When Good Doctors Get Negative Online Reviews

Negative online reviews are often what happens to good doctors when “The operation was a success but the patient died.”

It’s a classic old medical joke about the so-called “Harvard death”.

But in an era of ubiquitous online reviews, it’s not so funny when a doctor or other health care provider does all they can, yet still achieves a less than satisfactory outcome and is left facing the wrath of an outraged Yelper.

Or maybe it was just slow WiFi or old magazines in the waiting room that drew the online ire.

A lot of very good doctors, dentists, and other healthcare professionals are struggling to adapt to a new reality where patients turn to RateMD, Yelp, Vitals, and similar sites to review and rate their caregivers as if they were restaurants.

Yelp Healthcare Provider Reviews

And those reviews do matter.

Research by Thomson Reuters FindLaw reveals that 59% percent of people report using online reviews when choosing a professional service provider such as a lawyer or doctor. Nearly three-quarters (71%) of Millennials and half (49%) of Baby Boomers have used consumer reviews of professional services.

When it comes to online reviews, it’s a confirmed diagnosis of “We have some good news and some bad news.”

Fighting Negative Online Reviews Can Yield Negative Real Life Outcomes

When a caregiver has an online presence, negative comments inevitably pop up, as they will in any type of review stream, and some understandably outraged and frustrated professionals wade into the online fray. But publicly responding to negative reviews can lead healthcare providers onto thin ice.

It’s sad to see a highly educated professional reduced to arguing on the Internet. Worse yet, responding in this way brings a risk of violating HIPAA, the Health Insurance Portability and Accountability Act regulations that protect the privacy and security of patient medical information.

When a patient blamed a Washington State dentist for the loss of a tooth, the dentist fired back with “Due to your clenching and grinding habit, this is not the first molar tooth you have lost due to a fractured root.”

A chiropractor in California answered a mother’s claim that her daughter had received a false diagnosis of scoliosis by reminding her that “You brought your daughter in for the exam in early March 2014. The exam identified one or more of the signs I mentioned above for scoliosis. I absolutely recommended an x-ray to determine if this condition existed; this x-ray was at no additional cost to you.”

While arguably fair, responding like this is a tactic to be avoided. An examination of more than 1.7 million Yelp reviews by the non-profit public interest investigative journalism firm ProPublica revealed over 3,500 1-star reviews that mentioned HIPAA or privacy. In many cases, provider responses to complaints about care evolved into disputes over patient privacy.

The end result can be a HIPAA violation investigation by the U.S. Department of Health and Human Services Office for Civil Rights.

Other efforts to counter the effect of negative reviews are neither productive nor satisfying and also carry the potential for doing more harm than good.

A Seattle doctor ended up suing a woman after she wrote a dramatic Yelp posting claiming she almost died from a blood clot in the leg when her skiing knee injury was misdiagnosed in a Bellevue, WA emergency room. There is some precedent for businesses or service providers prevailing in lawsuits against posters of false and defamatory online reviews. However, as in most doctor versus patient lawsuits, the Seattle case was dismissed. But not before the doctor was dragged into far more financial damage and negative exposure than would have been caused by the original review.

Medice, Cura Te Ipsum

Physician, heal thyself. Doctors are especially vulnerable to negative online reviews. They do not serve customers or consumers. Doctors take care of patients, and are bound by oath to do the best they can to preserve and protect their patients’ health.

Even good doctors often need to do things that can make people unhappy.

Doctors may have to tell people they are too fat, point out poor lifestyle choices, or refuse to prescribe patients the narcotic pain killers they want. All healthcare professionals regularly deal with complicated situations that are difficult for patients to understand and comment accurately on. Caregivers also face the ever-present potential for unfortunate outcomes that are beyond their control.

At the same time, HIPAA restrictions, ethical concerns, and professional standards limit the ability of healthcare professionals to respond to online reviewers.

Nevertheless, as a recent article in Medscape points out, “Today’s Yelpification of doctors and healthcare is here to stay. Websites are proliferating like bacterial spores, enabling anyone—whether you’re a patient or not—to review doctors.”

              

The Medscape article has an interesting take on the three common types of negative online reviews received by physicians:

  1. “Crazy person”: The review is overly sensitive, over-reactive, and unrealistic, but could influence people.
  2. “Medical competence”: The reviewer complains about a misdiagnosis or medical error, casts doubt on the physician’s medical competence, or believes that he or she did not get the right tests or medication.
  3. “Nuts and bolts”: The review runs the gamut from office décor, staff attentiveness, doctor lateness, bad coffee, loud music, lack of WiFi, outdated magazines, cleanliness of the bathrooms, and more.

A constructive way to approach this list is to think of it as a list of symptoms. When viewed this way, only one of the three review types indicates the possibility of a serious and difficult malady.

Number 1 is a statistical effect that arises from the doctor having contact with the public at large. Any business with a review stream can and usually does suffer from it. The best treatment is to leave this type of review alone. Simply keep it covered with a far greater number of positive reviews.

Number 3 is caused by aspects of the caregiver/patient relationship that are easily controlled by the provider. It is not too difficult to manage the customer service side of healthcare. Look to the efficiency and professionalism of office staff, user-friendliness of appointment management systems and wait times, upkeep of facilities and equipment, and so forth. Putting some effort in here could pay significant dividends on relatively minor investment. In fact, according to Aaron Schur, senior director of litigation at Yelp, most reviews of doctors and dentists don’t concern the actual care delivered. People tend to complain about bedside manner, wait times, office staff, or billing procedures.

Number 4 arises from factors beyond the scope of this generalist overview. It may be an indicator of the layman’s view of proceedings that most patients hold. However, they comprise part of a trend, the ethical healthcare professional should view complaints of this sort as a call for careful reflection on practice.

Good Doctors Use a Minimally Invasive Approach to Handling Negative Reviews

Good doctors encourage their patients to write reviews.

The vast majority of the reviews patients post about their doctors constitute positive public accolades. Reviews also provide good doctors with useful feedback on what is being done right with the practice and what might need some adjustments. The wisdom of the crowd, accumulating over time, is far more credible than any single individual response. Finally, attempts to restrict patients’ freedom to post online reviews are unethical and possibly illegal.

As for the negative reviews that will almost surely appear, a web search quickly uncovers numerous articles that recommend supposedly effective ways to respond. You can find them on reputation management company websites and even on health care specialist sites.

However, a more rigorous analysis supports maintaining professional objectivity and engaging the sources of negative online reviews in a systematic fashion offline, impersonally, and supported by legal advocacy if necessary.

Avoid joining websites to respond to reviews – subscribing to such services may involve agreeing to a legally enforceable contract and/or waiving your rights to sue for defamation or take other courses of action. In any case, resist the urge to engage in defensive online arguments that are undignified often serve only to amplify the reviewer’s complaint.

Lawsuits should only be considered in extremis and in very clear-cut cases of defamation. Litigation takes years, draws increased negative attention, and in the case of doctor vs. patient suits, comes with an increasing body of precedent for failure to favor the plaintiff.

Embrace proactive rather than reactive responses to negative online reviews. Use websites, blogs, and social media sites to disseminate positive information about yourself and your practice. Combine this method with campaigns designed to boost your positive review stream until it buries any negative comments that show up on search engine results pages.

Work to let patients know they are heard and try to keep things in-house by establishing internal complaint/grievance procedures. Make feedback forms available and distribute surveys to provide forums where patients can immediately express their opinions. This may steer them away from posting negative reactions online.

When issues do come up, address the situation directly and compassionately. This has the potential to convert a negative review into a positive effect on your practice by improving your standing with patients. Patients may also edit or delete a negative review when they know their concerns have been heard.

Good Doctors Use Online Reviews to Promote Their Practices

In a recent New England Journal of Medicine article, Vivian Lee, MBA, MD, PhD notes that patient reviews are a source of valuable performance feedback that can help clinicians learn and improve. Reviews are data, and when physicians accept the validity of the data and become receptive to performance feedback, a culture of learning and patient-centeredness is facilitated for the practice.

When the correct strategies are employed, negative reviews can be greatly reduced. The few remaining can be used to produce nearly as much value as positive comments.

Busy healthcare providers seeking to leverage the full power of a strong online review stream will find it far more convenient and efficient to deploy professional review management tools. This is the best way to stay on top of reviews across all of the important review websites while maintaining strong communication links with patients and remaining at a distance from stressful and potentially risky interactions over negative online reviews. It’s the remedy good doctors choose when dealing with negative online reviews.

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