Using Sentiment Analysis to Understand What Patients Are Saying About Hand Surgeons Online

Background: Physician review websites have influence on a patient’s selection of a provider. Written reviews are subjective and difficult to quantitatively analyze. Sentiment analysis of writing can quantitatively assess surgeon reviews to provide actionable feedback for surgeons to improve practice. The objective of this study is to quantitatively analyze large subset of written reviews of hand surgeons using sentiment analysis and report unbiased trends in words used to describe the reviewed surgeons and biases associated with surgeon demographic factors. Methods: Online written and star-rating reviews of hand surgeons were obtained from healthgrades.com and webmd.com . A sentiment analysis package was used to calculate compound scores of all reviews. Mann-Whitney U tests were performed to determine the relationship between demographic variables and average sentiment score of written reviews. Positive and negative word and word-pair frequency analysis was also performed. Results: A total of 786 hand surgeons’ reviews were analyzed. Analysis showed a significant relationship between the sentiment scores and overall average star-rated reviews ( r2 = 0.604, P ≤ .01). There was no significant difference in review sentiment by provider sex; however, surgeons aged 50 years and younger had more positive reviews than older ( P < .01). The most frequently used bigrams used to describe top-rated surgeons were associated with good bedside manner and efficient pain management, whereas those with the worst reviews are often characterized as rude and unable to relieve pain. Conclusions: This study provides insight into both demographic and behavioral factors contributing to positive reviews and reinforces the importance of pain expectation management.

Perception and Use of Primary Healthcare Services Among People With Cardiometabolic Diseases in Two Resource-Limited Areas in Nepal: A Mixed Methods Study

Nepal is a country in south Asia with a high burden of cardiometabolic diseases (CMDs). Strengthening primary healthcare (PHC) is a key strategy to mitigate this increasing burden and achieve universal health coverage. While previous studies in Nepal have assessed PHC use among the elderly, none have specifically explored PHC use among people with CMDs. Therefore, this mixed-methods study aimed to assess the use and perception of PHC services in Nepal among people living with CMDs for primary and secondary prevention of cardiovascular disease. We used a quantitative survey followed-up by semi-structured qualitative interviews. The sampling frame comprised five PHC facilities in Sindhuli district (rural; eastern Nepal) and five in Kailali district (urban; western Nepal), with participants selected from each facility via convenience sampling. 114 people (mean age: 54.5 ± 14.7, sex ratio 1.04) with CMDs participated in the survey. Survey data showed general dissatisfaction with PHC services. Medicine cost was rated “too expensive” by 52 and 63% of rural and urban participants, respectively. Interview data showed that perceived poor bedside manner was tied to negative perceptions of PHC quality, and vice versa. Lack of resources and excessive barriers to care was mentioned by every interviewee. In conclusion, PHC use was high but overall satisfaction relatively low. Our results suggest that bedside manner is a practical target for future research. Additionally, we identified several barriers to care, and, based on existing literature, we suggest electronic-health interventions may have potential to mitigate these challenges.

Assessing Patient Satisfaction Following Blepharoplasty Using Social Media Reviews

Background As patient satisfaction is a significant qualitative consideration in measuring aesthetic surgery outcome, it is important to characterize the individual factors which shape the patient perspective about blepharoplasty. Objectives This study analyzed patient reviews following blepharoplasty on the aesthetic surgery social media platform Realself.com to determine which aspects of the surgical process have the most significant impact on patient satisfaction. Methods Blepharoplasty reviews were gathered from Realself.com using an automated web crawler. These reviews were characterized as positive or negative, then given a specific category that more specifically defined the theme of the review. Additional variables including the specialty of the reviewed physician and any patient self-reported ratings were documented. Results A total of 1991 reviews pertaining to blepharoplasty were collected. Among reviews with self-reported “worth it” ratings, 93.5% were positive. Following categorization of all reviews, 1865 (93.7%) were positive and 126 (6.3%) were negative. Of the positive reviews, the most common overall themes were bedside manner (n=899, 48.2%), aesthetic result (n=859, 46.1%), and overall comfort (n=58, 3.1%). Among negative reviews, most pertained to aesthetic result (n=100, 79.4%), and bedside manner (n=14, 11.1%). The most frequently encountered physician specialties performing blepharoplasty were plastic surgery (n=1101, 55.3%), ophthalmology (n=634, 31.8%), and otolaryngology (n=69, 3.5%). Conclusions The majority of patient blepharoplasty reviews were positive. The most prominent factor driving positive reviews was bedside manner, followed by aesthetic results. Negative reviews were most frequently attributed to sub-optimal aesthetic results. Most blepharoplasties in our study cohort were performed by plastic and oculoplastic surgeons.

Creepy, but Persuasive: In a Virtual Consultation, Physician Bedside Manner, Rather than the Uncanny Valley, Predicts Adherence

Care for chronic disease requires patient adherence to treatment advice. Nonadherence worsens health outcomes and increases healthcare costs. When healthcare professionals are in short supply, a virtual physician could serve as a persuasive technology to promote adherence. However, acceptance of advice may be hampered by the uncanny valley effect—a feeling of eeriness elicited by human simulations. In a hypothetical virtual doctor consultation, 441 participants assumed the patient’s role. Variables from the stereotype content model and the heuristic–systematic model were used to predict adherence intention and behavior change. This 2 × 5 between-groups experiment manipulated the doctor’s bedside manner—either good or poor—and virtual depiction at five levels of realism. These independent variables were designed to manipulate the doctor’s level of warmth and eeriness. In hypothesis testing, depiction had a nonsignificant effect on adherence intention and diet and exercise change, even though the 3-D computer-animated versions of the doctor (i.e., animation, swapped, and bigeye) were perceived as eerier than the others (i.e., real and cartoon). The low-warmth, high-eeriness doctor prompted heuristic processing of information, while the high-warmth doctor prompted systematic processing. This pattern contradicts evidence reported in the persuasion literature. For the stereotype content model, a path analysis found that good bedside manner increased the doctor’s perceived warmth significantly, which indirectly increased physical activity. For the heuristic–systematic model, the doctor’s eeriness, measured in a pretest, had no significant effect on adherence intention and physical activity, while good bedside manner increased both significantly. Surprisingly, cognitive perspective-taking was a stronger predictor of change in physical activity than adherence intention. Although virtual characters can elicit the uncanny valley effect, their effect on adherence intention and physical activity was comparable to a video of a real person. This finding supports the development of virtual consultations.

Patient Perspectives of Rural Kansas Maternity Care

Introduction. Pregnant women in rural areas face a unique set of challenges due to geographic maldistribution of obstetric services. The perspectives of rural Kansas women were sought regarding experience of birth and satisfaction with maternity care. Methods. Medical student research assistants facilitated discussion groups in rural Kansas communities with women who had given birth in the last 24 months. Guiding questions were used to facilitate discussion. Survey instruments were used to gather information about satisfaction with maternity care. Data for qualitative and quantitative analysis was aggregated using Rural Urban Commuting Area (RUCA) codes. Results. 14 groups with 47 total participants completed the survey and discussion. Participants were representative of a variety of Large Rural, Small Rural, and Isolated areas in Kansas as described by RUCA Code Four Category Classification. Survey results indicate that satisfaction with maternity care in participants’ home county was significantly higher in Small Rural and Isolated compared to Large Rural RUCA. Qualitative analysis results show positive experiences related to: doctor characteristics, relationship with doctor, doctor’s involvement with care, alternative labor options, and distance convenience. Negative experiences were related to: doctor bedside manner, doctor not there until delivery, and staff related complaints. Conclusions. Women in Small Rural and Isolated RUCA codes appear to be more satisfied with care contrary to previous study findings.

Item Generation in the Development of an Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT): A Qualitative Study Utilizing Technology-Based Focus Groups in the United States

An alarming 30% to 50% prevalence rate of disease-related malnutrition among hospitalized patients compels the need for early diagnosis and treatment of malnutrition. Registered Dietitian Nutritionists (RDNs) can utilize the nutrition-focused physical examination (NFPE) as one of the nutrition assessment criteria to accurately diagnose malnutrition. Although RDNs are striving to employ NFPE in practice, a lack of experience and adequate training impedes full utilization of this technique. This results in wide skill variations requiring continuous evaluation of RDNs’ NFPE competency. However, a standardized, validated competency tool is not widely available and hence this study aims to develop a standardized, interactive nutrition-specific physical exam competency tool (INSPECT). As a first step in the development of INSPECT, a qualitative, technology-based focus group approach with 7 content and practice experts was utilized to generate appropriate tool items. A total of 70 NFPE items under 9 areas including 12 items for muscle loss, 4 items for subcutaneous fat loss, 31 items for micronutrient deficiencies, 1 item for fluid status, 2 items for handgrip strength, 5 items for initial preparation, 4 items for bedside manner, 8 items for swallowing, and 3 items for abdominal evaluation were generated. This study successfully utilized technology-based focus groups to generate appropriate NFPE items for the competency tool development. Using the items, an initial version of INSPECT has been developed, which is presently being investigated for content and face validity. The final version will undergo field tests and will be examined for reliability, validity, and item-level psychometric properties.

From Bedside to Webside: A Qualitative Study of Pediatric Clinicians’ Use of Telemedicine (Preprint)

BACKGROUND With accelerated use of telemedicine, especially broad adoption with the COVID-19 pandemic, it is essential to maintain care standards and quality through effective communication. Virtual communication or webside manner may require modifications to traditional bedside manner. OBJECTIVE Our aim was to understand how clinicians conduct patient-to-provider virtual visits and communicate with families at a single large-volume children’s hospital to inform program development and training of future clinicians. METHODS Two focus groups of pediatric clinicians performing virtual visits prior to the COVID-19 pandemic, with a range of experience and specialty, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semi-structured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded and the corresponding transcripts reviewed for data analysis. Transcripts were coded based on the main themes and subthemes identified. Based on higher level analysis of these codes, study authors generated a final set of key themes to describe the collected data. RESULTS Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialty and practice. Three key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt telemedicine required new skills for patient interaction, and not all were comfortable with their training. CONCLUSIONS Telemedicine provides benefits as well as challenges in healthcare delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. Inclusion of webside manner instruction within training curricula is crucial as telemedicine becomes an established modality for providing healthcare. CLINICALTRIAL n/a

Academic Rhinologists’ Online Rating and Perception, Scholarly Productivity, and Industry Payments

Introduction The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction. Methods Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1–5 scale. Results A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender ( p = 0.58), geographic quartile ( p = 0.48), social media presence ( p = 0.41), or attending top-ranked medical school ( p = 0.86) or residency programs ( p = 0.89). Years of practice negatively correlated with RS (R = –0.22, p<0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively ( p = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments ( p<0.01) and H-index ( p = 0.02). Conclusion Academic rhinologists’ online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.

Palliative and end-of-life care in the ICU

What happens when organ support leads to prolongation of life, but with no hope of ultimate survival, or survival with unacceptable quality of life? For many—but not all—patients, families, and physicians, prolongation of life with little or no hope of a good quality of life is considered worse than death. This chapter looks at the cultural milieu in determining the responses and needs of all parties in regard to end-of-life care. Excellent communication is required to prevent potential conflicts and provide both the medical team and the patient/family with peace of mind. The decision to institute palliative or end-of-life care should, if at all possible, always be reached via a negotiating process between the medical staff and the patient or their family. The best protection against conflict comes from a good bedside manner reflecting patience with the family, honesty, and some optimism.