In the not-too-distant-past, a physician's reputation and practice were built by word of mouth. Today, word of mouth is no longer limited to people talking face-to-face. The freedom of the Internet allows anyone with access to a computer to share his or her opinions with a larger population.

The restaurant and travel industries have had a long history of online reviews, with many of the Web sites now becoming more mature and reliable. In the past few years, medicine has entered this world of Internet reviews. Much in the same way people can review the restaurant where they had dinner last night, patients can now get online and give their opinions of the care they've received from physicians and hospitals.

This article provides an overview of the Web sites that allow physician reviews and explains what to do if a patient posts a negative review about you or your practice.

Web sites that post physician reviews

The number of Web sites that post physician reviews has been growing recently (see "Web sites that offer physician reviews and ratings"). Some sites (such as yellowpages.com or local.yahoo.com) allow postings related to any industry, some (such as Angieslist.com) include reviews of all service industries, and others (such as Revolutionhealth.com, Healthgrades.com and Ratemds.com) focus only on medical issues.

Many of the Web sites allow users to post general comments (e.g., “I would never recommend this doctor to my family and friends” or “The doctor is phenomenal, but the receptionists are the worst”), while others have a more formal rating system based on specific criteria. The medically oriented Web sites tend to have rating systems specific to the medical profession, with questions such as “How would you rate the wait time for seeing the physician?” (See additional questions below.)

Patients are not the only ones who check these sites for physician ratings. Insurance companies are beginning to use them as another tool for physician performance review. Companies such as WellPoint are partnering with restaurant and hotel ratings companies such as Zagat to provide their members a forum to review physicians.¹ Even some physicians are using these Web sites – for example, to check out job candidates online before hiring them.

Because of the proliferation of these Web sites and the fact that many of them are relatively new, a physician might have just one or two reviews per site. One Web site might have only a glowing review, while another Web site might have only a scathing comment on the same doctor. Unlike the restaurant and travel industries that now have more established Web sites with large databases of reviews, the medical industry does not currently have the volume of reviews to make any one Web site reliable.

Perhaps as a result of these factors, there is some skepticism from patients about the reliability of these reviews. A Harris Interactive poll done for the California HealthCare Foundation showed that while 80 percent of patients use the Internet to find information on their health, only 25 percent have looked at physician-rating Web sites.² In addition, only 2 percent of respondents reported making a change in physicians based on the information on a rating Web site. As some of the review sites gather more data and become more established, their usefulness may improve and public trust may follow.

How should your practice deal with online reviews?

The first step is to get online and see what's out there. Visit the Web sites listed below and search for your name or your practice's name, or go to google.com to perform the same search. You may want to assign a staff member to this task and have him or her monitor these sites on a regular basis. If nothing else, these Web sites will often have incorrect demographic information on you (incorrect address, links to old practices, etc.), and you will want to update it or add to it. The idea is to get as much correct information out there as possible.

If you do find a negative review of you or your practice online, try to stay calm and keep it in perspective. Disgruntled patients are more likely than satisfied patients to post reviews, so it helps to be thick skinned as you review these sites. In most cases, it is best not to respond online and try to refute the negative review point by point. However, it may be appropriate to post a general, positive response such as “Main Street Family Medicine aims to provide each patient with the highest quality of care in a respectful, friendly environment. Please check out our Web site for more information.”

It is extremely difficult to get a negative review taken off a Web site. Even if the review is libelous, the burden of proof is on the provider, and libel is difficult to prove. While some providers have pursued this, it may take more time, money and legal resources than it may be worth. However, if the review contains obscenities or hateful language, some sites will remove the content, if asked, because such language likely violates their terms of use.

One legal option a few practices have been taking is to have patients sign waivers saying they won't post reviews that could be considered libelous. In fact, Web sites such as Medi-calJustice.com have sprung up in an effort to legally protect physicians in these situations. Presenting a waiver to your patients may open up a Pandora's box of legal and ethical issues, but it may help protect your practice against libelous reviews. The difficulty, once again, is that even if you can find the libelous review, the onus is on you to prove the libel.

Another strategy to boost your practice's image on the Internet is to politely encourage your satisfied patients to submit their own reviews. This generally works best if you target one or two Web sites that you have found to be most helpful and ask patients to write reviews for those sites.

You should also post positive comments from patients on your own Web site. If you don't have a Web site for your practice yet, building one is essential. As more and more patients and potential patients search online for information about you, you want them to find your practice's Web site with accurate, positive information about you, rather than just finding those sites with negative reviews. When it comes to designing your Web site, don't be bashful. Make sure to list your credentials, honors and accomplishments so that potential patients can see them. Update your site regularly with information about projects your clinic is involved with or things you are actively working on to improve care to patients. Some clinics are even starting to post their practices on Web sites like Facebook. com to get more positive exposure and communicate better with their patients.

The ultimate solution

Because bad news doesn't go away quickly on the Internet (it can remain posted on Web sites for years), it's best to do what you can to keep your reputation as clean as possible. This means making sure your practice is treating patients right. Communicate with them, ask for their feedback, and don't let them leave your office angry. Good old-fashioned bedside manner can go a long way toward creating satisfied patients, even in today's technology-driven world.