Health Policy$ense

Yelp Reviews and Opioids

Implications for pain management and patient care

Researchers are discovering that social media offers a window into the lived experience of patients and their caregivers. Using Yelp reviews about US hospitals, our team at Penn’s Center for Health Care Innovation attempted to give voice to these experiences related to pain management and opioids during recent hospital visits.

The study, conducted with LDI Senior Fellows Jeanmarie Perrone, Zachary Meisel, and Raina Merchant, analyzed 836 Yelp reviews that mentioned an opioid medication. We found that patient narratives about their pain management can reveal aspects of care not assessed by closed-ended surveys. Some of our results reinforce ideas about the aspects of pain management we know to be important, such as compassionate and responsive care. Others introduce little explored aspects of the patient experience and present new questions and challenges for medical providers and health care systems.

Using manual coding and natural language processing, we characterized content from patients’ Yelp reviews by categories (e.g., care logistics, staff traits and behaviors, and adequacy of pain control), and selected representative quotes from patients that illustrate these categories. These quotes are particularly powerful and instructive:

Staff behavior (attentiveness):

“They gave me…morphine and left. I wasn’t monitored for over an hour. I…should have been watched carefully.”

Reaction to opioids:

“[Morphine] did nothing but make me [vomit and] feel worse and I continued to be in excruciating pain.”

Discharge or decision-making under the influence:

“Then they discharge me…no sooner than 5 minutes go by and I’m on the floor, about [to] pass out…apparently from the side effects of the morphine they gave me. Thanks for letting me know what I was in for!!”

Inappropriate opioid prescribing:

“When I asked him if it was prudent to prescribe a narcotic to a patient with a mental illness in case he overdosed, instead of cautioning my brother…he encouraged my brother to take as many oxycodone pills as he needed to manage pain.”

These quotes point to specific problems in how individual health care providers and medical teams address the potential consequences of the use of pain medication. These include failures to consider important parts of patients’ medical history, how patients respond to the medications, and how analgesics influence other aspects of holistic patient care and can interfere with patient decisionmaking abilities.

Medication is a critical tool in the armamentarium of pain management, particularly for patients with certain medical conditions like terminal cancer and certain other types of chronic pain. However, our results demonstrate that, in many cases, decisions regarding the use of pain medications and other pain management tools are made without consideration of aspects that are central to patient satisfaction, and perhaps more importantly, to the safety and wellbeing of individual patients.

More comprehensive training of physicians, establishment and dynamic revision of pain management standards, and ongoing analysis of pain-related outcomes are all critical for improving understanding of appropriate pain management and the role of opioids in it. On an individual level, health care providers must assume personal accountability for awareness of and adherence to established pain management standards; treatment decisions should be based on a comprehensive understanding of each patient’s medical history. On a system level, health systems must make appropriate pain management a core objective, in particular by establishing standards of practice and providing ongoing training for physicians, and must allocate resources as necessary to accomplish that objective.

Insufficient and inappropriate pain management has tremendous, potentially devastating consequences for individual patients, families, communities, and the medical establishment itself. Historically, we, the medical community, have contributed to those consequences. We now have the opportunity and responsibility to make a positive difference in the lives of our patients by using our wealth of material resources and human capital to define and implement pain management practices that best serve our patients.

Rachel Graves is a fourth-year medical student at the University of Pennsylvania.