Texas Medicine: Physicians Can Help Shape Their Presence On Influential Online Rating Sites

Physicians Can Help Shape Their Presence On Influential Online Rating Sites 

Joey Berlin, Associate Editor, Texas Medicine 

March 2017 

Volume 113, Number 3, Pages 33-40 

Chances are, by now, most physicians know online review sites allow patients to post a review of their doctor visit the same way they might review their car mechanic or a local restaurant.

Maybe you think review repositories like Yelp or medicine-specific review sites like Health Grades are mainly places for crabby customers or patients to complain. With that perception in mind, perhaps you think the minuses of setting up a profile on a review site outweigh the pluses, and you don’t even want to get involved in the online review racket. Or maybe you’re undecided about whether to do so.

That’s too bad because, in effect, the internet already has decided for you. You already have an online presence, and you can decide to shape it, says Nashua, N.H., internal medicine physician Kevin Pho, MD, an author and blogger who focuses on social media in health care. And, in fact, research has shown patients don’t just use online reviews to air grievances. “What these sites will do is create profile pages of every single doctor, whether these doctors want one or not,” said Dr. Pho, the founder of the health blog KevinMD.com and a scheduled speaker at TexMed 2017 May 5–9 in Houston.

A February 2014 Journal of the American Medical Association (JAMA) article reported 35 percent of prospective patients who sought online reviews chose a physician based on good reviews from a ratings site, and about the same percentage took negative reviews as a cue to look elsewhere for their care.

If physicians aren’t aware that those profiles of them are already out there, Dr. Pho adds, “that’s going to be the first impression of them online. When patients Google their doctors’ names, there’s a possibility that these rating sites may come up first, and that will form these patients’ first impressions of the doctor. That’s why it’s imperative that they be proactive.”

Being reactive is important, too. But when physicians and practices react to something they see online ― say, a viciously critical review ― they also must be careful to react in the right way. 

Owning Your Presence And Learning The Sites

Dr. Pho and medical content strategist Susan Gay coauthored the 2013 book Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. The book notes most review sites pull information on medical practices from commercially available databases, so those practices already will be listed on the sites without any effort from the physician to establish a presence on them.

The review sites generally operate in a similar fashion, Dr. Pho notes. Most of them allow physicians and practices to “claim” their profiles, which allows them to personalize those profiles with photos, a description of the practice, credentials, and other information. Doing so is an important piece of taking command of an online presence, Dr. Pho says.

Kyle Bickling, practice manager for Eye Institute of Austin, says the ophthalmology practice tries to give review site searchers a snapshot of the services it offers. Eye Institute’s page on Zocdoc, for example, has a practice summary, list of specialties, its in-network insurance plans, and pictures and credentials for physicians. “We want to make sure that patients know and can easily find out what sort of a practice we are, where we are, what sort of broad-picture services we offer,” Mr. Bickling said.

Although the review sites operate similarly ― usually allowing a user to leave a practice a star rating, as well as a comment ― learning some of the nuances of each can prove valuable. The directory and review site Vitals, for example, allows a profile owner to hide two negative reviews, a useful tool to negate a patient whose criticism crosses the line. The site Health Grades has a similar option available to hide reviews, says Texas Medical Association practice consultant Brad Davis. “Some of them have a do-it-yourself vault where you can put X number of items in there, whereas some of them have an appeals process for reviews, so you want to know how those sites work so you can deal with each accordingly,” he said.

Other popular medicine-specific rating sites include http://www.ratemds.com, http://www.healthcarereviews.com, and http://www.drscore.com.

If you’d rather a prospective patient’s first impression of your practice not come from review sites, you can take steps to minimize that from occurring. While search engine optimization (SEO) professionals hinge their reputations on favorably portraying a client or employer on Google, physicians and practices can potentially do some leveraging of Google on their own without any SEO expertise. The easiest way, Dr. Pho says, is to generate online content about yourself and your practice. (See “Reaching Patients Across the Web,” December 2015 Texas Medicine, pages 33–38.) He says a great way for physicians to get started is simply to establish a profile on either the general professional social networking site LinkedIn, http://www.linkedin.com, or the health care professional network Doximity. Great SEO-shaping potential also comes from generating content on Twitter, Facebook, or a blog, he says. “It depends on how big you want your digital footprint to be; obviously, the bigger, the better, so the more social media platforms that a doctor engages in, the bigger their online presence will be,” Dr. Pho said. “And not only will that expand their digital footprint, it’s going to push down the visibility of third-party rating sites.”

TMA recommends physicians set up Google Alerts to be notified when their name or their practice’s name is mentioned online. For more tips on managing your online presence, check out Get Social: Put Your Practice on the Social Media Map, a TMA book offering a road map for physicians looking to begin or to improve their social media experience.

TMA Practice Consulting can also help your practice make its mark online with its new Online Visibility Assessment. (See “Online Visibility.”) In July, TMA will host a modern marketing seminar that shows physicians how to properly leverage their online presence, refresh their current marketing strategy, and more. (See “TMA Modern Marketing Seminar.”) And for website and internet marketing assistance, Officite, a TMA-endorsed vendor, can help. (See “Marketing Help From Officite.”)

Reacting The Right Way

Dr. Pho offers five tips to handle online reviews:

  1. Listen to or read the review,
  2. Take the conversation offline,
  3. Read the fine print on a review site,
  4. Ask more patients to rate you online, and
  5. Don’t sue over a negative review.

Seeing what patients say can provide valuable insight into not just what they think of you but also what they think of the entire experience.”If you look at negative reviews, it’s not necessarily the doctor himself or herself,” Dr. Pho said. “It could be the support staff. It could be the nurse. It could be the medical assistant. It could be the fact that there’s not enough parking. It could be the fact that the magazines in the waiting room aren’t up to date. And it’s important for physicians to be aware of problems in a practice that they may not have been aware of previously.”

Eye Institute of Austin always tries to reach out to any patient who posts a negative review, Mr. Bickling says. “The more positive reviews we have, the shout-outs from patients about specific individuals or specific functions of our practice, it’s always great affirmation and a way for us to see that, hey, we’re doing the right things. And typically, if it’s a negative review, it may just be something where we missed the mark service-wise. It could be something as simple as we had a really long wait time one day.”

Taking the conversation offline has another implicit meaning: Don’t respond online to the treatment-related specifics of a negative review. If the physician can identify the patient who posted a scathing review, he or she can reach out privately to the patient to address and, if necessary, rectify the problem the patient had. That’s preferable to getting into a damaging, public back-and-forth that could also introduce potential patient confidentiality violations.

A ProPublica/Washington Post story last May detailed instances in which health care practices fought back against online reviews and appeared to violate HIPAA in doing so. Marisa Speed, the mother of a 3-year-old, posted a review of Phoenix’s North Valley Plastic Surgery several years ago after her son received stitches for a gash on his chin. Ms. Speed wrote that the physician “seemed flustered with my crying child” halfway through the procedure, then “ended up throwing the instruments on the floor. I understand that dealing with kids requires extra effort, but if you don’t like to do it, don’t even welcome them.”

An employee for North Valley responded online: “This patient presented in an agitated and uncontrollable state. Despite our best efforts, this patient was screaming, crying, inconsolable, and a danger to both himself and to our staff. As any parent that has raised a young boy knows, they have the strength to cause harm.”

That response prompted Ms. Speed to complain to the U.S. Office for Civil Rights (OCR). The office declined to undertake a formal investigation but sent North Valley’s privacy officer a letter asking the practice to examine the situation and ensure compliance. OCR told the practice it “may wish to remove any specific information about current or former patients from your web-blog.” OCR told Ms. Speed if North Valley “fails or refuses to take steps to address this concern,” it may need to contact her as part of a formal investigation.

Writing a quick online response to a positive review is good practice, the Online Reputation book says, but to stay HIPAA-compliant, ask patients for their permission to respond before posting.

The book says physicians can respond generally to negative reviews in a public forum without violating patient privacy laws if they’re responding to complaints about aspects of the visit, such as wait times or inadequate parking. Physicians can explain those aspects without confirming or denying that the reviewer was a patient. Also, if a physician reaches out to the patient and gets written consent, the practice can post a public response or apology, showing readers of the site that he or she is listening to patients.

Dr. Pho’s third tip, reading the fine print, essentially means knowing what the review site’s policies are so you’ll know what your options are if a disgruntled patient does something out of bounds, such as posting multiple negative reviews. As Get Social notes, some sites will allow the subject of a profile to flag reviews as inappropriate and will consider removing such reviews. “You want to report any comments that you think are suspicious because whenever patients post multiple times, that goes against the terms of service agreements for these sites,” and that can lead to the site removing the review, Dr. Pho said.

However, Mr. Davis cautions you to “pick your battles” when it comes to appealing a review. “If it’s not a good review, but it’s a legitimate concern and something that happened, I would say you have to let it go at some point,” he said. “If you start to appeal too many of them, I think you’re going to red-flag yourself. Yelp might start thinking that you’re just appealing every bad review, that there’s no validity now to what you’re saying.”

Dr. Pho says multiple studies have shown the majority of online reviews are actually positive. That’s why physicians should encourage all their patients to write one, instead of dreading it, he says. Get Social notes a 2012 report in the Journal of Medical Internet Research that found nearly half of all physicians get perfect online ratings, and Yelp reported in late 2013 that two-thirds of all reviews on its site were four- and five-star ratings. “If you ask all your patients to rate you online, chances are those reviews in aggregate will be positive and can make negative reviews more like outliers,” Dr. Pho said.

The fifth tip stresses that a physician pursuing a lawsuit over negative ratings is a high-risk, costly, and ill-advised move. Establishing, Managing, and Protecting Your Online Reputation highlights the case of Minnesota neurologist David McKee, MD, who sued over negative online comments the son of a stroke patient posted in 2009. Dr. McKee sued for defamation, claiming the poster also made false statements to the American Academy of Neurology and the American Neurological Association. A four-year legal battle concluded with the Minnesota Supreme Court dismissing the case in January 2013.

The book said Dr. McKee’s case created a media firestorm and became an example of the Streisand effect, a term for an attempt to suppress a piece of online information that actually results in the information garnering more publicity. The term derives from a Barbra Streisand lawsuit against an organization that published an aerial photo of the singer’s house.

“Whenever McKee’s name is put into a search engine, the publicity generated by his lawsuit will be featured prominently in the search results,” Dr. Pho and Ms. Gay wrote. “By suing the patient, not only is the outcome of the suit in doubt, but he actually made the situation much worse. No matter what kind of merit you think a case might have, doctors who sue patients for online ratings are going to lose in the more influential court of public opinion. Better that doctors take some slanderous lumps online, and instead, encourage more of their patients to rate them.”

What about preparing for litigation from the other side? If an online review hints that the patient is considering legal action, the Texas Medical Liability Trust recommends physicians contact their attorney and their medical liability insurance company immediately..

Encouraging Reviews

Get Social advises physicians to simply Google their own names and find out which rating sites show up at the top of the first page of that search. The physician can then consider passing out a handout or poster asking satisfied patients to post a review on one of those top sites. “All of that will leave you with a healthy balance of positive to negative online ratings,” Get Social states. “Prospective patients surfing for information about you will encounter a much more complete picture of you and your practice.”

There are still plenty of patients out there who don’t trust online reviews. The February 2014 JAMA study found that of patients who hadn’t sought physician rating sites, 43 percent said it was because of a lack of trust in the information they provide. But 59 percent of respondents said physician rating sites were “somewhat important or very important,” so being mindful of what the reviews say makes sense.

Mr. Bickling says the best way to generate good online reviews is to focus on the entire patient experience and make sure everyone in the office is working toward that goal. “You could have amazing doctors across the board who provided a phenomenal visit for every single patient every single time, 100 percent of the time,” he said. “And if that patient has a negative experience with your check-in desk or your checkout folks or your billing department or your optical department, whoever it may be, any sort of negative experience anywhere can ruin an entire visit for that patient. That’s why it’s so important to have the entire practice on board with that.”

Joey Berlin can be reached by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.

SOURCE

Defendant Dennis Laurion’s Web Posting

Defendant Dennis Laurion’s Patient Complaint

Plaintiff David McKee’s Reply To Patient Complaint

Plaintiff David McKee’s Cease And Desist Letter To Defendant Dennis Laurion

Defendant Dennis Laurion’s Complaint To Minnesota Board Of Medical Practice

Plaintiff David McKee’s Complaint To Sixth Judicial District Duluth Court

Plaintiff David McKee’s Response To Minnesota Board Of Medical Practice

Defendant Dennis Laurion’s Answer To Plaintiff David McKee’s Complaint

Defendant Dennis Laurion’s Motion For Summary Judgment

Defendant Dennis Laurion’s Deposition Extracts

Plaintiff David McKee’s Deposition Testimony About Circumstances Before Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony About Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony About Circumstances After Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony In Response To Questions By Marshall Tanick

Affidavits By Defendant Dennis Laurion’s Parents

Defendant Dennis Laurion’s Supplemental Motion For Summary Judgment

Plaintiff David McKee’s Motion To Oppose Summary Judgment

Defendant Dennis Laurion’s Reply Memo In Support Of Motion For Summary Judgment

Sixth Judicial District Court’s Order On Motion For Summary Judgment

Plaintiff David McKee’s Appeal Of Order On Motion For Summary Judgment

Plaintiff David McKee’s Brief To Minnesota Court Of Appeals

Defendant Dennis Laurion’s Brief To Minnesota Court Of Appeals

Plaintiff David McKee’s Reply Brief To Minnesota Court Of Appeals

Minnesota Court Of Appeals Order To Strike Portion Of Plaintiff David McKee’s Reply Brief

Minnesota Court Of Appeals Announces Decision

Defendant Dennis Laurion’s Petition For Review By Minnesota Supreme Court

Plaintiff David McKee’s Opposition To Review By Minnesota Supreme Court

Defendant Dennis Laurion’s Brief To Minnesota Supreme Court

Plaintiff David McKee’s Brief To Minnesota Supreme Court

Defendant Dennis Laurion’s Reply Brief To Minnesota Supreme Court

Minnesota Supreme Court Decision On David McKee MD V. Dennis K. Laurion

David McKee MD v. Dennis Laurion 2010

David McKee MD v. Dennis Laurion 2011

David McKee MD v. Dennis Laurion 2012

David McKee MD v. Dennis Laurion 2013

David McKee MD v. Dennis Laurion References And Precedents

Healthcare Employment Counsel: Defamation Claims By Medical Providers

FEBRUARY 5, 2013

“Defamation Claims By Medical Providers”

Breanne Sheetz, Healthcare Employment Counsel

The Minnesota Supreme Court recently held that statements posted by a patient’s son online describing rude and insensitive behavior by a neurologist, and a comment allegedly made by a nurse, were not defamatory. Hospitals and other healthcare employers, however, should remain cautious about the potential for defamation lawsuits when making personnel decisions.

Gossip (Isolated)

In McKee v. Laurion, a neurologist sued his patient’s son for defamation because of statements the son posted on various “rate your doctor” websites and letters of complaint he sent to medical institutions. Among the allegedly defamatory statements was a comment by an unnamed nurse who allegedly stated that the physician “is a real tool.”

Image-Doctor-With-Tool

This statement, the court held, was “pure opinion,” protected under the First Amendment because “it cannot be reasonably interpreted as stating a fact and it cannot be proven true or false.” The court rejected the physician’s argument that the possible fabrication of the existence of the nurse and the statement attributed to her created a genuine issue of fact as to the falsity of the statement, which is one of the elements of a defamation claim. Regardless of whether a nurse made the statement, the court concluded, it could not give rise to a valid defamation claim because the statement itself was an opinion and therefore “incapable” of being defamatory.

In contrast, earlier a California appellate court found that an alleged statement by hospital management that a surgeon is “incompetent” and “needs more training” was not an opinion and could constitute defamation because it could be proven true or false. Indeed, the trial court had conducted an evidentiary hearing to evaluate the doctor’s surgical technique and judgment, and determine the truth or falsity of the statement. Because the hearing established that the doctor’s surgical technique was substandard and his medical judgment was poor, the appellate court found in favor of the hospital on the doctor’s defamation claim, noting that truth is a complete defense to civil liability for defamation.

Although defamation claims are most often unsuccessful, employees, including medical providers, frequently allege defamation as part of wrongful termination lawsuits. If an employee prevails, the cost can be extremely high, particularly when a highly paid physician brings the suit. For example, a jury in Texas awarded an anesthesiologist $9.8 million in a lawsuit against his former employer, a hospital, for defamation and breach of contract. The hospital had accused the anesthesiologist of drug and alcohol abuse and medical incompetence, and fired him when he refused to submit to a peer review or to modify his employment contract. However, the hospital’s impaired physician program cleared the anesthesiologist of all charges. Based on the program’s findings, the hospital couldn’t shield itself from liability by claiming the statements were truthful.

Employees may also claim that the reason provided by the employer for termination is defamatory, whether it is communicated internally within the company, to a potential new employer, or even just to the employee. For example, some states, including Minnesota, Texas, California, and New York, have recognized the doctrine of “compelled self-publication,” which creates a cause of action when a defamatory statement is communicated only to the employee and the employee is compelled to publish the defamatory statement to a third person, such as a prospective employer. This doctrine has so far been applied narrowly, but nevertheless presents another potential claim that terminated employees can assert against their former employers.

The federal Health Care Quality Improvement Act (HCQIA) and some state laws may also protect statements made in the context of a “professional review action,” such as a peer review, if all of the statutory requirements are met, including a reasonable effort to obtain the facts of the case and the provision of notice and the opportunity for a hearing. To reduce the risk of defamation claims and other potential claims relating to the termination of hospital privileges or other adverse actions, healthcare employers are advised to consult with counsel when faced with disruptive or problem physicians or employees to understand potential claims and defenses, including the requirements for immunity from liability under the HCQIA and similar state statutes.

Breanne M. Sheetz advises and represents employers in a broad range of employment law matters arising under federal and state law. She has particular expertise with Wage and hour class and collective actions,Discrimination,Harassment, Retaliation,Wrongful discharge,Breach of contract. She regularly represents clients before federal and state courts and administrative agencies, as well as in arbitration. She has litigated numerous large-scale Fair Labor Standards Act collective actions in federal courts across the country.

Source Health Care Employment Counsel

Source Littler Employment And Law Solutions

Defendant Dennis Laurion’s Web Posting

Defendant Dennis Laurion’s Patient Complaint

Plaintiff David McKee’s Reply To Patient Complaint

Plaintiff David McKee’s Cease And Desist Letter To Defendant Dennis Laurion

Defendant Dennis Laurion’s Complaint To Minnesota Board Of Medical Practice

Plaintiff David McKee’s Complaint To Sixth Judicial District Duluth Court

Plaintiff David McKee’s Response To Minnesota Board Of Medical Practice

Defendant Dennis Laurion’s Answer To Plaintiff David McKee’s Complaint

Defendant Dennis Laurion’s Motion For Summary Judgment

Defendant Dennis Laurion’s Deposition Extracts

Plaintiff David McKee’s Deposition Testimony About Circumstances Before Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony About Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony About Circumstances After Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony In Response To Questions By Marshall Tanick

Affidavits By Defendant Dennis Laurion’s Parents

Defendant Dennis Laurion’s Supplemental Motion For Summary Judgment

Plaintiff David McKee’s Motion To Oppose Summary Judgment

Defendant Dennis Laurion’s Reply Memo In Support Of Motion For Summary Judgment

Sixth Judicial District Court’s Order On Motion For Summary Judgment

Plaintiff David McKee’s Appeal Of Order On Motion For Summary Judgment

Plaintiff David McKee’s Brief To Minnesota Court Of Appeals

Defendant Dennis Laurion’s Brief To Minnesota Court Of Appeals

Plaintiff David McKee’s Reply Brief To Minnesota Court Of Appeals

Minnesota Court Of Appeals Order To Strike Portion Of Plaintiff David McKee’s Reply Brief

Minnesota Court Of Appeals Announces Decision

Defendant Dennis Laurion’s Petition For Review By Minnesota Supreme Court

Plaintiff David McKee’s Opposition To Review By Minnesota Supreme Court

Defendant Dennis Laurion’s Brief To Minnesota Supreme Court

Plaintiff David McKee’s Brief To Minnesota Supreme Court

Defendant Dennis Laurion’s Reply Brief To Minnesota Supreme Court

Minnesota Supreme Court Decision On David McKee MD V. Dennis K. Laurion

David McKee MD v. Dennis Laurion 2010

David McKee MD v. Dennis Laurion 2011

David McKee MD v. Dennis Laurion 2012

David McKee MD v. Dennis Laurion 2013