Doctors’ Online Reputation Management and Patient Reviews (Talk Notes from ASAPS Annual Meeting)

By Eric Goldman

I recently spoke at the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Vancouver, BC. This is not a normal conference venue for me! (And given the number of fashion-conscious people at the conference, I stuck out like a sore thumb for more reasons than one). Last year, I was recruited to participate on a panel “Reputation Management–Managing Your Online Image” to cross swords with Dr. Jeffrey Segal, Medical Justice’s infamous CEO. It would have been an exciting session…except that Medical Justice “retired” its unacceptable approach late last fall, undercutting the main reason for my panel participation.

I nevertheless had the pleasure of meeting Dr. Segal, and no fisticuffs ensued, either physically or metaphorically. Medical Justice has totally reversed gears, and now they love patient reviews after trying to suppress them for four years. Unfortunately, Medical Justice screwed up the medical community with its persistent and mostly unrebutted advocacy for 4 years that patient reviews are evil. This miseducation really harmed the entire profession, and it will probably take years for the community to overcome the damage inflicted on it by Medical Justice and other anti-review naysayers.

As dramatic evidence of that, numerous entrepreneurs (including, I believe, Medical Justice) are helping doctors collect patient reviews through a centralized collection mechanism that, among other things, lets doctors review and spike patients’ reviews before posting those reviews on patients’ behalf to review sites. [UPDATE: Dr. Segal emailed me to indicate that Medical Justice's system passes through all reviews without giving doctors a veto.] Seriously, guys? The only advantage of this system is that the collection mechanism can authenticate review-submitters as actual patients of the doctor, but every other aspect of a mediated collection mechanism is bad news for patients, prospective patients and society at large. Doctors remain so petrified of organic word-of-mouth that they still feel the need to insert themselves in the middle of the process. Let it go, guys!!!

I made some notes before my talk, appended below. I also posted a reasonably comprehensive chart of doctor v. patient lawsuits over online reviews with the outcomes of those lawsuits to the best I could determine (if I’ve missed any lawsuits I should be tracking, please email me). I spoke fourth on the panel, so a lot of my remarks were preempted by the time we got to me. So here’s what I would have said if I had been first on the panel:

_______

My talk notes:

1) Doctors are often initially skeptical of patient reviews. Why?

• Doctors may take reviews personally (true of most small business owners)

• Most patients aren’t expert evaluators of medical advice (also true of all professional service providers).

– especially in aesthetic plastic surgery, where the outcomes may be inherently subjective

– but many patient reviews don’t critique issues requiring medical expertise

• Patient confidentiality (e.g., HIPAA) may limit doctors’ ability to respond (confidentiality restrictions apply to many professional service providers)

• Historically, doctors’ marketing efforts haven’t tied directly to patient satisfaction. Insurance programs, peer referrals and individual word-of-mouth were much more important. Specialty doctors often had de facto geographic monopolies

• Negative reviews can cost doctors money. This is especially for elective procedures (like aesthetic plastic surgery) where many doctors are building national customer bases—and thus competing with other doctors across the nation

2) Whether doctors like it or not, patient reviews are here to stay

• Review sites are proliferating

• Patients are legally entitled to have their say

– Efforts to suppress patient reviews, such as the scheme advocated by Medical Justice, are probably illegal, probably unethical and almost certainly counter-productive

Illegality: NY v Network Associates; HHS Office of Civil Rights; contract unconscionability; 512(f); others

– Review websites are legally protected by 47 USC 230

3) Rather than fighting patient reviews, doctors should embrace them

• Patients expect to check reviews before making economic decisions

– Consumer reviews are one of the most important pre-transaction information sources to consumers

– Consumers are skeptical of businesses that don’t have reviews

– If a doctor’s competitor has reviews and the doctor don’t, the doctor is probably falling behind

• The vast majority of patient reviews are positive (~90% of doctor reviews). Tom Seery of RealSelf will be publishing empirical stats from his site showing how the vast number of patient reviews are positive. He called it a “J curve” of reviews–small number of negative reviews, even smaller number of mixed reviews, and huge number of positive reviews.

– “Wisdom of the crowds”: any one review is unreliable, but averages across large sets of reviews are quite reliable. Thus, doctors should seek to develop a critical mass of reviews (Dr. Grant Stevens called this “diluting the pathogen”–not sure I like the rhetoric, but the concept is right)

– Given the odds that the reviews will be positive, there’s no need to trick or incent patients to give positive reviews (ex: hotels routinely encourage all of their customers to reviews at TripAdvisor, knowing that most will say positive things)

4) What should a doctor do about a negative patient review?

• Product marketing: try to avoid negative consumer reviews by delivering good value. A doctor’s patients can be its evangelists

• Consider if the negative review is right

– Patients provide incredibly useful feedback that can improve the doctor’s business. Listen and learn!

– Openly admitting mistakes earns a lot of credibility

• Most of the time, doctors should take no action against a negative consumer review

– Consumers often discount the “high”/“low” reviews and focus on trends in the reviews

– Consumers are skeptical of business that only have positive reviews

– A few negative reviews in a group of largely positive reviews can actually increase sales (it makes the reviews more credible and helps consumers better gauge the potential downsides)

• If a doctor needs to take action, reach out to the unhappy patient. Often, a little positive attention will go a long way

• If necessary (and possible), rebut the review

– It may not be necessary; often, other patients will correct the wrong information without any prompting

– Many criticisms do not involve patient confidentiality at all

– If the negative statements implicate patient privacy, see if the review site has required patients to waive their privacy; contact the patient and ask for permission to respond; if not, you can always say “I can’t respond to the specifics of this situation due to patient privacy, but in X situation, my standard protocol is Y”

• Legal enforcement actions should be a last resort

– Streisand Effect

– Lawsuits may not be cost-justified + risk of paying defendant’s attorneys’ fees (anti-SLAPP laws)

– Doctors often lose in court + risk further antagonism by patient (i.e., malpractice complaints)

5) But what about fake reviews?

• Consumers are more savvy to fakes than we might give them credit for

– Many consumers are rightly wary of anonymous reviews

• Contact the review site. Fake reviews are an attack on their credibility

• If a doctor’s competitor is gaming via fake reviews, consider contacting the FTC or state AGs. The FTC hates inauthentic online content!

_________

Prior posts on this topic:

* The Dangerous Meme That Won’t Go Away: Using Copyright Assignments to Suppress Unwanted Content–Scott v. WorldStarHipHop

* Medical Justice Capitulates by “Retiring” Its Anti-Patient Review Contracts

* Updates on DoctoredReviews.com and Medical Justice

* Dentist Pays Sizable Penalty for Not Knowing 47 USC 230–Wong v. Jing

* Announcing DoctoredReviews.com, a Website Against Doctors’ Efforts to Squelch Online Patient Reviews

* “Consumer Reviews of Doctors and Copyright Law” Talk Notes

* CA Anti-SLAPP Cases Involving Consumer Reviews as Matters of Public Concern

* Dentist Review on Yelp Gets Partial Anti-SLAPP Protection–Wong v. Jing

* Yelp Wins 47 USC 230 Dismissal of Dentist’s Lawsuit–Reit v. Yelp

* Griping Patient Goes Too Far Posting Fake Content in Doctor’s Name–Eppley v. Iacovelli

* Republishing Third Party Ratings in Marketing Material Might Be Copyright/Trademark Infringement–Health Grades v. Robert Wood Johnson Univ. Hospital

* Two 47 USC 230 Defense Losses–StubHub and Alvi Armani Medical

* Lifestyle Lift v. RealSelf Settles

* Lifestyle Lift Tries to Use TM Law to Shut Down User Discussions; Website Countersues for Shilling–Lifestyle Lift v. RealSelf