Trashed on the Internet? The Newer Way to Deal With It

Batya Swift Yasgur, MA, LSW

February 02, 2021

Dr Leonard P, a Delaware-based facial plastic surgeon, was shocked to discover a scathing 1-star Google review from a patient he had operated on 6 months earlier.

" Terrible Doctor!

Choosing Dr P for my nose job a few months ago was the biggest mistake I ever made in my entire life. My nose is RUINED and my sister says it looks like someone punched me in the face. I went to the doctor's office. I was literally crying. I told him I hated how I looked but the doctor said he couldn't do anything for me. Run, don't walk, in the other direction!"

"Negative reviews go with the territory, and I usually take them in stride, but I was stunned by this one," said Dr P. "I recognized who the patient was, and I knew she had been happy with the results of the rhinoplasty."

Then Dr P realized what went wrong. "She had begun to inundate me with messages through the patient portal, long after she had healed. Some seemed far-fetched and even flirtatious. I eventually stopped responding. This quickly turned to deep and inconsolable dissatisfaction, despite an excellent outcome, and she wrote this review."

Jeff Segal MD, JD, founder and CEO of Medical Justice, a Greensboro, North Carolina–based company that helps physicians manage their online reputations, worked with Dr P to turn the situation around. Segal suggested a way to mitigate the ill effects of the online attack and to actually use them to his benefit. Dr P described Segal's approach as "turning lemons into lemonade."

According to Segal, the new approach to dealing with bad online reviews is to "see them as an inexpensive form of 'marketing,' if handled correctly." Segal said. "A carefully crafted online response can enhance your image."

Bad Reviews Are No Longer a "Death Knell"

Online reviews of physicians have been around for close to 15 years, and their use and centrality have been dramatically increasing. A 2020 survey of over 16,000 US adults showed that in choosing a physician, patients are using search engines and patient reviews twice as much as traditional referrals and that the use of referrals declined by 44% in the previous year. Another survey of over 1000 patients found that almost three quarters used online reviews as their first step in finding a physician, and 43% said they would even go out of their insurance network for a provider who had favorable reviews.

"If we go back a decade, relatively few doctors had any online reviews, but today's patients are more comfortable writing reviews, so the number of reviews of a single doctor have proliferated," Segal said.

Although most physicians resent the review process, many have become resigned to it and regard negative reviews as an "unpleasant fact of life in this day and age," Segal said.

But physicians don't need to dread negative reviews as much as they used to, says Segal. "Doctors are beginning to understand that if you take care of 2000 patients each year, you won't make everyone happy, so no doctor needs to freak out about an occasional negative review. It's not the 'death knell' it used to be."

Some doctors are even beginning to wonder whether there may be a silver lining behind the cloud of negative reviews. Segal thinks there is and that even negative reviews can be leveraged to improve online image and shore up one's practice.

Use as an Inexpensive Marketing Tool

For starters, "negative reviews aren't all bad," Segal said. On the contrary, if the negative reviews are rare, "they make physicians look more trustworthy and believable. If there are hundreds of glowing 5-star reviews, patients begin to get suspicious and wonder if the reviews are fake."

No response should contain information that might violate HIPAA regulations. "Never make any statement acknowledging that the reviewer is your patient, and always use generic terminology to refer to the concerns raised in the review, so the patient's identity will not be apparent," Segal advised. Nor should specific billing information be posted online, although general billing policies can be posted.

Brad Bowman, MD, chief medical officer of Healthgrades, agreed that a negative review is an "opportunity to put out a positive message," but this can happen only if the patient does not feel dismissed or contradicted.

To that end, he warned against "canned cut-and-paste responses, because that will be offensive and feel dismissive to patients."

Additionally, "the worst thing you can do is to debate facts and make your response a truth-finding mission to prove the reviewer wrong," Bowman said.

Don't adopt an adversarial tone. Instead, "respond in a caring and empathetic way that acknowledges the reviewer's feelings and frustration and conveys the message that their experience is important to you," said Bowman.

Because crafting responses can be onerous, it might be helpful for physicians to have a staff member, such as an office manager, take on the task and serve as the "point person" for patients to contact with their feedback.

Can You Learn Something Useful?

As upsetting as it is to receive a negative review, the feedback can also highlight areas that need improvement.

Lawrence F, a California-based internist, is an example of a physician who used negative reviews as constructive criticism. "I was called on the carpet by my hospital administration for getting too many 3-star ratings, most focusing on poor communication and bedside manner," he said.

Although the experience was jarring, Dr F realized the feedback was also valuable. "I took it to heart, and once I had learned to communicate more clearly and compassionately, my reviews improved," he said.

The pressure to please patients and generate positive reviews is a double-edged sword that can potentially compromise good medical care if a patient insists on a particular treatment or procedure, Dr F pointed out. Such problems can also be mitigated by better communication.

"I address the review issue head-on," Dr F said. "For example, I'll explain why antibiotics are contraindicated for the common cold, and if the patient remains adamant in demanding an antibiotic, I'll say, 'I'm sorry you're upset with my decision. I want my patients to be happy with the care I provide. But I'm even willing to risk getting a bad review because my first commitment is to your health.' Patients have been very responsive, and my ratings remain high."

Reach Out to the Patient Privately

"If you know who the reviewer is, the first step is to speak to him or her offline to see how the problem might be resolved," Segal said.

Bowman encouraged physicians not to respond in the heat of the moment but to "just wait, think, step back, and acknowledge your anger, emotions, and hurt feelings. Then organize your thoughts and appreciate some of the 'up sides' that your response might convey."

But don't wait too long, Bowman cautioned. He noted that a delayed response allows more prospective patients to read the review. Ideally, it is best to respond within 24 hours.

Taking responsibility for any errors is the first step to resolving the issue, according to Michael Sacopulos, JD, CEO of Medical Risk Institute and partner with Sacopulos, Johnson & Sacopulos, in Terre Haute, Indiana. Patients tend to view apologies positively and are willing to go back to a provider who honestly acknowledges an error and seeks to rectify it.

Experts disagree, however, on whether to ask patients to take down the review once the matter has been resolved.

"If the patient feels the issue has been resolved to their satisfaction, you can request — not demand, but request — that they take down the review. If you couch it that way, and people have felt heard, they will likely reciprocate and remove the review," Segal said.

By contrast, Ron Harman King, MS, CEO of Vanguard Communications, a reputation management company designed to grow medical practices and increase online ratings, discourages physicians from asking patients to remove the review. Rather, "be an open listener, and by being receptive to the patient's input and attempting to address complaints as much as possible offline, in many cases — if not most — the patient will remove the review themselves and may even say the practice was great and called me to resolve my complaint."

Framing an Online Response

According to Segal, responses should consist of three components.

Acknowledge and validate the patient's concerns and express empathy.

  • We are distressed if any of our patients experience prolonged pain following surgery. Our patients' health and comfort are our no. 1 concern.

  • We respect our patients' time and life commitments and know that a long wait is a major inconvenience.

Explain why the problem might have taken place, which is an opportunity to highlight the positive features of your practice.

  • We take pride in the clinical expertise of our board-certified orthopedic surgeons. Studies show that a quarter of patients might continue to feel pain for extended times following knee replacement, and the percentage of prolonged pain our patients report is considerably lower.

  • We try to maintain a high level of punctuality, but sometimes a physician is unexpectedly delayed, owing to an emergency involving another patient. In urgent situations, all of our patients receive the same level of attentive care and prioritization.

Describe how the problem is being addressed.

  • We encourage patients to follow up with us if they experience pain. Some patients may be candidates for further interventions, such as newer minimally invasive procedures.

  • We are instituting a system where we will text patients if we anticipate a wait time of longer than 15 minutes.

Dr P contacted the disgruntled reviewer offline. He explained why he had not responded to her messages and offered to perform a revision surgery without a fee or to provide a refund of the first surgery, in hopes that she would agree to take down the review. She declined.

He then posted a response.

We are unable offer detailed comments because of patient confidentiality issues, but I can speak generally about the concerns raised in this review.

We are dedicated to the well-being and satisfaction of our patients. While the vast majority are pleased with their appearance following our procedures, on rare occasions, a patient might not be happy with the result. In these unusual circumstances, our policy is to waive our fee and offer a revision procedure to demonstrate our commitment to our patients' happiness. We counsel all recipients of rhinoplasty to be patient following the procedure. The final result will not be apparent during the first months because the healing process takes up to a year, and sometimes longer in certain patients.

Dr P said highlighting the positives of his practice was beneficial. Additionally, "since the majority of our patients are thrilled with their rhinoplasties, subsequent positive reviews from others served to dilute her vitriol, which eventually became old news."

How Has COVID-19 Affected Online Reviews?

The online review climate, like everything else, has been affected by COVID-19.

"From about mid-March through May/early June 2020, we noticed that the number of online reviews dropped dramatically," King said. "We can speculate why, but my best guess is that a lot of practices were closed, so people were not seeing the doctor as often or reviewing medical practices as much."

Practices began reopening in June, and reviews picked up and have been "growing ever since" — in fact, there has been a higher number in the last quarter of 2020, King said.

"Not only were there more reviews, but they were more critical," he said. He offered several "speculative theories" as to why this might be the case.

"Practices might have been hindered by the COVID-19 restrictions and procedures," he suggested, and "people may also be grumpy from social isolation and unemployment and everything else that goes along with the pandemic — and they're spending more time at home or working remotely at their computers, giving them more time to write online reviews."

Interestingly, there have been fewer complaints about telemedicine than about in-office encounters with providers and staff, King noted.

Segal suggested featuring COVID-19 procedures and protections on the practice's website and on online rating sites. "Proactively address issues such as longer wait times caused by limiting the number of patients due to optimal virus-related safety measures," he said. Also, indicate what other measures are being taken to keep patients safe, such as providing face masks and hand sanitizers and texting patients when it is their turn so as to minimize in-office wait times.

Additionally, Segal recommended empathizing with patients about how challenging the pandemic can be and how the practice is trying to meet the new needs with flexibility and a blend of telemedicine and in-person visits.

Prevention Is the Best Action

"Most negative online reviews are typically a result of mismanaged expectations," Segal said. These include misunderstandings about finances or billing, whether the patient understood potential risks or complications of a procedure or treatment, or misunderstandings about the process, such as recovery time.

King concurred. He cited a national internet survey of close to 35,000 reviews conducted by Vanguard that encompassed all specialties and hospitals. It found that customer service was the most common cause of negative online reviews.

"Too many doctors think of themselves as 'scientists for hire,' but I would encourage them to think of themselves as caregivers. Yes, patients want medical science, but they want it enveloped in an atmosphere of receptive, open, two-way communication," King said.

Every aspect of the patient's experience should reflect a welcoming environment, from parking to punctuality to cleanliness of the facilities to the behavior of the administrators, billing personnel, receptionists, and medical assistants.

Communication Is a Team Sport

According to the Vanguard survey, the no. 1 driver of negative reviews was poor communication, with over 53% of 1- and 2-star reviews related to calls that were not returned, portal questions not addressed, or logistical problems (such as problems involving scheduling and parking).

The better the communication and the more respected a patient feels, the better the chances of a positive review. Of the laudatory reviews analyzed in the Vanguard study, 40% were related to bedside manner, and 24% were related to communication.

King called communication a "team sport" that begins with the patient's very first phone call. "Getting an automated 'phone tree' when you call or having a receptionist answer the phone saying, 'Dr Smith's office, please hold,' is off-putting to patients."

Bowman reported that an analysis of close to 85 million medical provider reviews conducted in 2020 by Healthgrades and the Medical Group Management Association found that 59% of negative reviews mentioned communication and that 43% mentioned negative experiences with practice staff.

"Physicians, especially those in private practice, should realize they are the head of an organization with a certain culture. How their representatives behave is ultimately their responsibility, and their ratings will reflect that," King said.

Here to Stay

One thing is clear: online reviews are here to stay, and their use continues to expand, according to Sacopulos, who is the coauthor of Tweets, Likes, and Liabilities: Online and Electronic Risks to the Healthcare Professional (Greenbranch Publishing, 2018).

"Online reputation encompasses far more than attracting and keeping patients, also impacting credentialing and employment. Online reviews are becoming increasingly of interest to malpractice carriers," said Sacopulos, who is also general counsel at medical justice. "Physicians need to keep pace with the rapidly changing review landscape and take charge of their online presence."

King agreed. "You'll always have dissatisfied customers, so you need to live with the reality that someone will complain about you publicly. You can't control or eliminate that. The name of the game is getting, for every complaint, 10 or more reviews singing your praises."

Bowman added that he hopes medical schools will begin to include education about online reviews and similar topics related to digital technology in their curriculum.

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