MRKT 600 Week 2 Literature Review Example

Stars, Stories and the Choice of a Doctor: A Literature Review of Online Reviews in Physician Selection

Abstract

Online reviews have become a common source of information for people choosing a physician, yet research on how they work in health care is scattered across marketing, information systems and medicine. This review synthesizes twenty peer-reviewed studies on the role of online reviews in physician selection. It is organized around six themes: the theory of electronic word of mouth; the growth and character of physician reviews; the characteristics of people who use rating websites; the influence of reviews on choice; the relationship between reviews and quality of care; and the views of physicians and patients. The literature shows that reviews are increasingly common, generally positive and influential in both observational and experimental studies, but that their relationship to clinical quality is weak or uncertain. Few studies examine how patients weigh star ratings against written comments when choosing a primary care physician, which is the gap this research program will address.

Introduction

Choosing a physician is among the most consequential purchasing decisions consumers make, and one of the hardest to evaluate in advance. Health care is an experience good, and much of it is a credence good: patients often cannot judge the quality of a diagnosis even after receiving it. In such markets, consumers rely heavily on the experiences of others. For most of the twentieth century, that meant recommendations from friends, family and other physicians. Today, it increasingly means online reviews. Physician rating websites, appointment-booking platforms, general review sites and health systems' own physician directories now display star ratings and written comments beside physicians' names.

For marketers in health care, this shift raises practical questions. Which features of reviews persuade prospective patients? Do star averages or written comments matter more? Should practices respond to negative reviews, and how? And, because health care carries ethical obligations that other markets do not, what are patients actually learning from reviews about the quality of care? This review brings together research from marketing, information systems and medicine to answer as much of these questions as the literature allows. It is written for a marketing audience but takes seriously the clinical and ethical questions that make health care different from other markets. Where the evidence comes from other countries or from hospitals rather than individual physicians, the review notes the difference, because the transfer of findings across settings is one of the literature's open questions.

Method of the Review

Sources were identified through searches of business, medical and information science databases using combinations of the terms physician rating websites, online physician reviews, electronic word of mouth and online reviews. Studies were included if they were published in peer-reviewed journals, examined online reviews of physicians or hospitals or developed the theory of online reviews in consumer markets, and reported empirical findings or systematic analysis. Twenty studies published between 2004 and 2024 met these criteria. Four develop the general theory of electronic word of mouth, and sixteen examine reviews in health care, from the United States, Germany, China and other settings.

Electronic Word of Mouth and Why Consumers Read Reviews

Research on electronic word of mouth provides the theoretical foundation for understanding physician reviews. Hennig-Thurau et al. (2004), surveying about 2,000 consumers who posted on opinion platforms, found that the main motives for writing reviews were the desire for social interaction, economic incentives, concern for other consumers and the opportunity to enhance one's own self-worth. Concern for others is especially relevant in health care, where reviewers often describe their motive as warning or helping future patients. The same study suggests that reviewers are not a random sample of customers but people with particular motives, which helps explain why review sets can differ from systematic surveys of the same service. Cheung and Thadani (2012), in a literature analysis of electronic word of mouth research, proposed an integrative model in which the effects of online reviews depend on the communicator, the message, the receiver and the response, which suggests that a review's influence cannot be understood apart from who wrote it and who reads it.

Two classic studies establish that reviews affect behavior and that their content matters. Chevalier and Mayzlin (2006), comparing book reviews and relative sales on two retail websites, found that improvements in a book's reviews increased its sales, that a poor review generally moved sales more than a glowing one, and that customers appeared to read review text rather than relying only on averages. Mudambi and Schuff (2010), analyzing 1,587 reviews of six products, found that review depth increased perceived helpfulness and that extreme ratings were less helpful for experience goods than moderate ones. Because physician services are experience goods, these findings suggest that patients may find detailed, balanced reviews more useful than extreme ones, and that negative reviews may carry special weight.

The Growth and Character of Physician Reviews

Physician reviews grew rapidly after the mid-2000s. Gao et al. (2012), analyzing more than 386,000 ratings posted on a national website from 2005 to 2010, estimated that about one in six practicing U.S. physicians had received an online review by early 2010, found that obstetrician-gynecologists were about twice as likely to be rated as other physicians, and reported that reviews were generally positive, with a mean near four on a five-point scale. Lagu et al. (2010), examining physician-rating websites for a sample of Boston physicians, found that relatively few physicians had been rated, that most had only a handful of reviews and that the large majority of reviews were positive.

The scarcity of reviews has persisted. Lagu et al. (2017), studying commercial physician-rating websites, reported that most physicians had few reviews, too few to give an accurate picture of the experience of care, and noted that some health systems had begun publishing reviews drawn from their own patient experience surveys as an alternative. Research in Germany adds detail about what reviews say. Emmert et al. (2014), analyzing 3,000 narrative comments on a German physician rating website, found that most comments were positive and that they addressed the physician's manner and competence, the time taken with patients and the organization of the practice. Together, these studies describe a review environment that is growing, positive in tone and thin for most individual physicians, a combination that may make a single negative review conspicuous. The German comments analyzed by Emmert and colleagues also show that reviews describe service encounters in the patient's own terms, which is why marketing researchers have begun to treat review text as data about service quality, not only as advertising.

Limits of the Evidence on Review Volume and Tone

The descriptive studies share limitations that affect how their findings should be used. Most analyze reviews from a single website at a single point in time, so they cannot show how review patterns change as platforms grow or as practices begin soliciting reviews. Several draw on websites that no longer dominate the market, and the shift from independent rating sites to appointment-booking platforms and health system directories may have changed who writes reviews and why. The finding that reviews are mostly positive may also reflect selection: patients who had a poor experience may leave a practice without writing anything, while satisfied patients may be prompted by follow-up messages. For marketers, the practical lesson is that the visible body of reviews for any one physician is a small and possibly unrepresentative sample of patients' experiences.

Who Uses Physician Rating Websites

Studies of use show that rating websites reach a substantial but uneven share of the public. Using a national survey of American adults, Hanauer et al. (2014) examined awareness and use of rating sites and found that many respondents considered ratings important in choosing a physician and that some had chosen or avoided a physician because of them. Emmert et al. (2013), surveying 1,505 German adults through an online panel, estimated awareness and use of rating websites and identified characteristics associated with using them. Terlutter et al. (2014), surveying 1,006 German patients, found that 29.3 percent knew of a rating website and 26.1 percent had used one, and that younger people, women, more highly educated people and people with chronic diseases were more likely to use them, while users and nonusers did not differ in their general internet use.

These findings matter for marketing because they show that the audience for reviews is not the whole patient population. A practice whose patients are older or less educated may find reviews less influential than one serving younger, more educated patients, and people with chronic conditions, who need long-term relationships with physicians, may be among the most attentive readers. The studies differ in country and sample, which limits direct comparison, but they agree that use is substantial and concentrated in identifiable groups. Both German surveys relied on online panels or online sampling, which may overstate use compared with the general population, a limitation the authors acknowledge and one that applies to many studies in this area.

How Reviews Influence Choice

Observational and experimental studies both show that reviews affect choice. Xu et al. (2021), using data from a leading U.S. appointment-booking website, derived seven service-quality topics from review text, bedside manner, diagnosis accuracy, waiting time, service time, insurance process, physician knowledge and office environment, and incorporated them into a model of patient choice. Including these text-based measures improved the model's predictions of patient choice by about 6 to 12 percent, which indicates that patients respond to what reviews say, not only to their star ratings.

Experiments isolate specific features. Grabner-Kräuter and Waiguny (2015), in a randomized experiment with 168 participants searching for a dentist, manipulated whether reviews were factual or emotional and whether a physician had few or many reviews, and examined how these features shaped acceptance of the reviews and attitudes toward the physician. Han et al. (2019) examined how review valence interacted with the riskiness of the patient's condition and trust in the platform in shaping choices based on online physician reviews. Han et al. (2024), in an experiment with a high overall rating held constant, found that negative reviews reduced participants' intention to select a physician, that a higher proportion of negative reviews and factual rather than evaluative negative claims had larger effects, and that a physician's response helped but had a smaller effect than the negative reviews themselves. These experiments align with Chevalier and Mayzlin's finding that negative reviews carry disproportionate weight.

The observational and experimental evidence complement each other. Experiments can isolate a single feature of reviews, such as the share of negative comments or the presence of a physician's response, but they use hypothetical physicians and choices with no real consequences. Observational studies such as Xu et al. (2021) capture real decisions but cannot easily separate the effect of reviews from other features of physicians, such as location or availability. Taken together, they suggest that both the numeric rating and the written content influence choices, and that negative information is weighed more heavily than positive information, but they do not yet show how patients combine the two kinds of information when they disagree, for instance when a physician with a high average has several detailed negative comments.

Do Reviews Reflect Quality of Care?

Whether reviews are informative about quality is contested. Daskivich et al. (2018), studying 78 specialist physicians, found no significant association between consumer ratings on five platforms and specialty-specific performance scores, peer review by primary care physicians or administrator peer review, and only a small share of the lowest-performing physicians had ratings in the lowest quartile. Saifee et al. (2020) asked whether online reviews are reliable indicators of clinical outcomes in chronic disease management and found the relationship to be weaker and more conditional than patients reading reviews might assume.

Hospital studies give a somewhat different picture. Bardach et al. (2013), comparing Yelp scores with traditional measures for U.S. hospitals, found that among hospitals with more than five ratings, Yelp and the federal patient experience survey were correlated at 0.49, and that hospitals scoring well on either measure tended to have somewhat lower death rates for myocardial infarction and pneumonia. Ranard et al. (2016), analyzing hospital reviews on Yelp, found that the reviews touched on most of the topics in the federal patient experience survey and raised twelve more that the survey never asks about. The difference between these findings may reflect the unit of analysis, a point that matters for anyone using reviews to judge a single doctor: hospitals receive many reviews that capture the patient experience broadly, while individual physicians receive few, and the experience a review describes may have little to do with clinical skill.

Physicians' and Patients' Views of Rating Websites

Physicians and patients see rating websites differently. Holliday et al. (2017), surveying both groups, found patients generally more favorable toward public rating websites than physicians, many of whom doubted their accuracy. This difference has implications for marketing. Practices that ignore reviews because physicians distrust them may be disregarding a source patients rely on, while practices that promote favorable reviews without context may mislead patients about what reviews measure. The experimental finding that physician responses partly offset negative reviews (Han et al., 2024) suggests a middle path in which practices engage with reviews openly.

Implications for Health Care Marketers

The literature has several implications for practice. First, because reviews for individual physicians are few, a practice that encourages all of its patients to leave reviews can produce a larger and more representative picture of care, which may protect physicians from the outsized effect of one negative review. Second, because negative factual comments are especially damaging and responses only partly offset them (Han et al., 2024), practices should treat specific complaints about wait times or billing as operational information and fix the underlying problems, not only reply to them. Third, because reviews appear to capture service features such as bedside manner and wait times more than clinical quality (Daskivich et al., 2018; Xu et al., 2021), marketers should avoid presenting ratings as evidence of clinical excellence. Finally, because users of rating websites differ from nonusers (Terlutter et al., 2014), practices serving older or less connected patients should not rely on reviews alone to reach them.

Gaps in the Literature

Three gaps stand out. First, most experimental studies use specialists, dentists or general hypothetical physicians, and few focus on primary care, where patients seek a long-term relationship rather than a single procedure. Second, studies tend to examine either star ratings or review text, but few examine directly how patients weigh the two against each other when both are available, as they are on most current platforms. Third, much of the user research comes from Germany or China, and recent U.S. evidence on how adults use reviews when choosing a primary care physician is limited. The research program that follows this review will address the second gap for U.S. adults choosing primary care physicians.

A Christian Perspective

Scripture says a good name is to be chosen ahead of riches and favor ahead of silver and gold (English Standard Version Bible, 2001/2016, Proverbs 22:1). Online reviews have made a physician's name more public than ever, but the research suggests that the name reviews create reflects bedside manner and convenience more reliably than clinical skill. A Christian marketer's obligation is to help patients read reviews truthfully, neither hiding them nor presenting them as more than they are.

Conclusion

The literature shows that online reviews of physicians are common, mostly positive and thin for individual physicians; that their readers are concentrated among younger, more educated and chronically ill patients; and that reviews influence choice in both observational data and experiments, with negative and factual comments carrying particular weight. Whether reviews reflect quality of care is uncertain, with physician-level studies finding little connection and hospital-level studies finding moderate links to patient experience. For health care marketers, the research supports treating reviews as an important channel while presenting them honestly. For researchers, it leaves open how patients balance star ratings and written comments in choosing a primary care physician, the question this research program will take up.

References

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