The Internet has transformed the way we get information. It is no surprise that finding health information online is a common activity.
Significance for Practicing Psychiatrists
The Internet has transformed the way we get information. No one uses the telephone book anymore to find a phone number or a physical map to determine traveling directions. Smartphones and tablets have even supplanted laptop and desktop computers as the portal to the vast amount of information available online. Typing is not necessary-calling out “Hey Siri” and “Hey Google” have become the preferred method of finding information on these devices. Perhaps librarians are at risk of becoming an endangered profession as the public has become more dependent on digital assistants to find the information that they need.
Online information has been transformed
Thirty years ago, websites were mostly about distribution of information, usually curated by someone who may have been an authority in that arena but not necessarily so. The concept Web 2.0 may be largely forgotten, but it highlighted how the Internet and software have changed to harness collective intelligence or knowledge of the masses as well as how the web has become a platform.1 Blogs are a great example of the web as a platform. Technology has enabled everyone to put their opinion and other comments online and made them easier to find. Amazon has changed the retail industry as a platform for commerce, helped in part by its presentation of customer reviews and ratings as well as questions and answers that facilitate purchase decision making.
Physician rating sites
It is no surprise that finding health information online is a common activity. Google Trends has shown that since 2004, 70% of queries on average are health-related.2 Insurance companies use the web to provide information about health plan benefits as well as providers in their network. Searching for psychiatrists is even easier by entering the terms “psychiatrist,” “desired city,” and “appropriate state,” in any Internet search engine. This search also reveals a new web resource-the physician rating site.
Physician rating sites are just what you would imagine. The sites allow individuals to review their physician and add their opinion. Many of these websites list information such as where the physician trained (eg, medical school, hospital affiliations, board certifications), and what insurance plans he or she accepts. Some of this information comes from the American Medical Association while other information comes from partner websites such as Doximity.com. Healthgrades will conduct a background check that includes disciplinary actions, malpractice claims, and board actions.3
The majority of these sites use metrics to rate the psychiatrist, such as how easy it is to make an appointment, the friendliness of the staff, promptness of the physician, and how much time he or she spends with the patient. A typical rating scale ranges from zero to five stars. More significantly, an open comments section provides a platform for patients to state whatever they wish. Some sites allow anyone to rate and remain anonymous, while for other sites a valid email address is necessary to post reviews.
The implications of reviews are straightforward. Positive reviews help the online reputation of the physician, potentially increasing the number of patients who will contact the office to set up an appointment. Negative reviews will do the opposite. Many of these physician rating sites suggest several physicians with higher ratings for the prospective patient.
Implications of negative reviews
Given the impact on both reputation and referrals, what can physicians do to address this situation when negative reviews appear? One strategy is to hire a lawyer and sue the patient, which a New York gynecologist did when a patient posted negative reviews on Yelp.4 The patient took down the negative reviews, but the lawsuit persisted because the doctor stated that he suffered defamation, libel, and emotional stress. While this strategy may sound just and appropriate, in the field of mental health, some would consider this approach to be a bit draconian.
Hiring a professional firm such as Reputation Defender might also make sense.5 This firm says that they can help with search engine optimization so that positive reviews stay at the top search result and negative reviews are found on the last pages of the search. They accomplish this approach by creating new content and using metadata and link content on these pages to increase the presence of this content. However, this service comes at a cost of $3,000 to $25,000 per year depending on the number of personalized websites, professional content, and unique direct website desired. Keep in mind, they do not delete negative reviews, but help physicians to “bury” them.
Similarly, many of these physician rating sites offer premium accounts in addition to the free ones. Besides providing higher search result placement, they offer additional tools that may mitigate the negative review. They do not allow for negative reviews to be deleted as that practice would impact the integrity of the review platform. Instead, they improve attention to the profile by eliminating advertising and competitor ads. Healthgrades Advanced is $65 per month and Healthgrades Premium is $780 per month. Healthgrades Premium also provides the ability to promote your practice profile on other physician profile pages as well as to be featured on the website. Patient testimonials are utilized to combat anonymous negative reviews.
What you can do
The solutions discussed above involve a significant investment of time, energy, and capital. There are other options available with a little effort. While it may appear to be colluding with the enemy, physicians should claim their profile on the various physician rating sites. One reason to do so is that there may be erroneous information about your practice that may impact how patients perceive your practice.
Another reason is that a more accurate site will be higher on search engine hits. It sounds counter intuitive to help a site with negative reviews appear higher in search findings, but it is better exposure for your practice online. One thing to consider regarding negative reviews is that if the comments are full of vitriol, then many rating sites will consider removing these posts because they don’t wish to be perceived as a platform that enables scathing comments because it will diminish their reputation as well. They believe that a negative review should be factual such as “the psychiatrist was consistently running 30 minutes late for appointments” versus ‘the psychiatrist was a jerk and didn’t give me the time of day.”
It is common knowledge that most patients who post reviews are those who are dissatisfied with the service. Often, the psychiatrist knows exactly which patient wrote the anonymous post because of an identifying feature. For example, the patient didn’t get the medication he or she was seeking.
While it sounds like making lemonade out of lemons, it is important to keep in mind that prospective patients who read a negative review regarding denial of medications and decide to not make an appointment are likely patients whom you may not want as a patient anyway. A savvier prospective patient may choose to make an appointment with you because he or she understands that the person who wrote the negative review may have an ulterior motive such as drug seeking and find that the you were correct in declining to participate in the abuse.
You may be tempted to ask patients that you know appreciate your care to post reviews to drown out the negative ones. This strategy sounds appropriate, but it is risky because asking patients for reviews may be a boundary crossing in the psychiatrist-patient relationship. It is better to have a card or sign in the office waiting room with a link to a physician review site for all reviews, not just positive ones. Likewise, office staff should not prompt or remind patients to review the practice, which will appear to be coercion.
Staff and other colleagues could technically post positive reviews as well, but that would be disingenuous. Unlike retailers who often respond to negative reviews online, it is recommended that physicians and staff do not respond to reviews online because a response may lead to a HIPAA privacy breach because of the public nature of such communications. Instead, if a physician can ascertain the identity of the patient who posted a negative review, it is reasonable to engage with the patient in person with an open and nonconfrontational manner to better understand the patient’s concerns.
It is easy to create your own content online without spending extravagant amounts of money. A blog that highlights your professional activities or articles that you find interesting to read is easy to create on services such as WordPress. Registering a URL is fairly inexpensive, and today’s technology has made website creation easy without any programming skills.
By creating a website with links to physician rating sites that have more positive reviews as well as other social media such Twitter or LinkedIn, these sites will be placed higher on search engine hits over time. These “homemade” tactics will work just like hiring a professional service, no different from deciding to change the oil in the car yourself versus going to an automotive service shop.
The sting of negative reviews online hurts both professionally and personally. Feelings such as betrayal, shame, or disgust will certainly be evoked by negative online reviews. It is all too easy and understandable to fall into the void of negativity. However, you must remain objective and process your feelings. It is helpful to commiserate with trusted colleagues, especially those who have experienced the same situation. The challenge is to take that leap of faith that your colleagues won’t judge you but have empathy for your negative experience. Stay positive and well-balanced, understand that there are many patients who have benefited from your care and typically the disgruntled few use the physician rating forum to vent and bully you.
Given that social media can be taken out of context, it is better to share in person than to vent online with your peers. The court of social media is often too quick to judge before all the facts are available. For that reason, while it may be tempting to be open and share your feelings and experiences on all your posts, it may be wise to stay professional and neutral to political and social issues. Unfortunately, it comes down to the perception-not the intent of your post, which you have little control over.
Damage to your online reputation is unfair and much too easy to accomplish with the easy to use tools that the Internet has today. It is important to be resilient and keep in mind that it is a new climate to which we must adapt. Bullying hasn’t gone away but has found a new avenue on the Internet. We can take some comfort in that physician rating sites today have an Achilles’ heel. There are too many of them and most practices and physicians have a paltry number of reviews.
Dr Luo is Chief Medical Information Officer, University of California Riverside School of Medicine. Dr Luo reports no conflicts of interest concerning the subject matter of this article.
1. O’Reilly T. What is Web 2.0. 2005. https://www.oreilly.com/pub/a/web2/archive/what-is-web-20.html. Accessed April 2, 2019.
2. Google Trends. Health. https://trends.google.com/trends/explore?date=all&geo=US&q=health. Accessed April 2, 2019.
3. Healthgrades. https://www.healthgrades.com. Accessed April 2, 2019.
4. Rozner L. Manhattan Doctor Sues Patient For $1 Million For Posting Negative Reviews Online. 2018. https://newyork.cbslocal.com/2018/05/29/million-dollar-online-review-lawsuit/. Accessed April 2, 2019.
5. Reputation Defender. https://www.reputationdefender.com/lp/business/. Accessed April 2, 2019.