Online ratings are becoming "a fact of life," a researcher says.

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Online ratings of physicians haven't caught on as much as ratings of books, movies and plumbers, but a majority of consumers know they exist and one in four consulted them when picking a primary care doctor in 2012, new research shows.

Just 5% have rated a doctor themselves online, according to a research letter published Tuesday in JAMA, a journal of the American Medical Association.

The findings are based on a nationwide, representative survey of 2,137 U.S. adults taken in late 2012. It's likely that awareness and use have grown since then, says lead author David Hanauer, a pediatrician at the University of Michigan. Despite concerns by many physicians that the ratings can be misleading and harmful, they are here to stay, Hanauer says.

"We do have to accept that this is becoming a fact of life," he says. "The view of consumers is that they should be able to view and leave ratings on just about anything they want online."

Sites that include physician ratings include those devoted entirely to medical information, such as Healthgrades and Vitals, and broader consumer sites ranging from Yelp and Angie's List to Consumer Reports. Some score doctors based on patient surveys, and some allow patients to post comments.

The survey found:

• 65% knew ratings of doctors could be found online, but awareness was higher for ratings of cars (87%), books and movies (82%) and other service providers, such as plumbers and electricians (71%).

• 23% had sought out ratings to choose a primary care physician in the previous year. That rose to 36% among those aware of the ratings, compared with 46% for cars and 52% for books or movies. Those differences may partly reflect how often people seek the services or products, Hanauer says.

• 19% said online ratings were very important when choosing a primary care physician — behind every other factor researchers asked about, including insurance acceptance (89%), convenient location (59%), years of experience (46%) and word of mouth from family and friends (38%). An additional 40% called ratings somewhat important.

Ratings from other patients are just part of what a consumer should consider when picking a doctor, says Evan Marks, executive vice president for informatics and strategy at Healthgrades. That site does provide information on other factors, including insurance coverage, location and experience. Ratings at the site are based on a patient satisfaction survey that includes questions about such things as the friendliness of the office staff and a doctor's communication style.

Those things might be more important when choosing a primary care doctor, Marks says, than when choosing a surgeon for a single procedure — where patients might put more weight on the doctor's experience with the procedure and the safety record of the hospital where it will be performed, he says.

Most people "spend more time researching and understanding the refrigerator or car they are going to buy than understanding the doctor who is going to be operating on them," Marks says.

Consumers need to be aware that online ratings "can be easily gamed" by doctors and staffs seeking to raise their scores or even sabotage a competitor with low scores and negative comments, says patient advocate Trisha Torrey, author of You Bet Your Life: The 10 Mistakes Every Patient Makes. Some give patients gift certificates to post reviews, she says.

In any case, she says, at most sites, "the right questions aren't being asked to make the ratings truly useful. Just because a patient is appreciative that a doctor didn't keep her too long in the waiting room doesn't mean the doctor is any good."

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