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Proactively building a positive Internet presence for your practice can blunt the effect of a few bad reviews.

Fam Pract Manag. 2015;22(6):29-32

Author disclosure: Dr. Gin is cofounder of an online review website.

The Internet has given rise to amazing medical resources for physicians and patients, but it has also created some serious obstacles to doctor-patient relationships. One potential obstacle is your online reputation. In the past, managing one's reputation in the media was primarily the concern of celebrities, politicians, and other famous people. Today, about 30 percent of all online searches are of individuals' names, and everyone has to be concerned about their online reputation.1 For example, employers conduct online searches for information about job candidates, blind dates “Google” each other, and, yes, patients search for information about physicians.2

Many factors influence how a patient selects a doctor, including word of mouth, recommendations from friends, and referrals from other physicians. Social media and online reviews are playing an increasingly important role in physician selection. Social media influences more than 40 percent of consumers' decisions on choosing a physician, according to one study,3 and 59 percent consider physician rating websites “somewhat important” or “very important” when choosing a doctor.4

A poor online reputation can supersede a physician's education and training, at least to potential new patients. Websites that originally were designed to review restaurants are now being used to rank medical professionals using the same one-to-five-star system. Poor ratings can keep a prospective patient from selecting a physician in the same way it might deter a consumer from trying a new restaurant or hair salon, with similar financial results. A Harvard Business School study demonstrated that a one-star increase in the rating of an independent restaurant on a review website led to a 5 percent to 9 percent increase in sales.5

An absence of online reviews and ratings can negatively affect a physician's practice too. A 2014 study showed that 72 percent of people trusted a local business more if they could find at least some positive reviews online.6 Patients might be more likely to select a physician about whom there is at least some information online.

You devoted many years to education and training and have made the well-being of your patients a priority. So when a patient writes a negative online review, it can be damaging both personally and professionally. However, it is best to avoid taking online reviews personally. All doctors will likely have to deal with negative reviews from time to time.

The following strategies will help you respond productively to negative reviews and cultivate a positive online presence:

1. Search for yourself online. The first step to managing your online reputation is monitoring it. Google your name and your practice's name weekly. The results could prove surprising. They might include a combination of negative reviews, misinformation, and positive feedback.

2. Respond to reviews but avoid HIPAA (Health Insurance Portability and Accountability Act) violations. Almost all review websites allow individuals to respond to their online reviews. However, physicians must do so carefully to avoid violating HIPAA regulations. Although patients can write freely about their visit, physicians cannot do the same. A useful strategy for physicians is to simply and politely acknowledge the review. This helps to mitigate the negative effect of a review in which a patient vents about an unhappy experience. Your response can be as simple as writing a statement that acknowledges what the patient experienced and offers to make amends. For example, “Sorry to hear that your experience did not meet your expectations. Please contact our office manager if you would like to discuss it further.” This type of response can open up communication with the patient who wrote the review while letting others know that the physician is interested in hearing feedback and improving customer satisfaction.

3. Influence the search results for your name. As much as 90 percent of user clicks happen on the first page of Google search results.7 One common strategy is to attempt to push search results that point to websites with negative reviews off the first page of search results. This is not always easy or even possible, but you might be able to push them lower on the page. Review sites rank highly on Google because of their prominence on the Internet. By contrast, a physician's own website will often rank much lower in online searches of the physician's name. Creating accounts on other prominent Internet sites (e.g., LinkedIn, Facebook, or other major review websites), writing blogs or articles, or engaging in social media can all help reduce the chances that a review website will top the list of search results for your name. Pushing bad reviews down even a couple of spots among search results can significantly reduce the number of people who will click on them.7

4. Understand your legal options. Many physicians, when seeing a false claim about them online, initially seek to have the negative review removed and perhaps consider legal action. This is understandable, but it unfortunately is not helpful in most cases. If you see a review that you think is false, you can certainly request to have it removed. However, unless the review violates very specific review guidelines (e.g., hate speech or vulgarity) most review platforms will err on the side of the reviewer, freedom of speech, and so on, and will not remove the review from the website. Even if a review is removed on one website, the patient can put it up again on another website and spread the impression that the physician is trying to suppress feedback.

Legal action against the review website is also difficult because of a federal law called the Communications Decency Act. The courts have determined that the provider or user of an online service cannot be considered the responsible publisher or speaker for third-party content.8 Lawsuits against patients who post potentially defamatory reviews are also difficult to win in the United States because the First Amendment provides broad protection of freedom of speech. Filing a defamation lawsuit against a patient also brings a substantial risk of widespread bad publicity.

Some law firms have developed contracts physicians can ask patients to sign that contain “gag clauses.” These are clauses stating that the patient shall not post any adverse comments about the physician or the practice online and that the physician owns copyright to anything that is posted. The legality and enforcement of these types of contracts is murky. In 2011, the Center for Democracy and Technology filed a complaint with the Federal Trade Commission against a company that provided gag contracts to physicians, alleging that they were unethical and illegal. The company offering the gag contracts quickly announced it would retire the contracts and instruct clients to stop asking their patients to sign them.9 In September 2015, legislation was introduced in the U.S. Senate that would prohibit contract language restricting the consumer from discussing the goods or services provided in the contract.10 This could potentially outlaw gag clauses so it may be prudent not to include them until the legality of these types of clauses has been determined.

5. Build your brand identity using social media. In the past, branding was the business of major consumer products or service corporations, which used it to differentiate one product or service from another. In the digital age, branding applies to people as well. Creating a brand image that successfully demonstrates your potential value to current and potential patients is not easy and is often overlooked by practice managers and physicians. A brand image may include an important message or mission statement; education excellence such as board certification, university affiliation, or awards; affiliations with news or other media; major strengths or areas of expertise; and unique hobbies or volunteer work.

Once the branding message is clear, use social media to help build it. You can maintain a blog that discusses expertise in a specific area. A LinkedIn account can showcase your extensive education, training, and awards. Facebook can be used to personally connect with patients by sharing hobbies and interests. A YouTube channel can provide videos about your practice. An active and diverse social media presence can help you differentiate yourself to prospective patients.

6. Provide “social proof.” People are hardwired to follow the actions of others. In the past, physicians demonstrated patient satisfaction with their services or procedures mostly with written testimonials. Nowadays, patients want to base their decisions on more dynamic forms of “social proof.” The more evidence you can show prospective patients about your talent and expertise, the more likely they will select you as their physician. Online social proof can range from positive reviews to the number of followers a practice has on popular social media websites such as Facebook, LinkedIn, or Twitter. Numerous Facebook “likes” on a professional account can sometimes help offset a single bad review. If your website provides links to other websites with positive reviews and a positive social presence, this can also help generate social proof. Almost all review websites offer a way to connect a practice's website to their own; a link such as “Read our reviews here” can direct prospective patients to positive testimonials published on the review platform's website. Linking to a website in which a doctor has a positive presence is one of the easiest ways to create a positive online reputation.

7. Understand how review platforms work. Most popular review websites charge businesses, including physicians, for advertising, leads, and reputation management. By paying to advertise on a review website, a business can appear more prominently in the website's internal search results, receive more patient leads, or have its ads appear on the profile page of a competitor. Paying for leads can be a useful source of new business – just be sure to compare how much you pay for each new patient or lead with how much additional revenue is generated to make sure the exercise is worth your money. Some review websites offer reputation management services that can increase your rating, for example, by hiding or burying your negative reviews in order to boost your overall rating. This is an ethical gray zone, and once you stop paying these websites you may find your rating decreases. Also keep in mind that paying for reputation management on a single review site does not prevent the disgruntled patient from posting his or her review on multiple other platforms, where you may have to repair the damage again and again.

8. Seek patient feedback. The best way to reduce the effects of a few bad reviews and establish your brand online is to proactively build your profile and acquire a large number of reviews on at least one review platform. A significant number of reviews helps prevent just a handful of isolated complaints from resulting in a low-star rating. To do this, register your business on a review website, fill out your practice's basic information, and begin collecting reviews from patients. Although it may be tempting to ask all of your loyal clients to write five-star reviews, that is rarely successful. In fact, physicians who ask a loyal patient to write a great review for them on a popular review website may notice a week later that their five-star review appears to have vanished. This is because most review websites have filters in place to identify solicited reviews, or they allow for solicited reviews only if they come from a broad base of customers. The websites use algorithms to identify patterns such as multiple reviews coming from the same computer – such as one in your waiting room – or using similar language.

It is best to request honest reviews from all of your patients. Post signs in your waiting room saying you value feedback whether in person, by email, or on review websites. Email patients to ask their opinion of your practice's level of customer service. Don't be afraid of getting a bad review. You now know how to handle bad reviews, and you may find that patients, like other consumers, actually trust ratings more when they see both good and bad reviews.11

Be vigilant

Warren Buffet once said, “It takes 20 years to build a reputation and five minutes to ruin it.” In today's market, it is critical for physicians to establish and maintain a positive online reputation, which involves more than simply operating a user-friendly website, monitoring review websites, and responding to negative reviews. It also requires proactively building and maintaining a positive online presence and doing important “offline” work – regularly engaging with patients, understanding their needs, encouraging ongoing feedback, and anticipating problems before they lead to a damaged reputation.

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