Dealing with Online Patient Complaints

David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management, and Richard Cahill, JD, Vice President and Associate General Counsel

Physicians are understandably concerned about their reputations and the consequences of negative posts about them on social media platforms. Although the web is a powerful tool for physicians, it becomes problematic when patients post unfavorable opinions. It is nearly impossible to prevent negative comments from being posted and equally difficult to obtain a retraction or remove an adverse comment once posted.

Individuals who post disparaging information might post anonymously or use a false name. The fact that a patient starts a dialogue—albeit one that might be false and defamatory—and includes his or her name along with potentially protected information, does not open the door for the doctor to respond directly. Even if you know the source of the negative comments and can persuade the person to stop, comments remain in the public domain in perpetuity and might even be shared by others inadvertently or intentionally.

Responding to Negative Comments

It is never advisable to respond to adverse comments in a defensive manner. A defensive response can create a war of words that only escalates the situation. Additionally, acknowledging that an individual is your patient may violate federal and state privacy laws that could lead to a complaint to the Office of Civil Rights and a formal investigation.

Our guide, How Physicians Can Harness Social Media, offers the following steps for handling online criticism:

  • Listen to the criticism—online reviews are sometimes the only avenue patients have to express their concerns. Read what the patient has to say to see if there is anything in the criticism that your practice can correct.
  • Take the conversation offline. Have a standard reply thanking the patient for the comment and asking him or her to call your office. This action allows the public to see that the doctor/office is responsive to patients’ concerns but allows the doctor to then resolve the concern privately. Here is generic language:
  • Thank you for your comment. In accordance with state and federal privacy laws, healthcare providers are precluded from commenting in public or on social media sites specifically regarding a patient’s treatment. However, Dr._____ strives to maintain excellent communication with patients and is available to discuss concerns directly with the patient in order to achieve an amicable resolution. Patients are welcome to contact Dr. _____’s office so that issues may be addressed in a personal, confidential, and professional manner.
  • Resolve the dispute over the phone or in person if possible.

Following this approach has frequently proved successful for practices in terminating an ongoing public conversation. The disgruntled patient frequently realizes that he or she will not goad the physician into engaging in an endless back and forth and loses interest in continuing the online dialogue. Often, once the issue is resolved, patients will take down their comment or add an addendum that says, “The office listened to what I had to say.”

One study, featuring responses from over 800 people, noted that 51.8 percent of the patients that submitted negative online comments about a medical practice had not received a follow-up from the medical practice addressing their concerns. It is significant to note that the study revealed that patient satisfaction doubles when a medical practice addresses a negative online review.1

If the negative posts continue and the identity of the individual is known, a final option is to send a registered letter via U.S. Mail, return receipt requested, to the patient’s last known home address with the outside of the envelope marked “personal and confidential.” In the enclosed letter, indicate that you are aware of the false and defamatory comments recently posted by the individual on social media, demand that he or she cease immediately from engaging in any further improper conduct, and suggest that, if the posts don’t cease, your practice will have no alternative but to retain counsel and consider pursuing appropriate remedies.

No Easy Remedy

The Doctors Company frequently receives requests from members asking how to hold patients accountable for posting negative comments.

If you are considering pursuing a defamation suit, you will need to retain private counsel at your own expense. Many lawyers are not interested in pursuing these types of lawsuits—which are costly to prosecute and are not generally covered under the terms of your professional liability policy. Both federal and state courts have repeatedly held that individuals and internet service providers are protected by the First Amendment in exercising their right to free speech. Overcoming the First Amendment defense, proving actual damages at trial, and recovering a favorable judgment awarded by a jury against a former patient can be difficult and emotionally taxing.

Some physicians hire reputation management companies. Although these companies might promise to remove negative posts, this claim could be misleading. It is more likely they will manipulate search engine results to move negative posts down in the search result pages, rather than completely eliminate them.

Patient Safety Strategies

  • Consider sending a letter to new patients after their first visit, thanking them for choosing the practice and hoping to see them in the future. When you see new patients, discuss your commitment to answering their questions and keeping them informed.
  • Allow patients to have a voice by conducting patient experience surveys. Patients who have no other avenue for expressing their concerns and frustrations might turn to review sites. Discuss the survey results in staff meetings and address any patient concerns.
  • Consider posting select survey results and information about your actions to improve in areas where patients can see them, such as in the reception area or treatment rooms.
  • Consider conducting your own research to determine how any negative online comments have affected the practice. Have patients left the practice? Is the patient load decreasing? Do patients call about or comment on the negative posting? Answering these questions will provide reliable evidence to help you determine areas within your practice that might be improved.
  • Ensure that you and your staff communicate with patients and family members in a respectful and friendly manner. Encourage your staff to make eye contact with patients and offer a friendly greeting.
  • Educate your staff on communication techniques. When patients have a positive experience with the practice, they are likely to tell others. When patients in a community are consistently enthusiastic about a physician, negative postings tend to lose their intensity.
  • Do not respond to a negative post in a defensive manner; use the recommended general language for online responses.
  • Review and respond to patient complaints or postings privately in a timely fashion.
  • Contact your patient safety risk manager if you want to write off all or part of a dissatisfied patient’s fee. Your patient safety risk manager can evaluate the situation from professional liability and compliance standpoints.
  • Contact our Claims Service Team immediately if you receive a demand for money from a dissatisfied patient.
  • Use all negative reviews as an opportunity to identify potential problems, become a better clinician, and improve the operation of the practice.

Additional Resources from The Doctors Company

How Physicians Can Harness Social Media: our comprehensive guide to help you take control of your online reputation.

Patient Experience Surveys: versions available for physicians and dental professionals.

EHR, Telemedicine, and E-risk: learn more about avoiding potential liability risks associated with new technologies.

Reference

  1. The patient perspective 2019: online reputation survey. PatientPop website. April 4, 2019. patientpop.com/blog/online-reputation-reviews/patient-perspective-online-reputation-survey-report/.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J12297 03/20

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