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Point-of-Service Reviews. Are They Tainted by “Undue Influence?”

I recently presented at a conference. I was making the case for gathering patient feedback at the point-of-service. The benefit is that information captured at the point-of-service is not dated. It’s not stale. It’s timely and relevant. It makes no sense for patients to identify problems that presented days or weeks ago. Memories fade. I can’t even remember what I had for lunch the previous day. (Well, OK, I had a Greek Salad).

If you ask patients for feedback down the road, by email, letter, or phone, you typically get nothing. Minimal to no response.

The audience was receptive.

One person pushed back. He argued that asking patients for feedback in the office created “undue influence.” The patients would feel pressure to please and the information would be overly optimistic and valueless.

I explained the eMerit system is not asking for glowing praise. It asks for honest feedback. What worked. What didn’t. How can the practice be made better. Further, eMerit’s default setting is anonymity. If a patient chooses to give their name, great. But absent an affirmative step, only a pseudonym is tied to the review. The doctor would not know who the patient is, or even if the patient completed a survey.

I do concede that if the doctor or staff is sitting across from a patient, tapping a pencil while they complete a survey, then, yes, that could influence the outcome. But, who does that?

More importantly, doctors and patients have to manage a range of conflict of interests. And, it seems to work just fine the vast majority of times.

How about this one?

If a patient sees the doctor to discuss surgery versus conservative options, the patient understands the surgeon will be paid more for operating. Does the doctor have to explicitly disclose how much he will be paid with either option? Of course not. It’s assumed the doctor will behave like an adult and put the patients’ interest first, and the patient will make an informed decision.

Is it ever abused? Yes. With just under 1 million doctors in the US, some cannot resist the impulse to treat the patient as a cash cow. But, the majority of doctors comport themselves ethically –  with integrity.

And, if you develop a strong reputation of putting a patient’s interest first, you likely will have a stronger, economically successful practice.

Back to answering the original question about undue influence. How doctors interact with patients determines whether they are treating their patients with respect or whether they are tainting the relationship with undue influence. It has nothing to do with whether a practice asks for feedback at the point-of-service or somewhere else.

What do you think?

By |2017-07-14T11:14:31+00:00July 1st, 2016|Marketing, News, Online reputation, Online reviews|8 Comments

About the Author:

Helping patients find the best doctors online. Helping the best doctors be found online.At eMerit®, we focus on managing your Dental or Medical Identity toward a sustainable and growing business – where both doctors and patients thrive.And we minimize distractions away from patient care while meeting your business objectives by transforming everyday patient interactions into growth drivers.At eMerit, we take your Medical Identity® personally.

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Eric Joseph

“And, if you develop a strong reputation of putting a patient’s interest first, you likely will have a stronger, economically successful practice.” Completely true. When you treat patients like family, they are happy to pay-it-forward with an Internet review, especially if your internet presence is positive and if they found you by virtual word-of-mouth. Capturing an Internet review at the point of service is convenient for your patients, and completely ethical. Undue influence is not possible. If you were leaving a restaurant after a crappy meal, and the server asked you to write an iPad review, you would pay, leave,… Read more »

Rasheed Siddiqui MD

And, if you develop a strong reputation of putting a patient’s interest first, you likely will have a stronger, economically successful practice.


The doc in the audience who proclaimed ‘point-of-service reviews may unduly influence patients’ was a plant from Yelp. There is no other plausible explanation. At the VCS2016 meeting, Yelp was exposed as the “Mafia” when it comes to their unethical practices of posting and ranking their online physician reviews. If you don’t advertise with Yelp when the Yelp-Rep calls your office, their “filtered” positive reviews sink, and they force the crap-chat to float and dominate. Those darn Yelpers are empowered, and the physician should consider treating them cautiously – especially if they announce their prolific Yelp presence at a consultation.… Read more »

Juan Fitz MD FACEP

How often does it happen the patient receives a survey at the same time they receive the bill? Does this influence the patient? Yes ! Save a patient in the ED patient admitted and the pt does not receive a survey as to how the team and doctor did to save the patient. System is very flawed in some instances used to punish the medical team.


I completely agree that health care in the US has become untenable, and the cost of healthcare for patients is very high. eMerit is only helpful if the majority of your patients are happy with your care. It is impossible to prevent the discontented Yelpers from voicing their opinion.

If you see ten happy patients per week, and can get point-of-service reviews from half of them, that’s well over 200 positive reviews per year which is necessary to dilute the Yelpers. Thank you.


If I orovide perfect, up-to-date care but the patient is slapped with a huge deductible, a large copay, a whopping pharmacy bill, and more charges for all the testing I ordered—what do you think my review will be? And what if the testing is uncomfortable and then I recommend an expensive, painful surgery? Or worse, what if I can’t find anything wrong and they feel ripped off? They slam me!


If you see any patients in a private office, and if the majority of your outpatients are happy with your care, eMerit will work to dilute those who may be discontented. If you treat your patients like family, and explain why you are ordering expensive tests, or prescribing expensive medications, they may be more upset with their carrier than you. Hope this helps. Thank you.

In response to EJ/ Anon: I have been with Dr Siegel’s program for about 6 years. We started participating in e-merit about a year ago. I totally agree with your assessment of Yelp. Our experience was the following: about 2 years ago ( prior to e-merit ) we thought it would be a “great” idea to advertise on Yelp. Little did we know they are truly the MAFIA of online rating for doctors and others. Immediately upon joining them and Paying them we had all of our GOOD reviews be booted off to the “not reccommended ” section. A bad… Read more »