How to Find a Doctor

David A. Pfister, a Bay Area oncologist, was named “Best of the Bay Oncologist” in 2010 by KRON-TV, according to a Yelp reviewer. He was named one of America’s “Top Doctors” by US News, based on a “peer nomination process.” The biggest doctor rating site, at least in America, is HealthGrades. A HealthGrades  survey of Dr. Pfister’s patients (n = 31) asked  Would you recommend Dr. Pfister to family and friends? Dr. Pfister’s score — halfway between “mostly yes” and “definitely yes” — put him close to the national average.

The “Best of Bay” comment was one of seven Yelp reviews of Dr. Pfister that filtered out (= downgraded) by Yelp’s filtering algorithm. The filtered-out reviews were much more positive than the reviews that passed the filtering process. In the five passing reviews, Dr. Pfister received an average rating of 1 out of 5, with comments to match:

He was chronically late, and had poor time-management skills. . . . This was the third and final time that he’s made me wait at least an hour past my scheduled appointment time (requiring me to leave before seeing him). [2008]

He was 30+ min late, unfriendly and unapologetic. His bedside manner is horrific and he talked me into having a procedure that ended up being painful and unnecessary. The office is completely disorganized. There are records of deceased patients out in the open in the bathroom. [2011]

When I visit his office, the only thing he wishes to discuss with me are the results of my recent labs. If it were up to him, my appointment would last 2 minutes. . . All my other doctors have told me for years I should get my care elsewhere. Typical visits consists of 2 hours waiting, 5 minutes with the doctor. [2010]

He is consistently late, as much as two hours, to his first appointments of the day. He arrives completely disheveled, hair sticking up and shirt untucked as if he was up half the night drinking. He also forgets your history and has to be reminded who you are, despite continual and regular appointments. Finally, if you ask questions he becomes very defensive and has even yelled at me for asking questions. [2009]

Which view of Dr. Pfister is more accurate, KRON-TV or Yelp? In March 2012, his license was suspended. He “admitted he has a psychiatric problem and a substance abuse problem.” The Yelp reviews that passed the filtering algorithm, with their complaints about lateness, poor grooming, and disorganization, predicted the suspension (assuming that doctors with low yelp scores are more likely to be disciplined). HealthGrades has yet to figure out there is anything unusual about Dr. Pfister. He is not listed on vitals.com.

I came across Dr. Pfister while glancing through yelp ratings of Berkeley doctors. His low rating surprised me. A yelp reviewer linked to the license suspension.

My conclusion: When looking for a doctor, check yelp. Yelp’s filtering algorithm, which emphasized the low reviews, really works. In California, you can search state records for licensing board disciplinary actions but such actions are very rare.

Thanks to Bryan Castañeda for a long conversation about detecting bad doctors. In Unaccountable (which should have been on my Best Books of 2012 list), Marty Makary says that hospitals and surgeons are in many ways unaccountable for their mistakes. Yelp is a countervailing force.

5 Responses to “How to Find a Doctor”

  1. Tom Says:

    Off topic, Seth, but thought you’d be interested in this quote from the URL below:

    “Before Dr. Pringle started the study, a colleague suggested she was wasting her time: to prove that something doesn’t age would take far longer than the duration of a research grant, perhaps longer than a researcher’s career or even life. But she stood her ground.”

    http://www.nytimes.com/2013/01/01/science/studying-seemingly-immortal-lichens-in-a-place-for-the-dead.html

  2. Matt Says:

    While this scenario may have proved to be the more accurate portrayal, Yelp is a crooked organization. Yelp’s filtering “algorithm” goes something like this:
    1. Business begins receivng Yelp reviews of varying rank.
    2. Yelp contacts business, asking them to pay money to hide low ranked reviews.
    3a. Business pays yelp: low ranked reviews are hidden.
    3b. Business does not pay: Any positive review is filtered within a couple of days.

    Yelp claims that they filter when they suspect that the business solicits for positive reviews. While that is likely also true, the scenario I laid out, is also true.

    http://www.eastbayexpress.com/ebx/yelp-and-the-business-of-extortion-20/Content?oid=1176635

  3. Vince Says:

    (Disclosure: I work for Yelp.) Matt, your scenario is simply not true. Yelp’s review filter, which works to help consumers in precisely the manner described in Seth’s blog here, is applied equally to all business listed on Yelp, advertiser or not. There is no connection between how reviews are displayed on Yelp and advertising. As is described in numerous places on our website, Yelp advertisers pay to advertise (primarily local/search advertising, just like on the major search engines) and do not gain the ability to control the review content on their Yelp listing. Neither does Yelp penalize businesses that decline to advertise. The filter helps consumers trust and benefit from Yelp (as described here), which is why 84 million of them used our service on average last month.

    Seth: Thanks. Did Yelp reply to the East Bay Express article? I read it when it was published and still remember it. I do not remember any rebuttal.

  4. Matt Says:

    Sounds like we need an undercover investigation :) because the internet is full of stories like the one I heard from the business that warned me about Yelp reviews. You would think that my legitimate review that I placed on that organization’s Yelp page wouldn’t be filtered out, seeing that I’m a unique IP address, etc. But the business absolutely predicted that any positive review that was placed would be filtered within a matter of days, and that this all started soon after he declined the ad payment. A quick internet search to back up my personal experience revealed that East Bay article as well as other stories.

  5. Vince Says:

    Seth: Yes, Yelp did reply to the EBE article and published a number of rebuttals on our corporate blog. You can find them at:

    http://officialblog.yelp.com/2009/02/kathleen-richards-east-bay-express.html

    http://officialblog.yelp.com/2009/02/east-bay-express-story-starts-to-unravel.html

    Matt: We also published a number of posts on our blog about how our filter works and why some businesses may have come to believe in a grand (but untrue) conspiracy theory. Some good ones are here:

    http://officialblog.yelp.com/2010/02/lady-justice-needs-a-lawsuit-filter.html

    http://officialblog.yelp.com/2010/03/additional-thoughts-on-last-weeks-lawsuit-or-how-a-conspiracy-theory-is-born-.html

    As you can see, there have actually been some undercover investigations by the media and even some lawsuits brought making the same allegations; none of them found anything to substantiate the claims and the suits were dismissed with prejudice. The bottom line is, regardless of how much or how many businesses want to believe in an easily disproved conspiracy theory, it simply isn’t true. That’s why consumers trust Yelp and use it every day to connect with great local businesses. Which also happens to be our mission.