You just got dinged by a negative review on a doctor review web site. What can you do to minimize the damage and keep your online reputation clean?

If you are an emergency physician and you Google yourself, you’ll find a host of companies offering the world a chance to “rate” you as a doctor. On a scale of 1 to 5 stars, “How would you rate your overall experience?” asks eHealthScores. “Does the provider listen to you and answer your questions?” asks HealthGrades. The internet is replete with these sites, and now even mega-review sites like Yelp have gotten in the mix, stacking physician reviews right next to write-ups on bars and nightclubs.

Most likely, you haven’t had to worry about these review sites yet. Overall, the majority of physician reviews online are positive and primarily impact providers in specialties where patients pick and choose their doctor. However, more and more, ED administrators are evaluating their employees’ online reputations when they’re thinking about job placement and promotion. If you’ve ever had a dissatisfied patient in the ED, you know the negative potential for a “review” site which allows reviewers to rant without revealing their identity. For these reasons, emergency physicians need to know how to manage an online reputation.

First, keep yourself informed; know what information is out there about you on the internet. Google yourself regularly and consider how you want to proceed with any comments you discover.  Ask yourself, how much real difference is there between getting 2 and 3 stars on HealthGrades? Probably not a lot. Was your name specifically mentioned in a tweet or blog post? Is the review – and this may require some soul searching – actually true?

Next, whether it’s true or not, you’re going to want to deal with this negative review for the sake of your future career. Unfortunately, when it comes to getting the review removed, your options are limited. First, if the poster can be identified, try contacting them directly. Be mindful of HIPAA and do not violate confidentiality. Offer your apology if necessary and attempt to resolve the situation. If you can reach a viable solution, the patient may retract or amend their review. If you cannot reach the poster, approach the site itself and ask for identification of the poster, in the name of resolving the issue at hand. Finally, depending on what exactly was posted, you can simply resolve the issue under complaint and post your resolution on the site, again being mindful of HIPAA. Often there is a section on review sites for people or institutions being reviewed to respond. This is commonly utilized on sites like TripAdvisor by hotels wishing to apologize or offer remedy to patrons who have had a bad stay. Finally, if none of this is possible, and if the review warrants further action, ask the site to remove the negative review since you are willing to address the issue but cannot.

If these approaches fail and the review is false, contact your institution’s risk management and legal departments to see what remedies they can offer. However, as the following examples demonstrate, taking negative reviewers to court can be an uphill and often losing battle. 

Suing an Individual for Libel
In 2008, a patient in California posted a Yelp! review alleging that his chiropractor used dishonest and fraudulent billing practices. The chiropractor asked the patient to alter the review.  The requests were ignored. The chiropractor decided on legal action and then sued for libel and false light -invasion of privacy. The two parties eventually settled. Could this happen to you in the ED? Sure; patients often do not understand billing and an individualized bill can cause tempers to flare. A prudent approach is to make amends with an upset patient as the chiropractor attempted in this case. However, if requests are ignored, legal means may be the next option.

Suing a Web Site for Libel
In 2009, Dr. Yvonne Wong, a California dentist, sued the consumer review site Yelp! and the parent of a patient who posted a negative online review.  Wong sued for libel, intentional infliction of emotional distress and negligent infliction of emotional distress. Eventually Wong dropped the claims against Yelp! because section 230 of the Communications Decency Act bars recovery against a website for publishing third-party content. The Sixth Appellate District eventually dismissed all claims against the parent. Adding insult to injury, the Superior Court applied California’s Anti-SLAPP (A strategic lawsuit against public participation) statute and ordered Wong to pay her opponents’ legal fees for a total of $80,741.15.  Thus, the negative reviews remained online, the lawsuit brought further public attention to the reviews and Wong had to cover the attorney fees of all parties involved.

When a Rant is Merely “Emotional Discussion”
In 2011, an upset family member alleged that a Minnesota neurologist failed to treat his father with dignity following a neurovascular accident. The family member not only expressed his opinion, but reached out to several parties to express frustration. The maligned physician determined that the harm to his reputation warranted legal action and filed a lawsuit for defamation and interference with practice for false statements made. The court held that there was no defamatory meaning in the statements, rather the statements made were an emotional discussion. The court eventually dismissed the suit. 

When an Upset Client Goes Off the Deep End
Some patients get really, really upset. And a tiny slice of those patients may be inclined to use their creativity – and technological know-how – to make your life miserable. In 2001, Dr. Barry Eppley, a plastic surgeon, found himself in an unfortunate situation after performing procedural work for a patient. The patient was so unhappy that he created multiple fraudulent websites in an internet campaign designed to convince potential patients that the surgeon was incompetent. As far-fetched as this might seem, current technologies and web-design platforms make this kind of identity theft frighteningly easy. The surgeon sued on the basis of harassment, trade disparagement, defamation, false descriptions of fact, and false light. The court held that the websites and posts would not be protected by the First Amendment because of the defamatory and false nature. The court ordered the patient remove any links and web pages until the conclusion of the lawsuit.

What’s a physician to do?
Healthcare consumers will continue to desire physician and hospital rating information and litigation by physicians and hospitals will meet with stiff opposition from the First Amendment. In the end, the recommendations are relatively simple. Google yourself, your ED department and hospital. Invite feedback from patients to provide a non-permanent, offline venue for rants. This may decrease the likelihood of negative reviews from ever appearing online and will provide an opportunity for mitigation and resolution before there is a real issue. Recognize that there are times when doing what the patient wants or what they perceive is best is not a viable option.  Reaching out to colleagues or administration with challenging patients can provide for damage control before an angry patient decides to rant on the internet about perceived maltreatment. The best defense comes from the oldest medical advice – treat your patients like family members and know that you cannot please everyone all the time.

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