Responding to Negative Physician Reviews

Physicians sometimes call NORCAL Group Risk Management department for advice after a patient has posted a negative review online. Some callers want confirmation that fighting back in court or online is appropriate, but these seemingly satisfying solutions can backfire.

Suing the Reviewer for Defamation

“Absolutely the worst place to go to...Avoid this place.” — Brian R., Yelp Physician Review

Overall, healthcare entities and clinicians have not been successful in defamation lawsuits against patients for negative reviews.¹ Negative patient reviews are generally protected by the First Amendment, unless the post is a statement of incorrect facts.

Opinions, regardless of how hurtful, are not defamatory. For example, Brian R’s Yelp claim that his physician’s office was “absolutely the worst place to go” is Brian R’s opinion. Not only are defamation cases difficult to win, they are expensive. The reviewer most likely will not have the solvency necessary to satisfy a judgment, and the lawsuit will attract more online attention, thus directing more internet traffic to the negative review.¹ Additionally, Yelp is now warning consumers if a business has sued reviewers. Consequently, litigation should be considered a last resort.

Engaging in an Online Battle

Responding to a negative review may be appropriate, but should only be undertaken after careful consideration. Trading insults online with a disgruntled patient can quickly escalate, and the back-and-forth conversation will remain on the rating site for future patients to consider. An angry or defensive response from a physician can also prompt the patient to post negative reviews on various other physician review sites.

Some clinicians have taken to responding by posting the patient’s medical information, offering to remove it if the patient removes the negative comment. This is an obvious HIPAA violation that can result in federal investigations, which can, in turn, drive more traffic to the negative review.^1,2 In addition, entering into any online dialogue with the patient may lead to an inadvertent HIPAA violation by the physician. While the patient has a right to post any personal information he or she wishes, doing so does not mean the patient has waived his or her HIPAA/privacy rights. The physician may not post personal health information about a patient without a patient’s specific authorization.

Medical Liability Risk Management Recommendations

An occasional negative review can be expected in our online culture. Having a plan of action in place can reduce the impact of the review and facilitate a response, should one become necessary. Consider the following recommendations:^2,3,4

Social Media Action Plan

• Set up or claim profiles on review sites to extend your practice’s official online presence and enable engagement with reviewers in an “official” or “verified” way.
  • Link to your website and other controlled accounts from the rating websites to drive patients to positive content.
• Develop a social media plan for your practice where postings can be controlled.
• Periodically check rating websites to identify any specific issues or trends relative to your practice. Consider setting up online alerts that advise when comments have been posted under your name.
• Provide a patient satisfaction survey. If appropriate, use positive information gathered from the survey in your marketing and social media campaign.
  • Provide a patient complaint process so disgruntled patients can express their concerns or frustrations and receive timely resolution.

Negative Comment Action Plan

• Don’t panic.
• Do not respond immediately or impulsively.
  • Take time to consider the comment, reflect on why the individual felt compelled to post it, and decide if it is worthy of response.
  • If you feel the information is untrue, inappropriate, or simply meant to be provocative, report the review using the site’s reporting or flagging feature or their website contact form. Since rating sites have content guidelines, they may be willing to remove information that violates the site’s terms. For example, according to Yelp, they will remove posts for various reasons, but they “don’t typically take sides in factual disputes and generally allow Yelpers to stand behind their reviews.”⁵
• If you choose to respond in writing on the website:
  • If you are part of a large group, contact your group administrator or medical director regarding policies related to online social media prior to posting or responding to information.
  • Limit the response to general information or updates about how specific issues are addressed.
  • Attempt to move the discussion to a private forum.
    • Do not use patient identifiers, reveal protected health information, or confirm that the person posting is a patient of yours.
  • Do not directly or personally attack the individual posting the comment.
    • Understand that if you do resort to a personal attack, your response may not be well received by the general public or the patient in question. Have a strategy to help prevent a scenario that may lead to irreparable harm to your reputation.
  • If you can determine the identity of the posting individual:
    • Review the medical record for potential issues.
    • If it is appropriate, follow up with the patient directly in a non-confrontational manner to resolve the issues that led to the negative review.
      • Discuss any concerns the patient may have and address them to the best of your ability.
        • If the matter is resolved, ask the patient to remove the negative review or update it to a positive one.
      • If the issue directly affects patient care, document all communication and follow up with the patient in the medical record. Include dates and times you spoke with the patient, the patient’s exact concerns (use quotation marks as appropriate), your responses and recommendations, and the patient’s responses.
      • If there are significant issues or a lawsuit is threatened or probable, contact the claims department of your medical malpractice carrier.
  • Honestly look at yourself and the way you practice in light of the review.
    • The review may contain useful information you can use to improve your practice.
  • Periodically follow up a negative review with positive information about your practice on the review website.
    • Do not post fake consumer reviews, as this may result in significant fines and penalties.
  • Consult with a trusted attorney before taking any steps toward filing a lawsuit against a reviewer.

References

1. Charles Ornstein, Pro Publica. “Doctors Fire Back at Bad Yelp Reviews – And Reveal Patients’ Information Online.” Washington Post. 5/27/2016. (accessed 7/26/2019) – registration required

2. Kevin Pho, MD. Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. Greenbranch Publishing. Phoenix, MD. 2013. 153-169. (resource not available online at the time of publication)

3. Tara Lagu, MD, MPH, et al. “Patients’ Evaluations of Health Care Providers in the Era of Social Networking: an Analysis of Physician-Rating Websites.” Journal of General Internal Medicine. 2010;25(9):942–946. doi:10.1007/s11606-010-1383-0. (accessed 7/26/2019)

4. Kevin Pho, MD. “Doctors Should Not Sue Patients for Negative Online Reviews.” KevinMD.com. 5/14/2011. (accessed 7/26/2019)

5. “Will Yelp Remove a False or Defamatory Review?” Yelp Support Center. (accessed 7/26/2019)