Impact of mobile tablet computers on internal medicine resident efficiency.

performance, and people will inevitably use the Internet to voice opinions, so why not capture this information in a useful form. Arguments against using this data include the selection bias by those leaving reviews, the lack of meaningful data on technical quality of health care, and straining of physician-patient relationships. Although our results do not counter all of these arguments against, they suggest that discretionary patient ratings, obtained through a Web site, may be a more useful tool than previously considered for both patients and health care workers. If patients are making choices based on this information, they can be reassured that the ratings are not entirely misleading and may be providing relevant information about health care quality. In his book The Wisdom of Crowds, James Surowiecki argues that a diverse collection of “independently deciding individuals” is likely to make better predictions and decisions than single individuals or even experts. At least to an extent, the self-selecting crowd of patients appears to be wise. The use of Web-based patient ratings has become common in other industries such as hotels and restaurants, and consumers value these rankings in making choices. We believe that the information provided by these Web sites, although flawed, represents a potentially important development in the measurement of health care quality.