Online Patient Feedback: What to Do

Your staff is rude, your waiting room is dirty and your doctors couldn't diagnose their way out of a paper bag. That's the opinion of one disgruntled patient anyway, and thanks to the proliferation of physician rating websites, her venom is now online for all to see. Indeed, patients and ex-employees are empowered as never before to share their experience with prospective patients on sites like Vitals.com, RateMDs.com, Healthgrades.com, Google+, Angie's List, and Yelp. Many of the more than 30 such rating sites enable patients to post anonymously, with the intent of encouraging candor - for better or worse.

Not all that they say is negative, of course. In fact, a study by the University of Michigan School of Public Health and College of Pharmacy using data collected between 2004 and 2010 from online rating site Dr.Score.com found the average physician rating was 9.3 out of 10. At some point, however, the harsh review is inevitable for every practice. It's how you handle those critiques that determine their impact, says Noah Lang, vice president of business development for Reputation.com in Redwood City, Calif. "One of the most common questions I get from doctors is 'Should I respond to a negative review?'" he says. "Typically, the answer is no."

Responding back to a patient implicitly acknowledges that person is your patient. And worse, you risk disclosing personal health information when you confirm, deny, or alter what they said about their treatment - which violates HIPAA privacy rules. Steer clear, especially, of any discourse related to an alleged error in diagnosis or treatment, says Lang, which could expose your practice to risk in a future medical malpractice lawsuit. By engaging in dialogue, he says, you also create a potential new problem for your practice. "If you take the risk in responding to a patient review, that creates more chatter, which can lead to others posting something negative about their own experience so it becomes a very public discussion," says Lang.

There is one scenario in which it may be acceptable to respond - if someone complained about environmental factors that temporarily impacted their visit, he says. Noise related to a construction project, for example, or inadequate parking. "It's OK in that case to indicate that the office was undergoing a renovation and that you now have a peaceful, quiet office again," he says.

Take it off-line

Patricia Redsicker, a content marketing consultant with Baltimore-based Wordviewediting.com, agrees. While practices must adhere to privacy guidelines, she says, it's good business to reach out to a reviewer who expressed frustration with a staff member, scheduling problem, or billing matter. "People are talking about you in social media outlets whether you like it or not," she says. "Not taking part in it does not make the conversation go away. You might as well be part of the conversation, which allows you to respond in an appropriate and timely fashion."

When replying to a negative comment online, she says, it's important to be professional and adopt a caring tone. "Understand that a lot of times the people who are offended or write about a negative experience are not trying to demonize your brand," says Redsicker. "They are truly frustrated by something that happened." Better that they post a comment you can respond to than to tell 10 of their friends not to use your practice.

"When they take the time to write a negative comment, it's an opportunity for you to respond and regain their loyalty," says Redsicker, noting any response from your office should express empathy and ask what you can do to correct the matter. "You don't want that one negative comment to be the last thing new patients are seeing when they Google your name," she says. "This gives you the chance to resolve the matter and shows that you care enough about patient satisfaction to get it resolved." If the negative review involves personal health information, she suggests, express your desire to rectify the matter, but ask the patient to contact you by phone, e-mail, or in person. That takes the discussion off-line. Here again, however, keep your feedback generic. Don't acknowledge online that the reviewer is a patient, lest you run afoul of HIPAA.

Contact the website

If you believe a review about your physicians or practice is inappropriate or mean spirited, you can also contact the website directly to have it removed. Google and doctor review sites have standards that exclude certain content, including personal rants, malicious or offensive material, and comments that are deemed not relevant to the patient's office experience. RateMDs, for example, says it reviews new ratings and reserves the right to delete comments or an entire rating if it does not pertain to the reviewer's personal outcome or customer-service issues. That said, it also acknowledges that some slip through the cracks. If you feel that's the case, or wish to have a comment reviewed, RateMDs instructs physicians to click the red flag beside it. If the website agrees that the comments are out of line, they'll take it down. But it's at their discretion. Lang said Vitals.com also agrees to let doctors remove a total of up to two negative reviews. "They assume that any practice can get a few bad reviews, but they draw the line at two," he says.

Take it to court

If the comment involves defamation or libel, you may also have legal recourse, but the comments made must involve a false statement of fact, says Brian A. Hall, a partner with Traverse Legal in Traverse City, Mich., which specializes in Internet law. For example, someone falsely claims you failed to finish medical school, or injured someone during a procedure. To be actionable, says Hall, the defamatory comments must also be linked to monetary damages. But in cases where one's professional credibility is publicly challenged, damages to your practice are assumed, he says. Thus, any such lawsuit would fall under the legal definition of "defamation per se," which lowers the burden to prove damages.

That doesn't make it easier to win. "A lot of these cases in the online world are more difficult because you don't always know who posted the defamatory material," says Hall. "More often than not, it's posted anonymously, in which case you would need to file a lawsuit to get a subpoena, which gives you the power to get the information you need about the poster from the Internet Service Provider." Some websites are now requiring reviewers to create an account with contact information (even if they still offer anonymous postings) so the reviewer can be reached if needed. For its part, Google+ notes all of its reviews are posted under the reviewer's full name, which is posted publicly on the Internet.

According to Hall, however, lawsuits should be viewed as a last resort. Such cases can cost tens of thousands of dollars and tie up resources for years. "It's not out of the question for costs to exceed six figures," he says. If you know the name of the reviewer, it may be equally effective and far less costly to send a cease and desist letter from an attorney that asks them to remove their post and refrain from further similar postings. Failure to adhere would then result in legal action.

Encourage more reviews

By far, though, the most effective way to negate a bad review is to fight fire with fire. "There's really nothing you can do to stop a negative review," says Chris Thomas, founder of Practice Maximization in Grand Rapids, Mich., a medical marketing company. "The only way to counter them is to ask patients to go online and post a positive review." Make it a policy to ask all of your patients at check-out to offer their opinion online - and make it as easy for them to comply as possible. Print up a how-to guide, providing the names of the most prominent doctor review sites so they don't have to hunt them down on their own. A repository of positive feedback, says Thomas, not only elevates your reputation on social media outlets, but helps dilute the impact of any negative review that may crop up.

To help practices better manage their online reputation, the AMA recently partnered with reputation.com to offer members access to its online reputation management solution. Services range from real-time alerts when new comments are made online to a practice-based kiosk for patients to provide feedback following a visit.

"You can use review sites as a marketing tool for your business and build a bank of positive reviews so when someone does write a negative one it's not the only thing on the site," says Lang.

Whatever you do, though, don't review yourself online anonymously - or pay a friend or family member to do it for you. That's illegal, says Hall, and can result in fines from the Federal Trade Commission. "There's the regulatory issue with the FTC, but also the matter of civil liability," he says. "Competitors could sue you for false advertising if they know it's fake or false."

Why it matters

Though oft-criticized for letting a vocal minority skew the results, not to mention a lack of quality clinical information, unsolicited online ratings are not to be dismissed, adds Lang. For starters, the number of reviews your practice receives - good, bad, or ugly - impacts your search engine ranking on sites like Google. When prospective patients search for your practice or physicians by name, the online ranking sites with the most reviews will land higher on the search results page.

"It's a two-pronged problem," says Lang. "These are places where consumers are not only going to make healthcare decisions about who they're going to use for personal healthcare, but the reviews are rated highly by search engines so it impacts your search results as well."

Online patient reviews, of course, also reflect the sentiment expressed by patients in off-line satisfaction surveys, an increasingly important component of the formula used by CMS and private health insurers to determine reimbursement. A 2012 study by the University of Maryland's Center for Health Information and Decision Systems found that patients who indicated in off-line consumer satisfaction surveys they were happy with their quality of care were more likely to review their physicians online - suggesting that "online ratings are not driven by disgruntled patients, but rather those with high levels of consumer satisfaction," says study coauthor Jeff McCullough, an assistant professor at the University of Minnesota School of Public Health. That spells opportunity for practices that put patients first.

To ensure that most of your reviews are positive, practice managers should consider asking patients after every visit if their doctor addressed all their questions and concerns. Ask, too, if there is anything you can do to make their experience better, thus encouraging patients who are frustrated to vent in private rather than publicly. You can also help "bury" bad reviews by creating original content on your website, including blogs, articles, and patient education videos - all of which are favored in the search engine results by Google and other browsers. "If someone is writing a negative blog about your practice, we can help reposition where that blog shows up in your search results by moving higher quality content above that blog," says Lang.

Use what you learn

Lang adds that practices that fail to monitor their online presence are missing an important business opportunity. "Be aware of what your patients and prospective patients are saying, and use it to make changes to improve your business," he says. "Your customers are giving you live feedback and if you're not using it, you're missing a vital opportunity." If one of your patients notes, for example, that they waited over an hour to see their doctor, have a talk with your scheduling department to see what you can do to reduce wait times. Likewise, if someone indicates your front-desk clerk was unfriendly, take the time to review with your staff the importance of putting patients at ease.

It's easy to keep your finger on the pulse of social media mentions about your practice. For starters, you can set up Google alerts to notify you via e-mail when your office or any of your doctors get mentioned. Twitter Search will also call up a collection of tweets using keywords and names. For her part, Redsicker recommends socialmention.com and hootsuite.com to track brand mentions about your practice and physicians. "That way you can keep listening to the conversation happening about your practice on the social Web," she says.

Like it or not, online doctor reviews are here to stay. You can't control what your patients write, but you can take steps to manage your online reputation, and mitigate the impact of any negative ratings you receive. "Not everyone is going to love your practice and you will get some negative comments," says Redsicker. "How you deal with them can make the difference between whether you're a likeable social media brand or not."

In Summary

Online physician reviews are here to stay, but that doesn't mean your practice needs to sit idly by. Remember:

• Responding to patient reviews, in which personal information is disclosed, violates HIPAA privacy rules.

• Most patient reviews are positive.

• If patients comment on the quality of their care, offer to speak with them by phone or in person - but take the conversation off-line

• The only way to fight a bad patient review is to dilute it with positive ones.

• Use online alerts to monitor what patients are saying about your practice.

• Unsolicited feedback is an opportunity to improve your practice.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 18 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the January 2013 issue of Physicians Practice.