When a Patient Trashes You Online
"Hitler should have burned this doctor. Then we wouldn't have to deal with this scum doctor."
This inflammatory snippet was a real review that appeared on a well-known physician review Website. Welcome to the sometimes harsh world of the Internet.
Consumer reviews have long permeated most industries. Healthcare is the most recent entry. Online reviews are changing how patients provide feedback and even how patients choose their doctors.
Traditionally, patients found their doctor the old-fashioned way: by getting a referral from another doctor, a friend, or a family member. According to one survey of 50,000 patient reviews, 25% of patients now find their doctor on the Internet (Segal J. Unpublished data. 2014). This includes physician selection based on online reviews.
The number appears to be growing. Even if patients find their doctor in the traditional way, they are still going to the Internet to validate their decision. Physicians who ignore what is said about them on the Internet do so at their peril.
The collection of problems associated with online reviews is well known, but doctors can—and should—take control.
A Direct Rebuttal May Actually Be Illegal
Because of the Health Insurance Portability and Accountability Act (HIPAA), as well as state privacy laws, physicians are legally prevented from responding to negative commentary online. In the rest of the consumer world, if a person posts a negative comment on the Internet, the business can typically tell its side of the story.
Half a story is not the same as a full story, particularly when it concerns physicians. If a patient writes that his wound opened up three days post-op, that is a different story from "three days post-op, against the advice of the surgeon, the 350-lb patient went back to work digging ditches, and his wound opened up."
Does this mean that doctors cannot respond online? The answer is: Sometimes yes, sometimes no. HIPAA prevents a "covered entity" (ie, a physician) from disclosing protected health information without the patient's consent or unless authorized by law. Some doctors assume that if patients publicly disclose protected health information on their own, doctors are free to respond. This is not accurate. The reason is simple: The doctor does not have the patient's permission to disclose protected health information—regardless of whether the patient did so first on her own.
Furthermore, there is no explicit authorization embedded in the HIPAA or Health Information Technology for Economic and Clinical Health (HITECH) statutory language that allows a physician to disclose patients' health information. So be careful. The fines associated with making inaccurate assumptions about what HIPAA does and doesn't permit can be steep.
In one real-world example, a patient posted the following on Google:
"Dr X was really rude on my first consultation. Before scheduling any sinus or polyps operation, I didn't want to make any decisions, as I didn't have great contact with him. He was really angry and used such phrases as 'What did you say?' and 'I'm going to do an operation, and the only thing that doctors need to do before...'"
The patient's two-star review included what appeared to be his real first and last name.
The doctor responded:
"Hi, Davy. I'm sorry you think I came across as rude or angry. I was really concerned about you as a patient, and my concern may have been misinterpreted as anger or rudeness. Just for your information, I don't perform sinus surgery. I was trying to treat you nonsurgically, and then, if need be, I would have referred you to a competent professional who performs this surgery."
Although reasonable people can disagree about the efficacy of this type of response—a lawyer might argue that the doctor appeared to blame the patient for his misinterpretation—the doctor made a mistake that is inarguable: He publically disclosed that Davy was indeed his patient. This is a HIPAA violation.
To avoid running afoul of HIPAA, a better approach might have been to respond:
"While I do not perform sinus surgery, when I see patients who might benefit from sinus treatment, I typically offer nonsurgical alternatives. If those treatments fail, I generally refer to ENT surgeons."
Here, the doctor would have been responding to the public at large by discussing his general treatment philosophy—not to specifics affecting a particular patient. The semantic distinction may seem subtle. From the standpoint of HIPAA, the distinction is essential.
The public responds positively to doctors who take criticism seriously and do their best to remedy any problems. Doctors can often respond online, as long as they do not reveal protected health information—including acknowledging that the patient who posted a negative review was their patient.
Sometimes it's best to take the conflict offline. An orthopedic surgeon was recently slammed on the Yelp Website. The poster noted her daughter was there only for a surgical second opinion. The orthopedist said that conservative treatment was an option and sold her a brace—which, he admitted, might not be covered by her insurance. The reviewer continued that her daughter was an athlete and that conservative treatment was not desirable. And, yes, her insurance did not pay for the brace.
The orthopedist wrote a private letter directly to the patient's mother in which he said:
"I saw the review you posted on Yelp. I respect everyone's right to voice their opinion. But your review stung. I want to make it right. I believed, in good faith, that your daughter was not interested in surgery and there was a conservative option, a brace, which would allow her to walk and run without her knee giving way. That was why I offered the brace—as an alternative option to surgery. In any event, I apparently misinterpreted. For that, please accept my sincere apology. Also, I have enclosed a check for the full amount you paid for the brace—a brace that was essentially unused."
The patient's mother changed her review to five stars. The doctor's letter to the family turned a negative to a positive.
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Cite this: The Right Way to Fight Bad Online Reviews - Medscape - Nov 25, 2014.