92 | 74 (80.4) | 128 | 96 (75.0) | 220 | 170 (77.3) |
Dermatology and venereology | 61 | 53 (86.8) | 52 | 46 (88.5) | 113 | 99 (87.6) |
Total | 1009 | 466 (46.18) | 1221 | 500 (40.95) | 2230 | 966 (43.32) |
To identify PRWs on which patients can rate and review physicians in Switzerland, a systematic online search was conducted in June 2016 from a patient’s perspective [
The content of each narrative comment was analyzed and classified by the author according to a theoretical categorization framework of physician-, staff-, and practice-related issues. The categorization framework from Emmert et al was initially used [
The selected physicians in the sample had a total of 849 comments.
The 849 comments had a mean length of 253.5 characters (SD 298), ranging from 15 to 3258 characters. There was a significant difference in the mean character length of the following groups:
Positive comments (mean 222, SD 224) and negative comments (mean 436, SD 533);
Physicians from Zurich (mean 231, SD 242) and physicians from Geneva (mean 335, SD 439);
General practitioners (mean 193, SD 167) and specialists (mean 288, SD 347);
Okdoc (mean 154, SD 126), DocApp (mean 296, SD 202), Medicosearch (mean 174, SD 146), and Google (mean 292, SD 354);
However, there was no significant difference in the mean character length of male physicians (mean 256, SD 291) and female physicians (mean 250, SD 307);
The analysis of the 849 comments identified 43 subcategories addressing the physician (n=21), the staff (n=8), and the practice (n=14; see
None of the PRWs’ comments covered all 43 subcategories of the categorization framework (see
Physicians with comments.
Physician characteristics | OkDoc | DocApp | Medicosearch | Total | ||
|
||||||
|
Zurich, n/N (%) | 20/38 (52.6) | 56/57 (98.2) | 206/234 (88) | 386/520 (74.2) | 668/849 (78.7) |
|
Geneva, n/N (%) | 18/38 (47.4) | 1/57 (1.8) | 28/234 (12) | 134/520 (25.8) | 181/849 (21.3) |
|
Chi-squared test ( |
0.11 (1) | 53.1 ( |
135.4 ( |
122.1 ( |
46.7 ( |
|
.75 | <.001 | <.001 | <.001 | <.001 | |
|
||||||
|
General practitioners, n/N (%) | 23/38 (60.5) | 28/57 (49.1) | 108/234 (46.2) | 147/520 (28.3) | 306/849 (26) |
|
Specialists, n/N (%) | 15/38 (39.5) | 29/57 (50.9) | 126/234 (53.8) | 373/520 (71.7) | 543/849 (64) |
|
Chi-squared test ( |
1.6 ( |
0.02 ( |
1.4 ( |
98.2 ( |
38.1( |
|
.19 | .90 | .24 | <.001 | <.001 | |
|
||||||
|
Male, n/N (%) | 24/38 (63.2) | 27/57 (47.4) | 100/234 (42.7) | 326/520 (62.7) | 477/849 (56.2) |
|
Female, n/N (%) | 14/38 (36.8) | 30/57 (52.6) | 134/234 (57.3) | 194/520 (37.3) | 372/849 (43.8) |
|
Chi-squared test ( |
2.6 ( |
0.20 ( |
4.9 ( |
33.5 ( |
28.7 ( |
|
.11 | .70 | .03 | <.001 | <.001 |
Physician (n=21)
Overall assessment; Competence; Communication; Recommendation; Friendliness; Caring attitude; Satisfaction with treatment; Professionalism; Time spent with patient; Trust; Treatment cost/billing; Being taken seriously; Cooperation with medical specialists; Alternative medicine; Patient involvement; Telephone availability; Individualized service; House visits; Available outside normal hours; Privacy; Health insurance differentiation
Staff (n=8)
Friendliness; Service/assistance; Overall assessment; Professionalism; Communication; Availability by telephone; Recommendation; Time spent with patient
Practice (n=14)
Atmosphere; Waiting time within practice; Ability to get appointment; Overall assessment; Location; Organization; Equipment; Online appointment; Recommendation; Parking space; Consultation hours; Waiting room entertainment; Availability by telephone; Barrier-free access
Subcategories covered by physician rating websites’ comments.
Subcategories | OkDoc | DocApp | Medicosearch | |
Physician (N=21), n (%) | 16 (76) | 14 (66) | 17 (80) | 18 (85) |
Staff (N=8), n (%) | 3 (37) | 4 (50) | 5 (62) | 6 (75) |
Practice (N=14), n (%) | 5 (35) | 8 (57) | 9 (64) | 13 (92) |
Total (N=43), n (%) | 24 (55) | 26 (60) | 31 (72) | 37 (86) |
In total, 2441 distinct issues were identified within the 43 subcategories of the categorization framework; 83.65% (2042/2441) of the issues were related to the physician, 6.63% (162/2441) related to the staff, and 9.70% (237/2441) related to the practice (see
However, there were some significant differences between PRWs, regions, specialties, and gender (see
There were significant differences between comments regarding physicians from Zurich and Geneva in a number of subcategories. For instance, comments regarding physicians from Zurich mentioned the physician’s competence (263/668, 39.3%) significantly more often (χ21=22.3;
Overall, 83.0% (705/849) of comments were classified as positive, 2.5% (21/849) as neutral, and 14.5% (123/849) as negative (see
Categorization of issues.
Issue | Total (N=849), n (%) | Evaluation | |||
|
|
|
Positive, n (%) | Neutral, n (%) | Negative, n (%) |
|
|||||
|
Overall assessment | 300 (35.3) | 278 (92.7) | 7 (2.3) | 15 (5.0) |
|
Competence | 300 (35.3) | 284 (94.7) | 5 (1.7) | 11 (3.7) |
|
Communication | 232 (27.3) | 197 (84.9) | 2 (0.9) | 33 (14.2) |
|
Recommendation | 225 (26.5) | 194 (86.2) | 0 (0.0) | 31 (13.8) |
|
Friendliness | 215 (25.3) | 191 (88.8) | 5 (2.3) | 19 (8.8) |
|
Caring attitude | 192 (22.6) | 168 (87.5) | 3 (1.6) | 21 (10.9) |
|
Satisfaction with treatment | 149 (17.6) | 118 (79.2) | 4 (2.7) | 27 (18.1) |
|
Professionalism | 129 (15.2) | 99 (76.7) | 4 (3.1) | 26 (20.2) |
|
Time spent with patient | 107 (12.6) | 94 (87.9) | 2 (1.9) | 11 (10.3) |
|
Trust | 82 (9.7) | 73 (89) | 0 (0) | 9 (11) |
|
Treatment cost/billing | 43 (5.1) | 10 (23) | 1 (2) | 32 (74) |
|
Being taken seriously | 30 (3.5) | 25 (83) | 0 (0) | 5 (16) |
|
Cooperation with medical specialists | 11 (1.3) | 11 (100) | 0 (0) | 0 (0) |
|
Alternative medicine | 5 (0.6) | 5 (100) | 0 (0) | 0 (0) |
|
Patient involvement | 5 (0.6) | 5 (100) | 0 (0) | 0 (0) |
|
Telephone availability | 5 (0.6) | 4 (80) | 0 (0) | 1 (20) |
|
Individualized service | 4 (0.5) | 4 (100) | 0 (0) | 0 (0) |
|
House visits | 3 (0.4) | 3 (100) | 0 (0) | 0 (0) |
|
Available outside normal hours | 2 (0.2) | 2 (100) | 0 (0) | 0 (0) |
|
Privacy | 2 (0.2) | 2 (100) | 0 (0) | 0 (0) |
|
Health insurance differentiation | 1 (0.1) | 0 (0) | 0 (0) | 1 (100) |
|
|||||
|
Friendliness | 92 (10.8) | 78 (84) | 6 (6) | 8 (8) |
|
Service/assistance | 19 (2.2) | 17 (89) | 0 (0) | 2 (10) |
|
Overall assessment | 18 (2.1) | 16 (88) | 1 (5) | 1 (5) |
|
Professionalism | 15 (1.8) | 10 (66) | 1 (6) | 4 (26) |
|
Communication | 13 (1.5) | 5 (38) | 1 (7) | 7 (53) |
|
Availability by telephone | 3 (0.4) | 3 (100) | 0 (0) | 0 (0) |
|
Recommendation | 1 (0.1) | 1 (100) | 0 (0) | 0 (0) |
|
Time spent with patient | 1 (0.1) | 1 (100) | 0 (0) | 0 (0) |
|
|||||
|
Atmosphere | 59 (6.9) | 54 (91) | 3 (5) | 2 (3) |
|
Waiting time within practice | 58 (6.8) | 42 (72) | 4 (6) | 12 (20) |
|
Ability to get appointment | 39 (4.6) | 31 (79) | 0 (0) | 8 (20) |
|
Overall assessment | 22 (2.6) | 20 (90) | 1 (4) | 1 (4) |
|
Location | 15 (1.8) | 13 (86) | 0 (0) | 2 (13) |
|
Organization | 13 (1.5) | 10 (76) | 1 (7) | 2 (15) |
|
Equipment | 9 (1.1) | 8 (88) | 0 (0) | 1 (11) |
|
Online appointment | 5 (0.6) | 5 (100) | 0 (0) | 0 (0) |
|
Recommendation | 5 (0.6) | 5 (100) | 0 (0) | 0 (0) |
|
Parking space | 5 (0.6) | 5 (100) | 0 (0) | 0 (0) |
|
Consultation hours | 2 (0.2) | 2 (100) | 0 (0) | 0 (0) |
|
Waiting room entertainment | 2 (0.2) | 2 (100) | 0 (0) | 0 (0) |
|
Availability by telephone | 2 (0.2) | 1 (50) | 0 (0) | 1 (50) |
|
Barrier free access | 1 (0.1) | 0 (0) | 1 (100) | 0 (0) |
Evaluation results.
Region | OkDoc, n/N (%) | DocApp, n/N (%) | Medicosearch, n/N (%) | Google, n/N (%) | Total, n/N (%) | |
|
||||||
|
Positive | 19/20 (95) | 54/56 (96) | 192/206 (93.2) | 293/386 (74.9) | 558/668 (83.5) |
|
Neutral | 1/20 (5) | 0/56 (0) | 5/206 (2.4) | 12/386 (3.1) | 18/668 (2.7) |
|
Negative | 0/20 (0) | 2/56 (3) | 9/206 (4.4) | 81/386 (21) | 92/668 (13.8) |
|
||||||
|
Positive | 18/18 (100) | 1/1 (100) | 27/28 (96) | 101/134 (75.4) | 147/181 (81.2) |
|
Neutral | 0/18 (0) | 0/1 (0) | 0/28 (0) | 3/134 (2.2) | 3/181 (1.7) |
|
Negative | 0/18 (0) | 0/1 (0) | 1/28 (3) | 30/134 (22.4) | 31/181 (17.1) |
|
||||||
|
Positive | 37/38 (97) | 55/57 (96) | 219/234 (93.6) | 394/520 (75.8) | 705/849 (83) |
|
Neutral | 1/38 (2) | 0/57 (0) | 5/234 (2.1) | 15/520 (2.9) | 21/849 (2.5) |
|
Negative | 0/38 (0) | 2/57 (3) | 10/234 (4.3) | 111/520 (21.3) | 123/849 (14.5) |
As far as this author is aware, this is the first study to examine the content and nature of narrative comments on Swiss PRWs and has resulted in a number of key findings: (1) the vast majority of issues mentioned were concerning aspects of performance (interpersonal skills of physician and staff, infrastructure, and organization and management of practice) that are considered assessable by patients; (2) overall, the vast majority of comments were positive; and (3) there were significant differences between comments on Google and comments on the 3 dedicated PRWs.
The 5 most frequently mentioned issues identified from the narratives comments were (1) the overall assessment of the physician (300/849, 35.3%) and the physician’s competence (300/849, 35.3%); (2) the physician’s communication (232/849, 27.3%); (3) recommending the physician (225/849, 26.5%); (4) the physician’s friendliness (215/849, 25.3%); and 5) the physician’s caring attitude (192/849, 22.6%). In contrast, the top 5 mentioned issues identified by Emmert et al’s analysis of 3000 narrative comments from the German PRW, jameda, from 2012 were as follows: (1) the physician’s competence (1874/3000, 62.46%); (2) the physician’s friendliness and caring attitude (1148/3000, 38.26%); (3) the time the physician spent with the patient (987/3000, 32.90%); (4) the friendliness of the staff (667/3000, 22.23%); and (5) the information and advice from the physician (630/3000, 21.00%) [
Although both studies found that narrative comments most frequently mentioned the physician’s competence, it should be noted that while this study kept the issues of
Unsolicited critical comments on PRWs can be seen as a type of complaint, which can offer a
The analysis of the 849 narrative comments on Swiss PRWs reveals that 83% (705/849) of all comments were positive, 2.5% (21/849) were neutral, and 14.5% (123/849) were negative. This finding is very similar to the previous analysis of narrative comments on PRWs in other countries [
As far as this author is aware, this is the first time Google has been included in a project examining physician ratings internationally. It has already been reported that Google had the highest average number of quantitative ratings (3.74 ratings) and narrative comment (3.03 comments) ratings per identifiable physician [
This study has a number of limitations that should be taken into account when interpreting the results. First, although a systematic online search of Swiss PRWs was conducted, there may be other types of websites that allow Swiss physicians to be rated that were not included in this study. This is a fast-moving area, and it does appear that there are some websites that have started allowing ratings or making ratings publically available after this project had commenced (eg, deindoktor and doctena), which should be added to any future studies examining PRWs in Switzerland. Second, only German search terms were used for the systematic online search of Swiss PRWs. Although the author is confident that no important Swiss PRWs were missed at the time of developing and conducting the project, it would be preferable if French and Italian search terms are also included in future research in Switzerland to ensure that no PRWs are being missed. Third, the sample was only taken from 2 regions in Switzerland, which may limit the generalizability of the results. Although the study used a representative random sample from a German-speaking and French-speaking region of Switzerland with a comparable number of physicians, given the significant differences found between the 2 regions, it would be helpful for further research to include other regions to examine whether these differences are found between other German- and French-speaking regions and in the Italian-speaking region of Ticino. Fourth, a distinction was only made between general practitioners and specialists, and there may be further differences between the different specialties. Finally, the sociodemographic information of the rating patients is unknown and may not be representative of Swiss patients in general.
Categorization of issues by physician rating websites.
Categorization of issues by regions.
Categorization of issues by specialties.
Categorization of issues by gender.
physician rating website
This study was funded by the Swiss Academy of Medical Sciences’ Käthe-Zingg-Schwichtenberg-Fonds, which had no role in the project design, in the collection, analysis, or interpretation of data, in the writing of the paper, or in the decision to submit the paper for publication.
None declared.