Unfavorable Online Reviews a Challenge for Many Physicians

By Susan Kreimer
October 25, 2017

There is value in review websites, but they can lead to problems when literally anyone posts negative comments or false information.

With the proliferation of websites that solicit reviews from patients, it’s no wonder some physicians worry about their online reputation. It’s yet another reason to be cognizant of patient satisfaction.

“In addition to making the right diagnosis and prescribing the right therapy, you have to do the things that make people happy,” says Steven R. Feldman, MD, PhD, a professor of dermatology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Feldman isn’t fretting over the possibility of one or two disgruntled patients venting in cyberspace, maintaining that a few unflattering reviews won’t “make a lick of a difference.” While taking them in stride, he offered a prudent countermeasure: “If you’re confident in what you do, go ahead and encourage all your patients to do the ratings.”

Nonetheless, some physicians contend that review sites can create conundrums when patients, family members or literally anyone posts negative comments and false information.

The comments aren’t even reflective of the care patients received, according to a study published in September 2017. Researchers concluded that “online consumer ratings should not be used in isolation to select physicians, given their poor association with clinical performance.” The report, appearing in the Journal of the American Medical Informatics Association, looked at 78 physicians representing eight medical and surgical specialties.

Unable to appease everyone, “it can often be counter-therapeutic to give in to the demands of patients,” according to the article Internet Sabotage: Negative Reviews of Psychiatrists, published in the December 2016 issue of Psychiatric Annals.

The authors, psychiatrists Laura Kendall, MD, and Timothy Botello, MD, MPH, who work in the involuntary psychiatric unit of a Los Angeles County-operated hospital, highlighted the dilemmas posed by online reviews. “Sometimes, it is a psychiatrist’s duty to set limits,” they wrote, especially in treating patients with borderline personality disorder, who are prone to explosive reactions. “For these patients, such limit-setting could be fuel for the fire that leads them to write negative reviews online.”

To illustrate, they presented the case of a 70-year-old woman with schizophrenia who was admitted on a 72-hour hold after neighbors had notified the police due to her bizarre behavior and weight loss. During the hospitalization, it became known that “her daughter had been taking advantage of the patient financially and was emotionally abusive” to the mother, as well.

As required by law, the physician filed an adult protective services report. The daughter then lodged a complaint with the hospital, claiming that the physician had falsified information. She also personally attacked the physician in email and phone messages and posted derogatory reviews online.

According to Kendall, the physician prevailed in requesting that the websites remove the comments because the postings — written by a family member, not a patient — violated terms of service. After one of the sites had expunged the daughter’s review, it reappeared. This time, the physician reported the reviewer for harassment, and again, the site deleted the posting.

“It took a lot of … time and energy to take this down,” says Kendall, an assistant professor of clinical psychiatry and behavioral sciences in the Keck School of Medicine at the University of Southern California. However, this approach “probably wouldn’t work in a lot of cases” because some websites will “leave up all those reviews no matter what you do,” she says, citing feedback from other physicians.

The case helped Kendall and Botello better understand the value of what’s posted about themselves on the Internet.

“We started Googling ourselves a lot,” Kendall says.

“I didn’t know I had an ‘F’ rating,” added Botello, a clinical professor of psychiatry and behavioral sciences at USC and director of its forensic psychiatry fellowship program. “We were not savvy enough at the time. It’s just like checking your credit score.”

In forensic cases, which tend to be adversarial in nature, Botello explained that any decision leaves one side or the other unhappy. He and Kendall have become accustomed to this scenario in their positions.

“If we were working solely in private practice, these negative online reviews would be even more worrisome,” he says.

Steven Mandell, a First Amendment lawyer at the firm Mandell Menkes LLC in Chicago, recommended that physicians try to tactfully prevent conflicts from escalating into difficult situations. Taking a “hard line” with a disgruntled patient could result in a negative review.

When a patient posts a negative review, he suggested writing a response along these lines: “Our goal is to make our patients happy. I’m sorry if you had a negative experience. Please call me to discuss how we can make this right.”

This gives the physician an opportunity to resolve the issue while minimizing potential damage from bad publicity. In the response, Mandell advised, it’s important to avoid disclosing confidential information protected under the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA).

Online reviews seldom warrant legal action. Physicians should “seek advice to determine whether or not what has been says really rises to the level of defamation; or rather, is this someone voicing their disappointment, anger or frustration, which usually is characterized as opinion,” Mandell explained.

Unfavorable comments from patients often reflect their perception that a physician was rude and uncaring. The criticism may serve as a wakeup call to improve communication skills, says Feldman, the Wake Forest University professor.

In the February 2016 issue of JAMA Dermatology, he wrote that with unhappy patients feeling more inclined to air their discontent online, some practitioners may perceive these reviews as an adverse trend. But not Feldman.

“Negative feedback is a gift,” he says. “It’s more helpful than all the positive ratings.”

Susan Kreimer is a freelance health care journalist based in New York. 

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