Understanding PEWs & Online Reputation

Most pediatric gastroenterologists would think that the acronym PEWS referred to “Pediatric Early Warning Score” which is used to identify patient deterioration (Sensitivity of the Pediatric Early Warning Score to Identify Patient ).  This PEWS has been an important  achievement in patient safety contributing to lower mortality, reduced codes, and shortened intensive care unit stays (Simple Scoring System and Action Algorithm Identifies Children at ).

PEWs acronym also refers to “physician evaluation websites.”  These type of scores are growing in importance and may also reflect quality care.  As such, a recent article highlights this emerging phenomenon (Am J Gastroenterol 2013; 108: 1676-85 -thanks to Ben Gold for this reference).  While physicians are concerned about their reputations, these websites have not been widely embraced.  This article makes several points about why physicians may need to reconsider.

Key points:

  • 35 websites met criteria to be included in this study: 18 were dedicated physician evaluation websites, 5 were health information websites, and 12 were general information websites (eg. Angieslist.com, kudzu.com, yelp.com).
  • Frequent analysis/questions besides demographics/affiliations: punctuality, quality of staff (office/nursing), bedside manner, ability to make correct diagnosis, spent sufficient time, costs
  • Five sites allow physician feedback and chance to respond to dissatisfied patients: docspot.com, doctorscorecard.com, healthgrades.com, ratemds.com, and your city.md
  • Multiple charts indicate the huge traffic on these websites.  For dedicated PEWs, healthgrades.com has the highest volume at over 5 million unique visitors per month (2011-2012).
  • Most online evaluations are completed by females (with at least some college education) with a peak age between 45-65 years.  Some smaller PEWs attract a younger crowd (eg. Zocdoc.com -4th most visited dedicated PEW).
  • Most evaluations are positive.  “Site administrators…self-reported figures…ranged from 60-75% positive, 4-22% neutral, and 9-21% negative.”

Unique Aspects:

  • ucomparehealthcare.com (3rd most visited dedicated PEW) allows multiple physician profiles to be analyzed side-by-side.
  • docspot.com compiles existing reviews from over 15 other websites.
  • healthgrades.com (most visited dedicated PEW) allows users to rate physicians with a star scale but does not allow free response (avoids libelous comments).
  • vitals.com -2nd most visited dedicated PEW.
  • yourcity.md considered most “doctor friendly.” Prior to publicizing negative comments, this site allow doctors the option to respond publicly or privately; afterwards, the negative review can be revised.  In addition, per user agreement, a negative claim which cannot be substantiated could result in the anonymous reviewer’s name being revealed to the physician or be removed.

One of my mentors told me that the key to patient care was the the 3 A’s: availability, affability, and ability.  PEWs likely can help evaluate the first two A’s.  PEWs allow for constructive criticisms but need to evolve to include other measures of physician performance.  Ignoring PEWs would be a mistake for physicians –they are here to stay.

Related blog posts:

Why I blog

I was asked to participate in a “Meet the Professor Breakfast Session” at the NASPGHAN Annual Meeting. This year’s meeting is taking place at the Chicago Hilton Downtown, October 9-11th. The proposed title of my session:

“Twitter/Facebook/Blog- Use of Technology in your practice”
Co-presenter: Eric Benchimol; time 7am (central) tomorrow morning (October 11)

My focus will be to discuss this blog and how it relates to my practice.  I started this blog shortly after the NASPGHAN meeting in 2011.  There were two main factors that contributed to starting this blog.

1. The death of the palm pilot and other PDAs.  After my fellowship, in 1997 I joined Mike Hart in Atlanta at Egleston Children’s Hospital.  He had started using a palm pilot and I began using one as well. I stored a lot of useful information on drugs and personal contacts.  By each local physician, in addition to their name, I kept the names of referred patients and their diagnoses.  I also decided that instead of tearing journals I would make entries in my Palm device and keep annotated references of journals that I was reading. When the support services disappeared for my Palm device, I transferred a lot of information to Notespark but was not as pleased with this site as I had been with my Palm.

2. NASPGHAN meeting. While at the NASPGHAN meeting, I listened to a talk by Bryan Vartabedian (33 Charts — medicine. health. (social) media).  Prior to that meeting, I had not considered starting a blog.  He made several points that I considered important.

  • Physicians need to provide a voice and balance in social media.  In many areas of medicine, like immunizations, the voices of extremists dominant the conversation.  “The solution to pollution is dilution.”  When physicians add their reasoned opinions to topics related to public health, this will steer the conversation towards sanity.
  • Taking part in social media allows a physician to modify their digital footprint.  Without our participation, what is placed on the internet is beyond our control (Physician Online Reputation Management – 2 Realities – 33 Charts).

His blog on social media and medicine has been present for many years and elaborates on these points and many others.

So I decided to start a blog.  This might sound difficult but it wasn’t.  I didn’t even need to ask my teenage sons for hardly any help.  Though, in retrospect, it may have been a good idea.  I found that wordpress.com provides tools for individuals to create their own blogs at no cost (alternative sites are noted in my slides -see link below).  Though, they definitely encourage an upgrade ($18 per year). Basically, I registered a name, picked a design type for the blog, and made a few choices about the formatting.

If you have time, you can look at some amazing blogs: photographers post pictures from all corners of the earth, professional chefs & domestic chefs provide recipes for anything you could think of eating, Nate Silver can tell you who is going to win the next presidential race, KevinMD has thoughtful posts from a huge number of health professionals, our hospital (like many others) has a blog, improvecarenow has a blog, there are blogs explaining the NEJM articles, my sister has a blog about what turning 50 means, and so many others.

What were my goals/Why I blog?

  • To create a site where I could archive the references of journal articles and have them accessible for easy searching.
  • To develop a relatively non-controversial digital footprint.  Truth be told, I would love to create a joke blog.  However, I think that anything you put out on the internet is available for public consumption and I am certain that some of my jokes would not be well-received in some circles.
  • To add my voice to topics like immunization policy, judicious use of antibiotics, and healthy nutrition choices.
  • To share some of my readings with my colleagues and mid-level providers.  I hoped that some of the information might help with more uniform adoption of best practices.  For example, with H pylori, we have an international expert in our group (Benjamin Gold who is speaking at this conference). Yet, the information that clarithromycin should not be a 1st line drug had not been brought up in any of our meetings.
  • To promote some aspects of our groups’ accomplishments.  When one of our physicians publishes an article, I definitely want to review that for my blog.
  • To remember journal articles with more clarity.

While many physicians might see the opportunity for patient education, I decided to target the blog to a medical professional audience.  Our office website (Children’s Center for Digestive Healthcare, LLC (GI care 4 kids) already has a great deal of patient-related information and links to numerous other useful sites.

When I first started the blog, I only notified a few people outside of our group.  This included my mentors in Cincinnati (including Mitchell Cohen, William Balistreri, and Jim Heubi) as well as my former boss Mike Hart.  All of these individuals, along with my other mentors in training (Colin Rudolph, Jorge Bezerra, Mike Farrell, and Jon Bucuvalas), could probably provide a great deal more insight.

After writing a few blogs, I decided I would send an email to authors of papers that I commented on.  This would allow them to provide additional insight as well if they chose.  After about a year of blogging, Mike Hart asked if I was OK with him sending an email out to the pediatric GI bulletin board listserv because he thought more people might enjoy the blog’s contents.  Also, now I usually will post a link on twitter so that individuals who follow me can access the blog as well.

Many physicians have avoided social media due to either time constraints or concerns of potential risk about putting out medical information.  I do put in time and try to be careful about what I write.  And, unlike medical journals, I do not have any editors.

At the same time, I have a lot of advantages.

  • I can provide links to media.  Some of these links are just for fun.  For example, in previous posts:  “dont go ninjin nobody that dont need ninjin” Kung Fu Hillbilly – Training Video – YouTube or “Everybody Poops” – a bad lip reading of the Black Eyed Peas ….  In addition, it is not difficult to place graphs or pictures.
  • I can provide links to newspaper articles and original publications.
  • I have the opportunity to provide more timely information.
  • The information on my blog is much easier to search.
  • Many other physicians forward me articles that they think would be of interest.
  • I can link previous related posts.  This is a lot easier than tracking down other types of references.
  • I can use twitter to leverage a great deal of information.  For example, Kipp Ellsworth has a twitter feed, @PedNutritionGuy, which cites a large number of relevant nutritional studies. Jeff Schwimmer has a twitter feed, @TheLiverPost, which highlights recent hepatology advances.
  • The blog site has a lot of tools, like widgets, which can help present useful information

Since my blog is mainly for health professionals, I have on occasion written patient-related information for our hospital blog: When a Child Swallows a Button Battery – Dedicated to All Better.  I’ve been told that this posting has had more than a thousand views.

Full presentation (powerpoint): WhyIBlogSlides

Related post: