Join Your Colleagues on Healthcasts.

Gain instant access to 500,000 consults from verified providers.

If you're a Healthcasts member, login now.

Claim Your Free Membership. Sign Up Now!

262 Healthcasts Clinicians Discuss How to Establish Patients' Trust in their Referrals in the Age of "Dr. Google" and Online Reviews

In response to this clinical question posted in September 2024 by Healthcasts Member
Charles Kochan, MD, an Internist with 30 years in practice:

How can we reasonably reassure our patients that the specialists we are sending them to are competent?

I bring this up in light of the recent wrong organ removal surgery widely reported. I personally tell the patient that I, myself, and my family would see this specialist and base my opinion on knowing them for many years, hoping we would know if a problem existed. I find it troublesome that patients may second guess us and look up a specialist's medical record online. It feels like our word is no longer taken at face value anymore.

Healthcasts Community Consensus

262 consults submitted by verified healthcare providers

Clinicians agree with Dr. Kochan's approach to tell the patient they trust the specialist enough that they would see the physician themself or refer a close family member – though if doing so, this needs to be a genuine sentiment
They reinforce the specialist’s background/expertise (e.g. board certification, education, awards), and highlight the long-standing work relationship you have with them and positive experiences from your other patients
They encourage colleagues not to take the patient’s online research too personally as it is to be expected and their right; many even encourage such research as it is important patients advocate for their own care

RR | Roberto R, Internal Medicine

“I believe we live in an age where the patient is able to look up any specialist’s credentials and if any malpractice was done. It is their right as a patient. That being said, if I personally believe that the specialist is competent, I would do the same thing as OP – I would tell them that I, myself, and my family would see this specialist, and base my opinion on knowing them for many years.”

LG | Laura G, Internal Medicine

“I think the best endorsement that we can give is that we would trust a colleague with the care of ourselves/our family, that is the highest recommendation that can be given. Due to the easy access to information on the internet, I think we have to expect that patients will look things up on their own regardless. I do think that once you have a rapport and history with patients, they will put more weight and trust in what you say. But I also don't think it is wrong for them to look up their doctors (within reason).”

NL | Nour L, General Surgery

“In this day and age with the Internet, people are going to look up doctors no matter what you tell them. Like you said, I do the same thing with telling patient that I would myself go to the person I am referring them to or would trust my family member on their care. If the doctor has won awards or accolades, that also makes the patient feel better. And I've noticed patients just feel better when they know a particular surgeon has performed many of the procedure they are having, so maybe keeping a chart that updates yearly with the count of each surgery that the doctor has performed (of course this is specific to surgeons). I fear there is no perfect answer that will work for everyone but highlighting the great things each doctor you're referring to has done will help.”

AH | Angela H, Psychiatry

“I tell patients what I know about the physician, their training, other patients' experiences, the physician's personality, why I feel this person is the best person for them, that I myself would go to them for a condition or would want my family member to see them and finally, I encourage them to look them up online. However, I remind them that reviews will be mixed and to take them all with a grain of salt as we can't always please everyone. I encourage a patient to ask their friends and family for information and to do their own research, as ultimately, they need to feel comfortable about who they are choosing for their medical care.”

MM | Michael M, Emergency Medicine

“I've been practicing emergency medicine for over 4 decades, and frequently ignore the 'on call schedule' to send a patient to a physician I know is a better, more compassionate practitioner. You should only refer your patients to another physician you would go to yourself or send a member of your family to. That makes it easy to look your patient in the eye, and tell them, ‘Dr. Smith is someone I would go to myself or send a member of my family to.’"

Key Point: Depersonalization of Referrals Driven by Contractual Agreements, Insurance, and Fear of Malpractice

Physician autonomy is lost, and it’s not always possible to know the specialists to whom you are referring your patients

DH | David H, Internal Medicine

“Too many times, a referral is made to a personal friend or someone within the health system as that is "scored" for contractual purposes. It's unfortunate. In today's society, a patient has ready access to looking up a physician's records. Is there liability for the referring physician for a bad outcome from the referred physician? Possibly. Again, unfortunate, but until health care reform is universal and frivolous lawsuits are reduced or eliminated, that's the way it is.”

VS | Virginia S, Family Practice

“I don’t refer to a person but to the location for the referral. I live in Chicago and there are so many specialists there is no way I can speak to their competency. Many patients don’t have one PCP, and I may have never seen them before the referral. Even the trust between patient and PCP has eroded in today’s environment.”

AG | Anoj G, Family Practice

“Sometimes the referring physicians are forced to refer within the system. Sometimes the appointments are delayed due to requesting a specific physician. Both could impact optimal health care delivery. Does making a referral to specific physician generate malpractice risk for the referring physician? Patient should be encouraged to own responsibility for their care.”

HY | Heui Y, Internal Medicine

“Unfortunately, healthcare is changing in that most PCPs and specialists have lost their autonomy. Case in point, we no longer decide how much time to spend with and for our patients or the best treatment for our patients. The healthcare organizations, insurance companies, pharmaceutical companies, and regulatory companies that now dictate the landscape of medicine to maximize their profit do. There is little that providers can do to turn this onslaught around…”

AE | Alan E, Cardiology

“This is an interesting problem, particularly in light of the fact that you may not be able to send a patient to the specialist you would prefer because they are not in network. I don't think there is a great answer nowadays, because I may not know the specialist, and I myself am unsure of their competence.”

Key Point: Patients Should be Cautioned that Online Reviews are Misleading

And often paint a partial picture focused on factors that are irrelevant to a physician’s competence.

HS | Hari S, Internal Medicine

“I usually say something to the same effect - that this is the specialist I would go if it were my life on the line. Because that's usually the truth. I also tell patients not to trust online reviews. These are often based on superficial attributes and don't really speak to the actual competence of a doctor, which is best seen when the situation becomes difficult, and the doctor is able to navigate the patient through danger. I tell my patients, ‘You want the doctor who will be the best in case your situation is the worst. You don't want the doctor just because he smiled while doing your routine uncomplicated colonoscopy and his waiting room featured granite floors.’”

TT | Tricia T, Oncology|Hematology

“Patients should advocate for themselves and do their own research. The problem is that the only available information online are lay reviews from platforms that are more suited to reviewing restaurants or services… These do not give patients an opportunity to report on relevant experiences such as diagnosis and management, instead of rude front desk staff or a wait to see the doctor. Statistics such as number of procedures performed, years in practice or other objective information would be helpful… We should also instruct the patient to request that s/he is seen by a specialist with board eligibility/certification. The list of providers is typically available online…”

PS | Paul S, Anesthesia|Pain

“… I first make sure that the healthcare professionals to whom I refer patients ARE truly amongst the best in their field and take care of the whole person. And, I let my patients know this… I also tell them that online reviews should be given the LEAST priority. One of the best physicians I know has the worst reviews on how long one sometimes needs to wait in the waiting room to see that doctor. But why? Because I know that doctor is "old skool" and takes the time to answer all questions and address all concerns of each and every patient. Another MD who does pain medicine gets some of the worst reviews because he won't "just give them their opioids". Lots of disgruntled people with OUD who need treatment, not more opioids, but they don't like it, so they write nasty reviews with completely false and unsubstantiated issues…"