Managing fallout from online reviews

Oscar Wilde once quipped that the only thing in the world worse than being talked about is not being talked about. But that was decades before the Internet.

The anonymity of the Internet is slowly eroding conventional social etiquette. Anybody can post a review on numerous websites and tell the world exactly what they think—and they don’t have to be nice about it.

When it comes to health care provider review sites, consumers know exactly where to post and where to look for reviews. Health care professionals are learning to cope with the increasing threat of offensive, negative, and even libelous reviews and comments that can infiltrate popular sites such as Yelp and Healthgrades. Finding negative reviews about your practice on one of these sites can induce a gut-wrenching reaction.

Take, for example, a review that was posted on a popular patient website: “Dr. Bad-Doc is rude, unresponsive, and makes you wait an hour after your scheduled appointment. The rest of the staff is condescending and lack professionalism. I wonder why she ever became a doctor. I would not recommend her to a dog.”

If you’re Dr. Bad-Doc, you’re in a tough situation and need to figure out what to do. For all doctors, including psychologists, it’s important to contemplate how to prevent this scenario from happening to you.

It is important to remember that a bad review (or even two or three) generally will not ruin your practice. While you may not be able to completely avoid negative reviews, you can mitigate the possibility by addressing the issue of online reviews during the informed consent process before your work with the patient begins. By discussing the protocol for complaints up front, you may avoid a situation that might adversely impact the therapeutic relationship.

Whatever you do, refrain from asking your patient to sign an agreement to not rate your services online; they can do so without your permission, and such an agreement is not enforceable. Nor should you encourage patients to post positive reviews. That action may be contrary to the APA Ethics Code, which states, “Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence” (Standard 5.05 Testimonials, Ethical Principles of Psychologists and Code of Conduct).

Pertinent points to cover when discussing online reviews during the informed consent process include:

Confidentiality

Remind patients that your relationship with them is confidential and that, by commenting online, they risk divulging the fact that they are receiving mental health treatment. The more information provided in a review, the greater the chance that patients will unwittingly jeopardize their privacy. Make sure patients understand that they risk revealing their mental health treatment, and that the risk exists even if the comment is made anonymously.

Conflict resolution

Discuss your protocol for responding to complaints by unsatisfied or unhappy patients. Encourage the patient to speak to you privately in the clinical setting first so that you can attempt to resolve any problems the patient perceives. Often a patient just wants to be heard. At some point during treatment, a patient might tell you he or she posted an online review about you or is thinking of doing so in the future. If the patient brings up the subject, your response should reflect the nature of the review.

Here are suggestions for handling the ensuing discussion:

• Good reviews: Respond to the patient inquiry by saying the decision to post a review is his or hers to make. Let the patient know that you are not encouraging testimonials and that positive public comments will have no bearing on your treatment. You may want to remind the patient of privacy concerns and the steps they may take to protect it.
• Adverse reviews: Discuss the patient’s concerns to see if you can address them during the course of treatment. If the issues are not resolved, you will need to consider whether and how the potential or actual negative public review will impact your relationship.

You might experience a complicated reaction if the review is particularly nasty or malicious. In this case, consider consulting with colleagues about the best way to proceed with patient treatment—for example, whether the relationship can continue or if it has been ruptured and is unable to be repaired. A colleague may help you determine how to proceed or whether it is advisable to terminate the relationship. The patient might be better suited to work with another psychologist if your relationship has deteriorated. If the online postings rise to the level of harassment, threats, or abuse, you may need to consult with law enforcement or legal counsel.

You do have the right to respond. You first need to decide, however, whether you should respond. Sometimes the content of the posting is so outrageous that most readers will see it for what it is. It also helps put the situation in perspective for those seeing your reviews online if you have numerous positive reviews and just the one unfavorable review. You may also unintentionally draw greater attention to the negative post by responding to it. Factors such as these may suggest that it would be prudent not to respond at all.

If you think the comment does warrant a response, consider the following questions before composing your message:

• Does the patient make a truthful observation? As hard as it is to experience the very public criticism, take a close look at the comments to identify any kernels of truth from which you can learn. Try to read the review as an objective third party to see if you can improve your or your office staff’s performance.
• Can you be objective? Your job as a practicing psychologist is unique in that your business involves delivering highly sensitive care. You work very hard to help people improve their lives, so negative feedback can feel like a personal attack. If you decide to respond, reflect carefully on the wording of your post so that you are not perceived as being defensive. Take the time necessary to compose an objective, rather than emotional, response.
• Will it violate the patient’s right to confidentiality? Refrain from admitting that the individual who posted the review is or was a patient. Also be sure to refrain from disclosing or confirming any information related to diagnosis, symptoms, or method of treatment. The patient may have divulged some of this information in the review, but you should do all you can to protect that person’s privacy.
• Does the website allow you to respond in general without replying to that particular post? Some sites, like Yelp, will allow you to create a personal profile that will appear above reviews. Take advantage of this option and build your profile. Highlight your areas of practice, emphasize your procedure for addressing patient complaints, and link to your website.
• What should you say? Whatever you may say, always take the high road. Avoid making accusations or getting into an online argument. Don’t say anything to suggest that you know the identity of the commenter. You might simply wish to note that your practice follows and makes patients aware of standard procedures for addressing any complaints that may arise during treatment.

For example: I read the review complaining about my service. My professional Ethics Code and the laws governing psychology generally do not allow me to respond to individual complaints online because I cannot publicly acknowledge whether I have seen a particular patient. I must protect the confidentiality of each person who comes to see me. I encourage patients to talk with me privately about any concerns they have. Most of my patients have told me that they are very satisfied with my services (if accurate). Please see my website [provide link or web address] for more information.

People who offer opinions on review websites generally have broad protection under the law. Unless you can prove that the statement is false and that it has caused you harm, you have little chance of prevailing in a civil lawsuit.

Even if you have a good case, taking legal action might not be the best course. If the patient has limited financial means, you will not succeed in collecting damages or attorney fees. And if you gain the reputation of being a litigious practitioner, it may harm efforts to build your practice. A win for principle’s sake alone might be hard to justify if you cannot collect enough to pay for your lawyer, and you get a bad reputation to boot.

Similarly, suing the website is not typically an option. Websites are under no obligation to remove postings without a court order, and most have language in the user agreements that places responsibility for the content of a review on the poster. The website is not in the business of mediating disputes and generally will not investigate your claim that the commenter made false statements.

If you suspect that the “patient” is actually a competitor, however, you do have some recourse. Most review websites prohibit the practice of competitors posing as customers and writing bad reviews. They typically will remove a posting without court order once they can verify that the post was made by a competitor.

Although filing a lawsuit is not typically the best approach, there are circumstances that might warrant this response. Consult with an attorney and your malpractice insurance carrier to discuss your options and potential repercussions.

You can mitigate the impact of negative reviews and ratings by being proactive with your online—and offline— presence. Create an electronic footprint and make it positive, professional, and easy to find. Here are several tactics to assist with this strategy:

• Invest in a professional website. This is your first impression on most patients, so make it a good one!
• Consider structuring your website to accept comments. Perhaps people will go there before using a review website to voice concerns. You also have more control over what is published.
• Ask colleagues who refer to you to write positive reviews about your practice and include these reviews on your website.
• Google yourself and then set up a Google Alert to monitor online activity. You will receive an alert when your name is mentioned online. This helps keep you apprised and enhances your ability to address negative feedback quickly.
• Publish. Write articles for your local paper, contribute to blogs, or submit pieces for your state psychological association or volunteer organizations. You will likely show up on their respective websites, which will boost your presence during an online search.
• Get involved in the community. Participation in civic and community organizations (Rotary, Kiwanis, and Chamber of Commerce, for example) allows people to know you outside of the confines of the online world. False or questionable accusations about you are unlikely to gain traction when a lot of people know you personally.