Characterizing extremely negative reviews of total joint arthroplasty practices and surgeons on yelp.com

BACKGROUND: Although physicians tend to prefer data-driven quality metrics, emerging evidence suggests that patients prefer crowd-sourced information containing patient narrative descriptions of the care experience. Currently, yelp.com is the most commonly accessed Web resource among patients who use online information to choose a surgeon. The purpose of this study is to characterize extremely negative reviews of total joint arthroplasty surgeons and practices on yelp.com. METHODS: We searched yelp.com for one-star (out of 5) reviews of total joint providers and practices in 8 major US metropolitan areas. These reviews were then classified into categories based on content: clinical, nonclinical, or both. Reviews were further subcategorized as “surgical” and “nonsurgical” representing reviews of a nonsurgical experience (eg, initial office visit). RESULTS: A higher proportion of reviews came from patients who did not report prior surgery by the surgeon or practice named in the review than form those who reported surgery (240 reviews, 75.0%, 95% confidence interval: 70.0%-79.4% vs 80 reviews, 25.0%, 95% confidence interval: 20.6%-30.0%, P < .0001). Compared with surgical reviews, nonsurgical reviews were more likely to contain nonclinical complaints (92.1% vs 53.8%, P < .0001) and less likely to contain clinical complaints (21.3% vs 78.7%, P < .0001). CONCLUSIONS: The vast majority of extremely negative reviews of total joint arthroplasty surgeons and practices were related to nonclinical concerns posted by patients who did not report prior surgery by the surgeon or practice being reviewed. The results of this study may help explain the wide disparity commonly observed between conventional quality metrics and crowd-sourced online reviews.