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BACKGROUND: Physician online ratings are ubiquitous and influential, but they also have their detractors. Given the lack of scientific survey methodology used in online ratings, some health systems have begun to publish their own internal patient-submitted ratings of physicians. OBJECTIVE: The purpose of this study was to compare online physician ratings with internal ratings from a large healthcare system. DESIGN: Retrospective cohort study comparing online ratings with internal ratings from a large healthcare system. SETTING: Kaiser Permanente, a large integrated healthcare delivery system. PARTICIPANTS: Physicians in the Southern California region of Kaiser Permanente, including all specialties with ambulatory clinic visits. MAIN MEASURES: The primary outcome measure was correlation between online physician ratings and internal ratings from the integrated healthcare delivery system. RESULTS: Of 5438 physicians who met inclusion and exclusion criteria, 4191 (77.1%) were rated both online and internally. The online ratings were based on a mean of 3.5 patient reviews, while the internal ratings were based on a mean of 119 survey returns. The overall correlation between the online and internal ratings was weak (Spearman’s rho .23), but increased with the number of reviews used to formulate each online rating. CONCLUSIONS: Physician online ratings did not correlate well with internal ratings from a large integrated healthcare delivery system, although the correlation increased with the number of reviews used to formulate each online rating. Given that many consumers are not aware of the statistical issues associated with small sample sizes, we would recommend that online rating websites refrain from displaying a physician’s rating until the sample size is sufficiently large (for example, at least 15 patient reviews). However, hospitals and health systems may be able to provide better information for patients by publishing the internal ratings of their physicians.

To evaluate the clinical utility of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of peripheral cholangiocarcinoma of the liver, 11 patients with pathologically proven peripheral cholangiocarcinoma were examined with both CT and MRI. On CT scans in 10 cases, the tumors appeared as irregular, low-attenuation masses with a wide variation in heterogeneity. Contrast enhancement of the tumors was mild in nine cases and moderate in one case, at the periphery. Tumor was not identified in one case. On T1-weighted MRIs, the tumors showed low intensity in eight cases and isointensity in three cases. On T2-weighted images, the tumors showed high intensity in all 11 cases. Focal dilatation of the intrahepatic bile ducts around the tumor was seen in one case on MRIs and in four cases on CT scans. Portal vein invasion of the tumors was seen in one case, and lymphadenopathy was seen in four cases on both MRIs and CT scans. MRI was slightly superior to CT in detecting the tumors, was inferior to CT in delineating focal ductal dilatation around the tumors, and was equal to CT in assessing extent of the tumors.

Magnetic resonance (MR) imaging was performed on five tumors of three patients who had hepatic hemangiomas. Four tumors were given an intraarterial infusion of 3-8 ml of iodized oil, while one tumor was not. MR images were obtained at 2.0 or 0.5 T. A single spin echo sequence with TE of 30 ms and TR of 500 ms and a double echo sequence with TEs of 60 and 150 ms and TR of 2000 ms, were used to produce relatively T1-, T2-weighted, and heavily T2-weighted images, respectively. Follow-up MR imaging was done 1-5 months after infusion of iodized oil. On relatively T1-weighted images, hemangiomas showed iso- or hypointensity. On T2-weighted images, all tumors showed hyperintensity. However, on heavily T2-weighted images, tumors with iodized oil showed heterogeneous, slight hyperintensity, while tumors without iodized oil showed characteristic appearance of marked hyperintensity in hemangiomas. In hepatic cavernous hemangiomas with intraarterial infusion of iodized oil, familiarity with this unusual MR intensity of tumors on heavily T2-weighted images is useful to avoid the incorrect diagnosis and to reduce the frequency of inappropriate hepatic resection.