

‘Stay Far, Far Away’ and Other Things Gleaned from Yelp Health Reviews - danso
http://www.propublica.org/article/stay-far-far-away-and-other-things-gleaned-from-yelp-health-reviews

======
jff
> Acupuncturists, chiropractors [...] did far better, with average ratings of
> 4.5 to 4.6.

Surprise, charlatans who promise that they'll make everything ok by poking you
with needles/adjusting your spine get better reviews than the honest doctor
who says "Quit smoking or you'll get emphysema".

~~~
shiftpgdn
FYI there have been multiple legitimate studies on acupuncture that show it
has a positive effect on the body in regards to arthritis and migraines.

[http://well.blogs.nytimes.com/2012/09/11/acupuncture-
provide...](http://well.blogs.nytimes.com/2012/09/11/acupuncture-provides-
true-pain-relief-in-study/?_r=0)
[http://archinte.jamanetwork.com/article.aspx?articleid=13575...](http://archinte.jamanetwork.com/article.aspx?articleid=1357516)

THAT SAID anybody who claims they can adjust your chi or cure cancer is a
charlatan and deserves prison time.

~~~
henrikschroder
There are studies that show that sticking needles into the skin have various
positive effects, but the whole chi/meridians/acupuncture points is complete
pseudoscience.

~~~
belenos46
So sticking needles places --which is what acupuncture does-- works fine, but
the names used to describe it --which is what that chi/meridians stuff is--
mean that it's bunk? Why --because you saw a bunch of films attributing magic
powers to chi? How are those films significantly different than any science-
based event in any Hollywood film ever?

~~~
pluma
The difference is that acupuncturists claim that it is far more nuanced than
it has been scientifically proven to be and justify that claim with a lot of
pseudo-scientific woo.

There is basis for the claim that sticking needles in people can help with
some ailments. There is no basis for the claim that meridians are a thing and
in any way relevant to those effects.

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mazelife
No doubt there is interesting data to be mined here, but I wouldn't rely on it
solely. The vast majority of patients are not in a good position to evaluate
the quality of care they received. The kind of things they typically judge by
are often fairly superficial attributes:

* did I have a long wait time?

* was the office staff polite and helpful?

* was my physician/NP/PA polite and helpful?

* were there billing problems after the appointment?

These things do matter, but there are more important factors in play that
patients are not in a position to judge:

* were standards of care followed by the provider?

* were unnecessary tests ordered or unnecessary drugs proscribed?

* were necessary tests skipped or necessary drugs not proscribed?

* if they had access to my medical history, did the provider bother to review it before seeing me

* etc, etc.

Quality of care can absolutely be evaluated, and that's happening more and
more, it's just that patient satisfaction is only one small part of the whole
picture.

~~~
namewithhe1d
True, but Dr. Offices are a business. And in smaller offices, the Dr. is the
Owner/Manager. Frankly, for the vast majority of Dr. visits, you're there for
routine or minor care, and a badly run business will simply keep me away.

I don't care how good a chef at a restaurant is, if it takes me 2 hours to
order and wait for food, the silverware is dirty, and the surroundings are
miserable, I'm never coming back.

~~~
tptacek
The concern is that increased attention to superficial details will advantage
poorer doctors who are better at customer service, which isn't a win for
consumers.

Already in this story you see the effect of massage therapists being
statistically advantaged over internal medicine doctors. That's obviously
silly, but the same effect happens within the medical profession, between
different doctors.

~~~
namewithhe1d
It's true in the short run, though it will also place a much higher value on
those doctors that are good at what they do, and run a good business. And
those are the offices that will benefit the best in the long run.

/endrant

~~~
tptacek
At the very top tier, the most advantaged professionals will be those doctors
who are fundamentally effective and apt at customer service. Surfacing them is
a win for consumers.

But the next tier after that will be a raft of professionals who are not
necessarily effective, but still apt at customer service. Elevating them is a
loss for consumers.

The question you then want to ask is, is it harder to be good at customer
service, or harder to be good at internal medicine? I think customer service
is easier, and thus worry that the second tier will be the largest of the
tiers.

An easy response to this is to say that doctors will learn to get better at
customer service. Maybe. But the effect I'm talking about also happens if we
stipulate that none of these professionals really change at all, and instead
the market just changes the way we sort them. I think that is likelier than
the scenario where doctors who are not simultaneously good at medicine and
managing an office suddenly figure out customer service.

------
anon4
There is a very strong correlation between a doctor caring about you and
giving you good care. So I think the Yelp reviews are somewhat valuable.

On the other hand, the woman who gave her dentist a low score should also be
considered. Was the treatment her dentist recommended really unnecessary? My
dentist has told me that I should look into getting my wisdom teeth removed,
since they might become a problem later. Is this necessary? Right now it
isn't. Tomorrow my gums could become inflamed and I would be unable to chew
and will need immediate surgery. At what point is that surgery necessary?

However, a good dentist should have given her enough explanation so she can
make the choice herself.

In the end, I don't really want to end up in a situation where doctors
optimise for good review scores on Yelp at the expense of providing good care.

It's a thorny issue.

~~~
Robadob
I've had around 4 dentists over the space of ~3 years since my long time one
retired, and they all seem to have vastly different opinions about what dental
work is necessary, preventative, unnecessary.

With my original dentist I never had any fillings.

As soon as the next dentist came in she recommended 2 fillings and then a
later 3rd. Of these filings, one didn't even require anaesthetic for her to
drill and complete the filling.

After this dentist left, the next had a policy of, if it isn't causing you
pain, filling it is unnecessary (because you often have to drill a tooth
slightly to fill it, damaging the tooth worse).

That dentist eventually moved on, and two of those earlier fillings fell out
within a month of each other (really not a good time having to carefully eat
around these teeth, one on each side of my mouth), and the new dentist gave me
two root canals because the roots in the affected teeth had apparently died
(potentially my fault, for delaying an appointment due to the timing being
several weeks before I was to leave uni). Several months after these root
canals had been completed, I had an abscess on one of these teeth, but it
passed after a weekend of paracetamol(?). One of these root canal'd teeth then
further broke, and the dentist recommended having a crown placed on the tooth,
I did enquire about simply having the tooth removed because it had become so
much hassle, but the dentist was really against it.

Due to my situation of being at university, and having to travel several hours
down the country for each dental appointment, and the need for 4+ appointments
to have 2 crowns I opted to visit a dentist local to my university. They ended
up recommending removing both the root canal'd teeth (one specifically because
the tooth had broken below the gum-line, so it should not be crowned/filled)
and they also applied dental sealant to an unrelated tooth. This dentist also
stated, if you have an abscess on a root canal'd tooth, that it has become
infected, and that infection is unlikely to ever go away, it will simply come
back when your immune system is weak (at the initial abscess I had been doing
a 48 hr all-nighter for a large assignment deadline), so it's best to have
these teeth removed.

tldr; Dentists in my own anecdotal experience can have vastly different
opinions of best practise.

I'm also UK based, so dental treatment is relatively inexpensive, due to the
NHS funding a large part of it.

~~~
belenos46
I...just...Where I am, a root canal runs to 2k USD, and a crown to 1k USD, out
of pocket because dental is often not covered by medical insurance. Can you
feel my jealousy?

------
tacon
What a total waste of ProPublica's time. A recent Mixergy interview[0] of MD
Insider[1] paraded useless Yelp interviews of doctors as one of the reasons
for starting their company. In one of the cleverest applications of big data
I've seen, they process billions of medical billing records to generate the
actual performance records of specific doctors for specific procedures. Alas,
their business model requires selling to big companies with health plans,
instead of allowing access by individuals. So we will all need to identify a
friend who has access to MDinsider... :-)

[0] [http://mixergy.com/interviews/david-norris-md-
insider/](http://mixergy.com/interviews/david-norris-md-insider/)

[1] [http://mdinsider.com/](http://mdinsider.com/)

~~~
danielweber
It's weird how outright hostile doctor reviews are on Yelp. Every practice of
more than 10 people in my area has reviews saying it's horrible. I can only
imagine that there are doctors out there making sure every other practice has
negative reviews.

~~~
knodi123
> I can only imagine that there are doctors out there making sure every other
> practice has negative reviews.

Then your imagination is limited. It's more a function of the entire medical
experience. Sick people are grouchy. Busy places with waiting rooms make
people grouchier. Few doctors provide immediate relief, which means their
patients often leave just as grouchy. And upset customers are drastically more
likely to leave reviews than satisfied customers. It's just the nature of the
business.

~~~
mazelife
In addition, the realities of managed care and reimbursement rates mean that--
for many types of practices--doctors have to see a pretty large volume of
patients every day to be able to stay afloat. No doctor I've talked to likes
this state of affairs, but it's a reality. This leads to dissatisfaction
because patients feel that their doctor is rushing through the appointment
without giving them adequate time. It doesn't necessarily mean they're getting
substandard care, but it's also reasonable to feel angry or annoyed by that
kind of interaction.

Conversely, many practices will do everything they can to maximize physician
utilization, including scheduling lots of back-to-back appointments.
Inevitably, if a doctor is actually doing a good job, some visits will uncover
more complex health issues than planned and require more than the 15 or 30
minute allotted to address. This means that appointments start to back up,
people start having long wait times to see their doctor, and patient
dissatisfaction ensues. Again, this isn't a problem with individual doctors or
practices-- although it may seem that way to patients--it's systemic.

------
minimaxir
A long time ago, I made a chart containing the density histogram for ratings
in each category of Yelp businesses via the academic dataset:
[http://i.imgur.com/PqU30Ma.png](http://i.imgur.com/PqU30Ma.png)

Health and Medical reviews in general are skewed a bit toward 5 stars. The
average rating for Health business in general (3.87) is on par with that of
other categories.

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pbreit
Not a Yelp apologist but this confirms how easy it is to maintain decent Yelp
reviews: don't be rude. Pretty much every complaint can be rectified by
politeness. Any polite person should be able to easily get a job.

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ndomin
> “Choosing a physician is more complicated than choosing a good restaurant,
> and patients owe it to themselves to use the best available resources when
> making this important decision.”

And what are those resources?

I'm actually looking for a new PCP in NYC and there are hundreds or thousands
of options. It feels like my best course of action is to just pick one at
random.

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pbreit
Would it make sense or be workable for Yelp to somehow take into account geo-
location? I know it would not make sense to limit reviews to people who have
been at the location but there must be some way to usefully take this into
account.

