The Influence and Use of Individual Patient Comments
Comments from individual patients are becoming an increasingly popular ingredient in reports on the performance of health plans and providers, particularly physicians. Its use is controversial because of its potential to unduly influence consumer decisions.
Why Anecdotal Information Is Powerful
Studies have shown that patients who are presented with both formal research evidence and anecdotal information in the form of patient testimonials give insufficient weight to the formal research evidence.[1, 2] Reasons for the influence of anecdotal information include:
- It may be easier for people to identify with a specific individual who provides a comment about a doctor than with the experiences of a "statistically average person."[3]
- Anecdotal information is less difficult to process than statistical information.[4, 5]
- Decisions people make about health care are often influenced by the emotions evoked by the decision, and anecdotal information is known to generate more emotions than statistical information.[6, 7]
Another reason for the influence of patient comments may be that people are used to getting information about health care providers and plans from their family and friends. The practice of seeking and using this kind of personal information is familiar to them in this context.
Reporting Anecdotes Alongside Evidence-Based Measures
Because anecdotal information is nonrepresentative and unduly influential, report sponsors should be very cautious about making patient comments a health care consumer’s only source of information when making a health care decision. But when both formal research evidence and anecdotal information are available and point in the same direction, the two may reinforce each other and have an impact greater than that which could be achieved by either alone. In this case, anecdotes can help personalize, illustrate, and “sell” formal research findings by presenting them to consumers in more meaningful ways.
A problem arises, however, when the decision a person would make on the basis of formal research evidence differs from that which he or she would make on the basis of anecdotal information, that is, when the two kinds of information point in different directions. Research is needed to determine how to present both types of information to consumers in a way that maximizes the benefits of providing anecdotal information and minimizes the drawbacks.
[1] Freymuth AK, Ronan GF. Modeling patient decision-making: The role of base-rate and anecdotal information. J Clin Psychol Med Settings 2004;11:211-6.
[2] Ubel PA, Jepson C, Baron J. The inclusion of patient testimonials in decision aids: effects on treatment choices. Med Decis Making 2001 Jan-Feb;21(1):60-8.
[3] Jenni KE, Loewenstein G. Explaining the “identifiable victim effect.” J Risk Uncertain 1997;14(3):235–57.
[4] Schwartz LM, Woloshin S, Black WC, Welch HG. The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med 1997 Dec 1;127(11):966-72.
[5] Weinstein ND. What does it mean to understand a risk? Evaluating risk comprehension. J Natl Cancer Inst Monogr 1999;(25):15-20.
[6] Loewenstein GF, Weber EU, Hsee CK, Welch N. Risk as feelings. Psychol Bull 2001 Mar;127(2):267-86.
[7] Redelmeier DA, Rozin P, Kahneman D. Understanding patients’ decisions: Cognitive and emotional perspectives. JAMA 1993 Jul 7;270(1):72-6.
