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Teleconsultations and rating sites aren't all good news
To see and to be seen

Rinckside 2020; 31,7: 13-15.


his year, the use of commercial doctors’ directories and telemedicine by video link between doctors and patients has exploded. This changes some aspects of the medical and human relationships between them.


Teleconsultations: Seeing your doctor

Doctolib, for instance, a French company bolstered by substantial European and US-American venture capital, offers its technology and services to every doctor and other health care practitioners licensed to practice medicine by the French and German medical chambers. It is an online booking platform and management software provider for doctors and offers teleconsultation as well as a doctors’ directory.

Doctolib sees a boom in online video-linked medicine predicting it will last even after society returns to normal following the Covid-19 outbreak. The company states that it has helped to arrange about 2.5 million consultations in a month, usually surpassing 100,000 a day, as doctors and patients go online to avoid exposing themselves or others to the Corona virus. The numbers are a hundred times higher than at the start of the crisis. The number of doctors using the platform increased tenfold [1].

Teleconsultations may not be suitable for every population and medical question. They are mostly used for accidents and emergencies; in psychiatry, psychology, and neurology; general practice and pediatrics; and dermatology. During the period of the pandemic seeing the doctor on screen as opposed to just talking on the phone, might carry an important psychological weight. For radiology, patient-facing teleconsultations are of very limited use.

In general, face-to-face appointments will continue to be the gold standard. However, as a recent British review of the use of video links points out:

“Novel technological solutions already allow certain physiological parameters — such as peak expiratory flow rate, heart rate/rhythm, and remote blood sugar levels — to be monitored remotely … Wearable technology continues to develop, and solutions to other more nuanced aspects of physical examination may be developed in the future, however, for the time being, teleconsultations in outpatient settings are most likely to be confined to dialogue-based consultations where the need for rigorous physical examination is absent [2]."

All in all, Doctolib’s business model of dedicated and secure teleradiology for video consultations might have a golden future. I am not sure about doctors’ directories and advertising sites.


Online Yellow Pages: Finding a doctor

When looking for a doctor nowadays you don’t check the yellow pages of your telephone directory any more but rather a search engine on your computer or smartphone. Sooner rather than later you will land on a review portal for doctors where one finds not only the addresses and opening times of doctors’ offices, but also ratings.

An example is the German doctors’ rating portal Jameda. It is owned by the Hubert Burda Media, a highly complex, if not to say confusing, conglomerate of companies and holdings. The company is most likely best known for its DIY fashion magazines and celebrities and tabloid journalism publications, both printed and for some years also digital, among them "Bunte" and "Focus". Some years ago they started looking for new hunting grounds and came up with Jameda — a platform for classified advertising by medical discipline, a mixture of Tripadvisor and Facebook.

Every German physician is listed in Jameda’s doctors’ directory, whether they want it or not. Such lists are legal if they only contain data such as name, business address, telephone number, and medical discipline.

However, here Jameda dives into a twilight zone. Their directory contains two classes of doctors. Those who transfer between 59 and 139 euros to Jameda every month for a "premium package", which also includes adding a photo to their profile. Jameda calls them "customers". Then there are those who are listed by default and do not pay ("non-customers"). Jameda emphasizes that the premium package "has no influence on the doctors’ ratings or their place in the Jameda doctor lists". However, a data analysis by the German weekly Die Zeit based on several thousand rated entries showed a different picture of this two-tier customer system. Many doctors complain that who pays does better [3].

The grading of doctors follows the same scheme as in restaurant or airline reviews — doctors are items, like yogurt, cheese, cars, films … they are characterized by short reviews (more remarks) and yellow stars. Marking a human being, including physicians, with yellow stars reveals a deeply bad taste, in particular in Germany.

spaceholder red600   Often logistic or infrastructure factors such as "opening hours", "waiting times", "location" or even "lack of parking spaces" are reason enough to downgrade a medical doctor. This means that doctors are not assessed according to their professional qualifications but, basically, it is a rating of the office environment and the human relation skills of a physician. A good doctor can be grumpy, a bad doctor polite and pleasant. Hardly any patient possesses the experience to assess the medical knowledge and expertise of a physician: objectivity is not wanted and cannot be reached anyway. This opens the floodgates for fake reviews, positive or negative, some of them bought, some of them arranged.

One radiologist complained that an anonymous person wrote on Jameda that the doctor had been nasty to him and not explained the examination in detail to him, wanted to poison him and added some additional uncivil comments. However, the day the patient referred to happened to be in a period when the doctor was on holidays; the evaluation was fake. For physicians there is hardly any way to defend themselves. Just trying to respond to upsetting attacks means a waste precious time and energy.

spaceholder red600   Another colleague summarized the situation like this:

“I only can say that these reviews are both a curse and a blessing — many patients are into it! I would never choose my doctor this way — but a lot of people really do! Often it is those who comment who want to nag anyway — to simply let off steam. Some patients are always dissatisfied — and the whole Jameda system lives from them. Some people love these websites, some hate them — and others do not care.

“Still, patients have threatened me with a bad Jameda entry in order to get unauthorized treatments, examinations or sick leave. We're becoming even more vulnerable to blackmail than we already are. I have been lucky so far. On the other hand, there are so many portals that rate you. You don't even know that they exist.”


The more bizarre and nastier the comments, the greater the thrill of readers and the more clicks that drive advertising revenue.



The business model and psychology of Jameda and similar rating platforms has been adopted from the sensationalist tabloid press. The more bizarre and nastier the comments, the greater the thrill of readers and the more clicks that drive advertising revenue.

Some time ago a German court decision made clear that Jameda is not a "neutral information broker" delivering clean directory information and must not provide paying customers with "hidden advantages over non-paying basic customers". The basic customers included in Jameda’s listing without their consent should not be used as an "advertising platform" for premium customers [4].

In the center of its homepage Jameda cites another decision of a German court. The portal has the right to mark certain (positive) entries and ratings as “most likely fake.” Citing such court decisions on one’s homepage can easily ruin one’s own reputation.

The editors seem to turn to subtle character assassination of almost everyone involved to attract more readers. All platforms should require written proof of consent of the possible victims, in this case medical doctors.

As one doctor stated:

“[The portal] seems to me to be highly manipulative and non-transparent. I am not at all surprised that Jameda is regularly being sued.”

Rating portals deliver a non-essential but wanted service. Nevertheless, it is important to be aware that portals like Jameda pursue commercial interests. They make money from doctors who pay for their website representation.

A major nuisance doctors complain about is the behavior of patients; a large number of people booking an appointment just don't show up without canceling.

The list of clients, of patients making appointments, is extremely valuable. Having such lists and an approximate diagnosis by medical disciplines opens a wide field of interested users. Unfortunately, at least one of these platforms have already been hacked and patient data has been stolen.

spaceholder red600   Online physician directories and rating websites are marred by negative associations and bear a stigma of blackmail and viciousness — whether right or wrong, they are tainted with a sneaking suspicion that will never disappear. A lack of decency is hanging over this business model with its uncomfortable attraction of voyeurism. Therefore some providers see an attractive market for it. There is something enticing about denouncing somebody anonymously. It reverses the classic balance of power: vengeance is mine. Or, on the contrary, one can recommend oneself secretly to an unsuspecting public.

In a rampant way, the pandemic has exposed both promises of technologies and problematic applications. While Doctolib delivers an essential service at the time of a pandemic, Jameda and similar platforms exploit the situation by creating infotainment sites without delivering urgently needed positive contributions to healthcare.



References

1. Doctolib. Doctolib among the top 3 providers of online medical consultations in the world. Press Release. 22 April 2020.
2. O'Cathail M, Sivanandan A, Diver C, Patel P, Christian J. The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review. JMIR Med Inform. 2020 Mar; 8(3): e15380.
3. Fischer T. Zu welchem Arzt würden Sie gehen? Die Zeit 4/2018, 18 January 2018. https://www.zeit.de/2018/04/jameda-aerzte-bewertungsportal-profile-bezahlung
4. Grundmann S. OLG Köln: Jameda darf seinen Premiumkunden keine verdeckten Vorteile gewähren. 10 January 2020. https://www.kmh-medizinrecht.de/single-post/2020/01/10/OLG-Köln-Jameda-darf-seinen-Premiumkunden-keine-verdeckten-Vorteile-gewähren



Citation: Rinck PA. To see and to be seen. Rinckside 2020; 31,7: 13-15.

A digest version of this column was published as:
Teleconsultations and rating sites aren't all good news.
Aunt Minnie Europe. Maverinck. 16 December 2020.


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Rinckside • ISSN 2364-3889
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