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Fair or not, online reviews may be the first thing a potential patient sees about a dermatologist

The Internet allows for aggregation and dissemination of information on an incredible level. As a tool for communication, it’s unparalleled. And just as diners offer up their ratings for their favorite and least-favorite restaurants, with a few clicks, one can also find the best and worst things patients have to say about their doctors. Just as the opinion of a practice management consultant can improve one’s efficiency, operation, or patient care, harnessing online opinions can allow practice owners to keep tabs on their business and strive for continuous improvement.

Growing online influence

The Internet runs on opinion and social interaction, according to DePaul University assistant professor of public relations Matt Ragas, PhD. Throughout a host of platforms, whether Twitter, Facebook, or Yelp, people are broadcasting opinions about businesses 24 hours a day. How that feeds into the public perception of one’s practice, Dr. Ragas said, is a marketing concern for small business owners.

“What I tell my students and small businesspeople is that when you search using Google and Bing, what comes up in the first page or two of results — that’s your brand, that’s your reputation. Whether you like it or not,” Dr. Ragas said. “When you dive deeper into rating sites, if someone doesn’t have any other point of reference when it comes to your practice, those ratings have an impact and influence.” [pagebreak]

A survey released in early 2011 by the Pew Research Center confirmed the growing influence of the Internet in American health care. A nationwide survey of all Internet users found that while only 4 percent of users posted a review of a physician online, 80 percent of users (which translates to 59 percent of all U.S. adults) seek health information online, whether it’s reading the experiences of others, watching medical-related videos, or finding others with similar medical concerns.

The effect of anonymity

The biggest concern related to online opinions available for all to see is the permanence of the negative ones, according to Niagara Falls, Ontario, dermatologist Kevin C. Smith, MD, who gave a presentation on the topic at the American Academy of Dermatology’s 69th Annual Meeting in New Orleans.

“It’s kind of out of your control. In North America, at least, the laws are such that anybody who wants to can say whatever they want with a high probability of getting away with it, unless you want to spend a great deal of time and money,” Dr. Smith said. “Just like you will eventually be involved with a lawsuit during your career, you will eventually be slammed on the Internet. My advice is to get used to it.” [pagebreak]

While the most attention-getting comments are the negative ones, dermatologist Steve Feldman, MD, PhD, who founded DrScore.com, said that the vast majority of physicians are exceptionally rated by their patients.

“I think that the opportunity of online rating is to make it easy to collect and publish opinions that represent a real opportunity to set the record straight. The vast majority of patients love their doctors. If you ever look at representative ratings, you’ll see that if your patient satisfaction score is only nine out of 10, you are well in the bottom half — maybe the bottom quarter — of American physicians,” Dr. Feldman said. “You’ve got all these doctors, all getting scores around 95/100. Say you took a representative group of 100 doctors. If all 100 got one rating, then 95 of those doctors would have gotten 10s and five would have gotten zeroes. It doesn’t mean that five of those are different than the other 95, it’s just the randomness of events. I think patients are the same way. If we get a zero from a patient and say that they’re a chronic complainer, my guess is that those patients are giving 10s 95 percent of the time, just like everyone else. You got the unlucky straw and happened to catch them while unhappy with one event.” [pagebreak]

In combating statistical anomalies that can lead to unfairly low aggregate ratings, Dr. Feldman said, a number of physicians will ask each of their patients to rate them following the visit. While it doesn’t eliminate the possibility of negative or even unfair reviews, he said, it directs more loyal and happy patients to the ratings site or sites of one’s choice.

The high regard that most patients have for their dermatologists, Dr. Feldman said, is borne out by a national survey done by the National Psoriasis Foundation while he worked with the group. After daily calls by patients saying that they were finding it impossible to find a good dermatologist, the group did a quick survey asking its members about their dermatologists.

“The survey came back saying that the members loved their dermatologists. So the foundation thought that they must have done the survey wrong, and brought in a national survey research firm to carry out a representative survey in collaboration with dermatologists and epidemiologists,” Dr. Feldman said. “They carried out the survey, and found that patients loved their dermatologists. They realized that they weren’t getting calls from all the people who were very happy with their doctors, and that what they were seeing was an unrepresentative sample. You can get that same impression if you only read the negative online reviews of your practice.” [pagebreak]

Acceptance and adjustment, according to Dr. Smith, seem to be the best course of action in most cases. Under HIPAA, a doctor’s recourse to negative online comments is severely constrained compared to other business owners. Doctors, of course, cannot discuss a patient, only how their practice is generally run without any patient specifics. The last legal recourse — suing for defamation — is also the most attention-grabbing, which can backfire, according to Dr. Ragas.

“The media spotlight has a way of being attracted to threats and lawsuits. The person you’ve filed suit against, regardless of the facts of the case, can try to turn things around on you, the doctor suing the regular person for saying something online,” Dr. Ragas said. “Legal recourse is always an option, but it has to be considered in the larger scheme of things. Perception doesn’t always line up the way you intend, so you have to be careful.”

The key to achieving acceptance, Dr. Feldman said, is to gain something from the negative experience that helps improve one’s practice. [pagebreak]

“I know when I get a negative rating, my first thought is that patient must have me mistaken for someone else, or that they’re just acting like a jerk — but I don’t think that for very long. How patients feel at the end of a visit is usually under my control, and my patients need to be happy with the service I provide,” Dr. Feldman said. “Good businesses take these comments and use the negative ones as the customer telling them how to improve on something we do. It’s not a level playing field, but a lot of people wouldn’t feel comfortable telling their doctor what they could do better without the benefit of anonymity. We have to look at even the negative ratings as a gift.”

Assessing the risks of online reputation management is crucial to effectively coping with the potential damage and stresses of negative ratings, according to Ron Culp, who previously directed the public relations efforts of Sara Lee and Sears, is a former partner for global public relations agency Ketchum, and currently serves as the professional director of DePaul University’s public relations and advertising graduate program.

“Too often marketers focus 99.9 percent of their energy on the bells and whistles and not enough time on what might go wrong. Someone in the organization should be the devil’s advocate so that you’re ready for the unexpected,” Culp said. “Physicians and others need to address business model issues that are causing negative online comment — poor scheduling that causes late appointments or front-office staff that needs more training — and they also have to do something that makes them very uncomfortable. They have to engage in social media themselves. Too often, they take criticism personally and write off the complaint as being from a hard-to-please patient. That approach worked before, but not today.” [pagebreak]

Physicians who see a comment that they seemed impersonal or rushed, for example, may write off the complaint as a hard-to-please patient. But, he said, it’s an opportunity to consider whether one is making adequate time to provide patient care and address concerns.

Addressing complaints ethically

Putting one’s credentials online in an informative and positive light often serves as an effective tool against inaccurate reviews, according to dermatologist Stephen Webster, MD, a member of the AAD Ethics Committee. At the very least, he said, it makes for a more trustworthy public face than a marketing-heavy promotional page.

“I encourage doctors to have a website that lists their training, their certification, what procedures they do, and things like that which profile one’s qualifications and practice patterns in a very positive way,” Dr. Webster said. “We very much discourage websites that discuss I do something better than anyone else does, I have better secret compound that I can give you, I can do things with lasers that other doctors can’t do.’” [pagebreak]

Where some physicians might adopt a defensive attitude over negative online ratings, Jeff Segal, MD, JD, the founder and CEO of physician reputation management group Medical Justice, said that the best course of action may be to actively solicit more of one’s patient population for ratings and specific feedback.

“On the vast majority of review sites, there are between zero and three reviews for the average physician. So when you get the inevitable negative review, you would certainly like it to be balanced by a more representative sample of your practice. Take advantage of your patient base to do that,” Dr. Segal said. He explained that his company provides practices with an iPad that patients in exam or waiting rooms can use to complete a point-of-service survey. With the patient’s permission, information from the survey can also be posted online, helping to create a more representative sample of reviews.

Dr. Webster agreed with Dr. Segal that encouraging positive feedback engages the physician-patient relationship far more effectively than attempting to prohibit negative online feedback, an approach Dr. Segal used to recommend but no longer considers appropriate that required patients to agree not to make negative statements about practices. [pagebreak]

“Restrictive online behavior agreements are something that patients are looking at and losing interest in a practice. That, we feel, is a little unethical, in that it strains the doctor-patient relationship,” Dr. Webster said. “Try to be positive with the patient, emphasize answering their questions above anything else.”

Read more about online reviews and their effects in our online-only supplement.

Avoiding HIPAA concerns when responding

Dr. Segal now advises a three-step approach for handling a practice’s online reputation that breaks down to monitoring what’s said online, engaging patients directly to respond to complaints where possible, and promoting patient feedback. Learning how to craft a HIPAA-compliant response, he said, can help a physician provide better care to patients in cases in miscommunication.

“We work with a fertility group, and in the survey, there was a comment that we brought to the doctor’s attention that a patient had said it would be good if there was a counselor on site for patients whose treatments had failed. What’s interesting is that there was, in fact, a counselor on site. But the patient didn’t know that, and the doctor didn’t know that the patient didn’t have access,” Dr. Segal said. “So they responded by saying we’re sorry to hear about your experience. We do have a counselor on site, and we’ve changed the processes to make sure that all patients receiving news of this type do have an opportunity to meet and work with a counselor.’” [pagebreak]

The response was perfectly crafted, Dr. Segal said, under the circumstances of the visit and the solicited online feedback, which lacked any identifying patient information. The key, he said, is to tailor one’s response expertly to the unique demands of patient privacy.

“The reason that they were able to produce this public response [without triggering HIPAA concerns] is because the patient’s note was public and anonymous, and there was no personal health information to tie it back to that patient,” Dr. Segal said. “HIPAA is a strange beast. You have to know what you’re doing. If a patient posts with their real name online, you can’t respond publicly to that because it identifies that you’re the doctor for this patient. It’s walking the line, but you do need to be aware that when a patient has posted online, they haven’t waived their expectation of privacy under HIPAA.” [pagebreak]

In addition, anonymous patient complaints that cannot be engaged directly may fall outside a rating website’s terms of service agreement with the patient-user if the information is false or potentially libelous. Many of the more popular rating websites, Dr. Segal said, have showed an increasing willingness to work with physicians recently.

“Right now there are probably 80 sites out there, and no one has become the go-to site, the TripAdvisor, if you will, of medical ratings. And because of that, some of the more high-profile ones have been more open to taking into account the concerns of the doctors,” Dr. Segal said. “If a person doesn’t have first-hand information, they will remove posts that say something like my wife visited Dr. Smith, and said he was very rude,’ if you bring it to their attention. In addition, if a patient’s calling the doctor, for example, an alcoholic without any terms to substantiate, they’ll remove those posts. A lot of these places are putting together some moderation in the effort to become a go-to site. We have a long way to go until it’s doctor-friendly, but it’s improved a lot recently. We’ll know when we’ve gotten to the correct place when doctors and nurses are using these sites to choose their own doctors.” [pagebreak]

Online comments

The anonymity of online review sites creates a far different dialogue and tone than most practitioners would expect before the advent of the Internet. This is a sample of some of both the positive and the negative things that online reviewers have had to say about dermatologists on rating websites. All comments have had the physician’s name removed. The negative reviews have been paraphrased to reflect their sentiments. Spelling and grammar have not been altered.

“Dr. [redacted] is the best doctor I’ve ever seen. He is unbelievably friendly, and after talking to him for just a few minutes, you really feel like you’ve made a good friend/ally in your battle against whatever it is you are seeing him for. He is great at forming a treatment plan and making his patients feel as though they are in it together, rather than just outlining a list of things the patient should do. My only regret is that I didn’t come to see him sooner.” - Yelp.com, 2011

Shocked at the indifference and unfriendliness Dr. [redacted] showed on my first visit ... She came off as unconcerned about me and anxious for me to leave... The look on her face made it clear she thought she was indulging me by responding to questions. I wasn’t expecting a fun chat or a new friend, but I have been to a lot of doctors and I’ve never been made to feel this unwelcome. - RateMDs.com, 2008

“Doctor [redacted] was excellent! He is very patient, and I felt very comfortable with him. I could tell he is very experienced in his field. After listening to my concerns and examining me, he gave me an exact diagnosis and proper treatment. My problem went away within 5 days. The office is clean and welcoming and the staff is friendly while answering questions and scheduling appointments.” - Google.com, 2012

During my short visit with him, he received a phone call. I listened to him discuss his new couch for about 12 minutes. It would have been nice if he’d been interested enough in me to spend 12 minutes! - Yelp.com, 2011

“My experience at Dr. [redacted] office had to have been one of the best I have ever had. The office staff was professional, courteous and efficient and Dr. [redacted] was caring, considerate and extremely thorough. She allayed my fears about my problem and explained everything in clear, understandable language. She not only diagnosed and treated me appropriately, but she also went to great lengths to coordinate my care with a plastic surgeon and my general dermatologist. She also called me personally the night of my surgery which is unheard of in today’s world. I have never seen such a conscientious, intelligent, and thorough physician. I would highly recommend Dr. [redacted]” - Vitals.com, 2009

“The location is great right off the highway, easily accessible with it’s own lot. The office is warm and welcoming.... The receptionists, most of whom I know by name and who also return the favor, are very sweet.... I couldn’t ask for a team of professionals who work harder or care more about their patients.

Dr. [redacted], as well, has been an excellent doctor.... has a great bedside manner, he knows each one of his patients. Every time I see him he is able to ask about my school, studies and my family. I even remember being privy to his and his wife’s decision regarding indoor paint colors. I have had warts removed, fungus treated, acne medicated and many other embarrassing conditions examined by Dr. [redacted] without ever feeling awkward or uncomfortable. He treats everything as very important, and will continue to recommend different treatments until you are satisfied! - Yelp.com, 2010

Read more case studies in an online-only supplement to this story.

Rating sites for doctors

Ratings of doctors appear on a variety of sites across the Internet. Those listed below are good places to start when checking out your own online reputation.

Google Maps www.maps.google.com

Yelp www.yelp.com

Rate MDs www.ratemds.com

HealthGrades www.healthgrades.com

Vitals www.vitals.com

DrScore www.drscore.com

ZocDoc www.zocdoc.com

Angie’s List www.angieslist.com

 

Related Resources

Online comments
Rating sites for doctors