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You've been criticized online — Now what? Monitoring your online reputation

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The Internet has empowered patients, allowing them to look up their symptoms, do a good job of informing themselves before an office visit, and take more responsibility for their care. (1)

The Internet has also become a place for patients to voice their dissatisfaction with their physicians and the treatment they receive. Some patient blogs have become settings for patients to denigrate their physicians.

Consider the following sequence of events. A patient, disappointed with a medical outcome, launches a blog that includes professional and personal attacks against the physician. Other "anonymous" patients join in and post negative comments. The physician's staff, patients, colleagues, and family all see the comments. When the physician performs a Google search for the name of the practice, the negative comments come up third on the list. Many physicians have found themselves in a similar predicament. When it comes to online, anonymous comments, what recourse do physicians have? This article will explore the actions that physicians can consider taking if they are attacked online with negative comments.

LET IT GO

False personal attacks are ugly and cause distress. The attacks sting even more when they are made on the Internet for all the world to see. However, according to risk management and claim management staff at TMLT, the best action for the physician may be to ignore the comments.

"This is hard for physicians to hear, but because of health care privacy laws, physicians cannot respond online," says Jane Holeman, vice president of risk management at TMLT. "The risk of violating HIPAA is real. By responding online you are acknowledging that this is your patient."

HIPAA requires physicians to protect the identity of their patients. According to an article from the Dallas Medical Journal, "privacy laws in health care will not allow physicians to defend themselves in the same manner. The fact that even a patient's identity is protected information directly hinders the physician's ability to refute a complaint. Simply acknowledging publicly that the complaining party is a patient breaches confidentiality and violates HIPAA laws." (2)

To avoid violating HIPAA laws, some physicians may consider responding to the comments anonymously. This is also not advisable. There is no such thing as anonymity on the web. IP addresses (unique numbers that identify computers accessing the Internet) act as a fingerprint and can identify the user's computer. "Physicians should also consider that whatever you write cannot be taken back and may remain on the Internet for a very long time," says Holeman.

If the complaints indicate that the patient is considering legal action, the physician should contact his or her medical liability insurance company as soon as possible. "If a patient makes an accusation of medical malpractice, it is even more important that you do not reply online," says Jill McLain, senior vice president of claim operations at TMLT.

"Anything said in response could be used in the claim against the physician." Physicians, understandably frustrated with the situation, may ask themselves what they can do in the face of online criticism. "One option is to ask yourself if the patient has a point," says McLain. "Take a look at the comments and see if there is a grain of truth to them. Is there room for improvement in your care or office policies?"

Physicians can also consider giving patients more constructive ways to offer their feedback. "Conducting a patient survey, for example, would be a good way for patients to express their dissatisfaction and feel empowered," says McLain.

When investigating complaints, Holeman advises that physicians ask the following questions. Is the complaint legitimate? Was the problem with a procedure, a staff member, or the patient's wait time? Can action be taken to fix the problem?

"It can also be helpful to tell patients that they can contact you if they are disappointed with their care. This keeps the door open and lets patients know that you care about their experience in your practice," says Holeman.

DISCUSS THE MATTER IN PERSON

Another option is available if the physician can identify the patient making the complaints — talk to the patient directly. This can be done over the phone or in person, but the conversation should not occur via email because the email could end up on the Internet.

"When it occurs, this conversation should proceed with caution," says Holeman. "The physician-patient relationship has obviously been damaged, otherwise the patient would not be posting negative comments on the Internet. Begin by asking the patient why he or she is dissatisfied."

In some cases it may not be possible to repair the physician-patient relationship. "The relationship between a physician and a patient is based on trust; a patient who posts complaints is communicating to everyone reading that he or she does not trust the physician. The physician should evaluate the patient-physician relationship and determine if the level of trust is enough to promote the highest quality of care." (2)

CONTACT THE WEB PUBLISHER

Physicians can also try to contact the web publisher and ask to have the comments removed. A publisher may be convinced to remove the comments if given a good reason.

When contacting a web publisher, sending an email is fine, but a phone call may work better. The physician should ask for the web publisher's content removal policies, which will help determine the best way to approach the request. Before making a request, the physician should gather the evidence, present the evidence, and be mindful of his or her tone of voice. (3)

TAKE LEGAL ACTION

Individuals who have been defamed on the Internet and who have tried to take legal action against web publishers have met with little success. Web developers can take advantage of the protections in the Communications Decency Act of 1996. The act "provides immunity to sites, so the hosts are not responsible for what the users post." (4) The immunity is usually absolute unless the physician can show that the publisher was actually the source of the disparaging comments.

In spite of this, if certain conditions are met, a physician can try to sue for libel. "If a physician is identified, and if he or she can prove damages and that the statement is untrue, then there may be a case for libel," says Jill McLain. Any physician considering a libel suit should first consult an attorney experienced in defamation litigation.

However, libel cases are costly and time consuming, and there is often no benefit to the physician except to have the negative comments taken down. (2) "There have been cases of physicians suing hospitals or other physicians for slander or libel over conflicts during peer-review or credentialing. These cases had mixed results." says McLain.

Before considering legal action, McLain reiterated, "Take an honest look at yourself and your practice and determine if there is room for improvement. Take steps to improve your practice and let your patients know those steps."

CONCLUSION

It is safe to assume that some of your patients are active on blogs and other patient comment sites. To find out what is being said, conduct web searches on yourself and your practice regularly. If you maintain a web site, it should come up first on the search. Review the first 30 hits of the search. (Any hit past 30 is generally considered extraneous and not likely to be read.) (5) Among the top 30 hits, what are these sites saying about you? Continue to monitor these online discussions.

Only a small minority of patients post negative online comments. The Internet also offers many opportunities to physicians. Start your own web site to highlight your practice. Learn to use the Internet, blogs, and Google searches to your advantage; they can help you cultivate a positive brand and market to new patients. Becoming active on the Internet is one way to manage your online reputation before it manages you.

WHERE TO SEARCH

The following sites can be used to search for comments about your practice.

SOURCES

  1. Wald HS, Dube CE, Anthony, DC. Untangling the web — the impact of Internet use on health care and the patient-physician relationship. Patient Education and Counseling. 2007; 6:218-224.
  2. White B. Satisfaction Ratings: patients reporting on quality. Dallas Medical Journal

    . 2008; 94 (7). Available at http://www.dallas-cms.org/ss9/bizmed/07-08.html. Accessed April 29, 2009.

  3. Mayor T. Erasing your tracks. Computer World. November 17, 2008.
  4. Ali L, Ramirez J. Google yourself — and enjoy it; a host of new companies are offering to polish and shine reputations online. Newsweek. February 18, 2008.
  5. Hoffman T. Online reputation management; cleaning up your image is hot, but is it ethical? Computer World. February 12, 2008.