Wendy Lewis takes a look at how you can navigate the shark‑infested waters of managing your online reputation.
It’s 2015 and we have all become acclimated to checking reviews before booking a hotel room, choosing a restaurant or buying a laptop. Think about it. You want to take a weekend getaway with your significant other. The first thing you might do is to ask a few friends for a recommendation. Next, you go online and do some research; you log on to TripAdvisor or Trivago and skim the first five or ten reviews. What moves you to make a split second decision on whether to book or to bolt? Comments like ‘service was slow’, ‘dated facility needs an update’, ‘overpriced for what they offer’, ‘inconvenient and out of the way location’, and ‘staff was rude and inattentive’, would put most of us off. Newsflash: consumers choosing healthcare services think the same way. The process is pretty much identical.
As costs for healthcare have skyrocketed, people are increasingly shopping around for doctors and comparing reviews. For Generation X and Y, they have grown up with RateMyProfessors.com, they order their vegan sandwiches on Seamless.com, and prowl for hook-ups on Tinder. So they have come to expect the same level of digital experience with scheduling a dental exam or a stress test that they have used in all other aspects of their lives. They live on their mobile devices and expect instant gratification and real time responses.
Patients: the new consumers
Among the challenges facing physicians online is that they have very different expectations from patients. For a doctor, the way they are trained to measure quality is the end result, whether that means curing a disease, removing a tumour, or augmenting a breast. Physicians are programmed from medical school to go right to the clinical aspects.
Patients think totally differently. They are more inclined to rate the touchy feely stuff, the overall experience, whether it was pleasant or not, if the doctor or nurse treated them well, or how long they had to wait to be seen. The inherent difference is that patients assume a certain degree of successful outcomes. They expect to be cured or to have the bump removed from their nose during a rhinoplasty. It comes with the territory. In today’s world, hiring a doctor or surgeon is akin to hiring a mechanic to tune up the motor in your BMW or a gardener to make your rose bushes blossom.
There is a major disconnect between how doctors and patients see things, and therein lies the greatest challenge in the entire review process. Although no doctor enjoys being rated like a retail store or a restaurant, and it’s hard for them to wrap their heads around the idea that patients now have this kind of control over their practices. Doctors see their relationship with patients entirely differently than other service providers do, but in actual fact, it is not all that different. Patients are consumers today. They can make or break a medical practice and impact significantly on the doctor’s lifestyle. They expect or rather demand to be treated well by the doctor and the office staff, and if they are not, they vote with their feet. But before they go somewhere else, the truth is they are likely to write about a less than ideal experience, even if it’s just to let-off some steam. After all, there are no consequences for them to consider. In fact they sometimes view physicians as they view house painters and accountants, and they don’t really give much thought to what giving a three-star rating to a physician really means. And they probably don’t care.
Negative content posted about healthcare practitioners can directly affect the success of their practices, as more consumers rely on ratings and reviews to select their doctors and to rule out the ones they do not want to visit. In the digital world, consumers are inclined to speak their minds and share their opinions about your practice, whether they are fair or not. Historically, unhappy patients tend to be the most vocal, while the happy ones may never tell a soul about how good your work is. There is nothing really new about doctors being rating and reviewed by patients. They used to be whispered in the ladies room at the country club, or discussed at the mall over tuna salad. The big difference is that these critiques were not online in a public forum for the entire world to see.
No matter how good you are as a physician, you are bound to get some snide remarks about your fees, complaints about waiting, or your attitude at some point, especially if you have a busy practice. It is just the nature of a service business. The more patients you treat, the higher your chances of having some who are not your biggest fans and are prone to spread the word. In reality, no practice can have 100% happy patients, despite your best efforts. Regrettably, ratings sites and social media platforms have become the logical place for patients and customers to vent and air their grievances. They are the first port of call for spite-based attacks on your professional reputation. Patients know this and some of them will use it as a weapon.
However, consumers are becoming more skeptical of reviews and they look for red flags. They no longer trust doctors who have hundreds of glowing reviews that sound as if they were written by a publicist. It’s all about the ratio of good to bad. For example, if you have a mix of reviews yet the negative ones are focused on a particular topic or recurring theme, you might want to look at that more closely. Perhaps you are a little arrogant in the consultation, or your front desk staff are not always as welcoming as they should be. Address these kinds of issues when they arise to turn them around. It can be a very humbling exercise to read what people are writing about you. Patient ratings are the new word-of-mouth.
What not to do
By now you should be keeping tabs of online critiques leveled against your reputation. Set alerts on Google and Yahoo, and assign a staff member to watch what is being posted on all relevant sites and social networking platforms.
If you are extremely OCD, you can consider enlisting an external monitoring service to help alert you to any new developments, such as reposts of negative content and any derivative attacks that appear in response, so you can be proactive. For example, sites like Brandseye.com and Rankur.com offer extensive tools to analyze your online reputation but these services are costly and probably overkill for a solo practitioner.
Management of negative online content can take many forms. Some approaches help distill an unflattering or defamatory post, while others can backfire significantly and escalate a situation. The last thing you want is to stimulate one comment and have it spread like Poison Ivy into a chain of comments.
The worst thing you can do is to react in a defensive or aggressive manner. It is important to try and maintain a calm, rational, and reasonable approach at all times, even when the patient is completely unreasonable.
When negative posts show up, doctors often tend to take it very personally, which is understandable. In general, the best approach is: less is more. You can do more harm than good by opening up a dialogue and engaging with consumers in a public forum.
Whenever possible, keep your emotions out of it. If you are inclined to respond, please stop yourself. This is the time for cooler minds to prevail. A response from the physician can be seen as defensive, which readers can easily misconstrue as arrogance. In my view and many others, physicians should avoid entering into any potentially negative conversations online. Your office staff can respond for the practice using the ‘we’ voice. You may consider drafting a post that is very general without acknowledging any doctor-patient relationship, or risk of stirring the pot further. For example; ‘Thank you for expressing your concerns. Please contact our office to discuss this further. We would be happy to hear from you.’
Your Administrator or Manager can try to respond to the poster with some form of an offer to continue the dialogue. The next step is to take the matter offline to continue the dialogue in the hopes of arriving at a resolution. In this way, you have demonstrated that you stand behind your reputation and pay attention to situations flagged in public forums. You can then privately try to resolve the conflict, assuming that the post is actually a real patient with a valid issue.
Common complaints and causes for negative reviews often center on long waiting times, customer service, a rushed staff, the doctor didn’t spend enough time, the feeling that the practice was too busy, overcharging for services, the perception that the fees are too high, and the ubiquitous bedside manner.
Getting posts taken down
It can be difficult to stay calm when you read posts that are unfair or untrue, and particularly when you know them to be fabricated or fake. Unfortunately, this practice is rampant. In fact, there is a cottage industry that has arose around extracting fees from physicians and other small businesses to get rid of negative reviews. In general, unsolicited emails and aggressive calls to your office offering this kind of service should be met with a grain of salt. Doctors are easy prey for the unscrupulous tactics of these companies who call on the pretense that they have seen negative reviews about your practice online and can help you take them down.
If you do get unfair negative comments, read the Terms of Service on the site with a fine-toothed comb. If the poster has violated the terms even slightly, you may have recourse to get the post removed. Whenever possible and appropriate, gather factual information in an effort to prove that the offending post if fake. For example, if a person posts about having an open rhinoplasty that collapsed, when you have not performed an open rhinoplasty for the past decade, you may be able to make a case that the poster is not your patient or is confused.
Website hosts have some latitude to keep or pull a thread, but they may not always be inclined to. However, there are circumstances where they are more likely to do so. If there is a clear violation of the site’s terms of service, you can often get the post removed. In some cases, you may need to enlist an attorney experienced in reputation management to handle it for you. That is the best case scenario.
If the poster is ranting about you, you can try to get it taken down if it is not merely an opinion. Your chances are better if they are stating something as fact that can be perceived as defamatory. Opinions are legal; we live in a free speech society. Defamation is the term used to describe any statement that hurts someone’s reputation. Written defamation is libel; spoken defamation is slander. Libel is obviously easier to prove since it is in writing. Defamation also has to be false. Even vicious, mean comments may not be considered defamation unless they are knowingly false, and even then you would have to prove that these comments caused injury in the form of being harassed or shunned as a direct result of the comments.
The method of choice to get rid of bad reviews is to have them flagged as inappropriate and try to get them reviewed by the site. However, this takes time and is not always successful and the damage may already have been done long before someone even reviews your case. You need to have solid grounds or a friendly website to get reviews taken down, whether you are an advertiser or not. Physicians have also tried to file lawsuits against patients or rating sites over negative reviews, but this is often a futile exercise.
Five star ratings
The best way to avoid patient complaints is to not create any reason for having them in the first place, but this is nearly impossible to do. The second best way to counter negative ratings is to make sure they are buried under a slew of positive ratings from real satisfied patients who are your advocates.
Sometimes you just have to ask patients to write a review for you. It is usually easier for staff to ask than for the doctor. When a patient compliments their result or the office, the staff may say something like, ‘We would be honored if you would give us a positive review.’ Even if the patient has good intentions, they may forget or opt not to do it for reasons of confidentiality. Consider handing them a card with the most important rating sites to simplify the process for them. Post a sign at the reception desk stating that you value patient feedback by any means, including in person, by phone, email, or via online forums.
Encouraging patients to post good reviews about your practice should be an ongoing activity. Start early in the relationship from the initial consultation when they are sitting in the waiting room. Use patient satisfaction surveys so you show them that you value their opinion and get them to participate.
If you do everything possible to generate a positive patient experience, you may be able to avoid falling into the common rut of getting a negative critique and scrambling to get good reviews to counteract it. Consumers are wise to that, and this approach may be very apparent when someone searches for you online.
Aim for transparency
In general, transparency is not necessarily a bad thing. It has the potential to improve the way you practice and may tend to keep you on your toes. If you are being honest with yourself, you might admit that the threat of negative reviews hanging over your head has made doctors, in general, a little more caring and humble, as bad behavior can have expensive consequences now. Everyone gets some negative reviews, some are unwarranted but some may be deserved. When it happens, first look in the mirror and ask yourself if there may be some truth to those observations. If so, take steps to make your practice better and take better care of patients.
If you are consistently getting three stars or less, there may be some things that need immediate attention. Take this opportunity to turn it around. For example, apologize to patients who were kept waiting, let them know that their time is valuable too, and get the staff involved in answering questions to move patients through faster. Make an extra effort to avoid scheduling mishaps and billing disputes that are sure to cause patients to get mad at you. A big patient pet peeve is letting little details slip through the cracks—such as having the nurse call them back, contacting their insurance company, sending a receipt, and calling in a prescription.
A collection of sincere and favorable reviews by real patients will outweigh a few negative ones. Persuade patients to write good reviews about your practice by showing that it matters to you. The long-term mission is to create a large body of positive content to outweigh the occasional negative posts that may arise—and they will.