The Internet

Physicians from coast to coast and in Canada are voicing concern over Web sites and medical Web logs (“blogs”) that publish negative comments from patients about their physicians.

Other industries, such as restaurants and retail stores, have been regularly reviewed online for years, but now some business ratings and review sites (such as San Francisco–based Yelp) have expanded to include physicians. Recently, there has also been an increase in the number of Web sites that focus exclusively on physicians, including www.ratemds.com, www.drscore.com, and www.ratemydoctor.net .

These sites provide consumers with a forum for rating physicians on a variety of experience points, including bedside manners, waiting times, and treatment choices. In reviewing some of the ratings, it appears that prescriptions are a frequent source of consumer frustration, with complaints ranging from difficulty in obtaining refills to the physician’s choice of medication. Other complaints center on insurance issues, like the amounts of co-pays or co-insurance. Patients also express anger over physicians who drop a particular insurance plan or choose not to contract with any insurance plan at all.

A business ratings and review site might provide a way for a physician to respond to a negative comment, but it’s unlikely that the site will remove the comment. Physicians can encourage their patients to post positive comments on these Web sites as well, but each site determines which comments to post. The sites might even choose not to post positive comments—especially those they identify as originating from the physician’s office computer.

In the March 2007 issue of Plastic Surgery News, Neal Reisman, MD, JD, a practicing plastic surgeon in Houston, states, “Patients who use the Internet to damage a plastic surgeon’s practice usually have one of two motives: They are angry over their real or perceived treatment by the physician or staff and feel compelled to lash out in any manner at their disposal, or they have demanded a refund and/or other financial compensation for work they deem to be substandard—contrary to objective standards—and they want to exact revenge in a public forum when their demands are not met.” Dr. Reisman adds, “The anonymity of blogging and the difficulty in assigning legal responsibility—or what should be held responsible—make it hard to hold accountable the people who post negative statements and the entities that post them.”

Many physicians wonder how these sites can legally post such inflammatory remarks against a physician, but the protections available to them include the First Amend-ment. There is also 47 USC Section 230, which provides federal immunity to any cause of action that makes service providers liable for information originating with a third-party user of the service. (See Zeran v. American Online, Inc., 129 F. 3d 327, 330 [4th Cir. 1997].)

A very practical concern when trying to fight a blog or a business rating and review site is the fact that responding to a negative comment may just draw more attention to it and increase its online profile. Having said that, however, there is an ever-growing interest in the development of Internet law to somehow control “consumer” comments that might be proven in a court of law to be defamatory.

Until that time comes, what can physicians do about these reviews?

Provide a Forum for Patients to Address Their Concerns, and Encourage Patients to Use It
Patients who have no other avenue for expressing their concerns and frustrations might turn to review sites. A simple way to encourage feedback in your office is to place a suggestion box in a convenient location. At the end of each visit, ask if the patient or family has any concerns or questions.

Develop a Policy for Handling Complaints
Complaints should be reviewed carefully and routinely and responded to in a timely manner.

Utilize a Patient Satisfaction Survey
Patients can rate their encounter with your practice and provide you with valuable feedback about both you and your staff.

Review Websites Regularly
Use a search engine, such as Google, to identify sites where your name or the name of your practice can be found. Review these Web sites for positive and negative comments, and learn from both. Make it an interactive process with your patients.

Design Your Own Website
Patients are searching the Internet for physicians. Creating your own Web site gives you a chance to showcase your education, certifications, practice philosophy, and personality.

Buy Domain Names
For a relatively inexpensive price, you can buy all of the domain names that are close to your name or your practice’s name. (Godaddy.com is an example of where you can buy domain names.)

Remember that image control begins with the patient’s first encounter with your office. Generally, that means the patient’s first impression of you is made by your office staff, so make sure that it is a good impression. Encourage your staff to make eye contact with the patient and to offer a friendly greeting. Educate your staff on communication techniques.

The Internet is expanding from being not only a source of consumer information about businesses but also the preferred method of obtaining information about physicians. While you may not be able to control negative information on blogs or physician review sites, you can monitor the sites as you might monitor your own credit report. Take charge of your image by creating your own Web site. Finally, provide high-quality care in a manner that promotes patient satisfaction.