Physicians Can Help Shape Their Presence on Influential Online Rating Sites

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Tex Med. 2017;113(3):33-40.

By Joey Berlin
Associate Editor

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 Healthgrades 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 Healthgrades 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 www.ratemds.com, www.healthcarereviews.com, and 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, 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.

SIDEBAR

Online Visibility

TMA Practice Consulting's new Online Visibility Assessment helps evaluate and educate physicians on cost-effective ways to improve their online presence. As part of the service, a TMA practice management consultant will help ensure the information your practice displays online is complete and up to date. A written gap analysis will highlight areas of potential improvement and provide step-by-step instructions on how to make those improvements.

Learn more about TMA Practice Consulting by calling (800) 523-8776, or by emailing TMA Practice Consulting.

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SIDEBAR

Marketing Help From Officite

Officite, a TMA-endorsed vendor, offers website and internet marketing services for medical practices. Officite helps physicians build their web presence and connect with patients using proven strategies and technologies to help physicians generate new patient referrals online.

Services include website design, search engine optimization, social networking, and management of patients' online practice reviews.  

 SIDEBAR

TMA Modern Marketing Seminar

More than 80 percent of patients start their search for a physician on the internet. Modern Marketing for Five-Star Reviews, a TMA live seminar scheduled for July 28 at the TMA building in Austin, will show you how to take control of your online presence, customize online review pages, leverage social media, and deploy the latest marketing tactics to reach a new generation of patients. 

Topics will include:   

  • What's your reputation, and why is it important? 
  • Determining visibility and how to improve it;
  • Responding to negative reviews;
  • Ways to refresh existing marketing; and
  • Referrals and other missed marketing opportunities.  

A live webcast of the seminar will also be available. You may register online or by calling toll-free (877) 880-1335. 

March 2017 Texas Medicine Contents
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Last Updated On

May 17, 2017

Joey Berlin

Associate Editor

(512) 370-1393
JoeyBerlinSQ

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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