Dealing With Online Patient Complaints

Richard Cahill, JD, Vice President and Associate General Counsel, and Kathleen Stillwell, MPA/HSA, RN, Senior Patient Safety Risk Manager, The Doctors Company

Clinicians are understandably concerned about their reputations and the consequences of any negative comments posted about them on social media platforms. Although the web can be a powerful tool for healthcare practices, 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. Patients who start an online dialogue and identify themselves by name—potentially providing protected information—do not open the door for the practice to respond directly. Even if you know the source of the negative posts and can persuade the person to reconsider, 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 start 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 for Civil Rights and a formal investigation—and it may garner the attention of the state medical board, resulting in an official inquiry and potential administrative sanctions.

Follow these steps for handling online criticism:

• Listen to the criticism. Online reviews are sometimes the only avenue patients have available to express their concerns. Do the patient’s criticisms reveal any issues that your practice can and should address?
• Take the conversation offline. Have a standard reply thanking patients for comments and asking them to call your office. This action allows the public to see that the practice is responsive to patients’ concerns but allows the clinician to then resolve the concern privately.
• Respond with generic language.

Thank you for your comment. All concerns are taken seriously by the practice and are promptly addressed with the individuals involved. Pursuant to federal and state privacy laws, [Name of clinician] is unable to respond to this post online. Individuals with concerns are encouraged to contact our office staff to discuss concerns directly and to achieve an amicable resolution 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. Often, the disgruntled patient realizes that the clinician cannot be goaded into engaging in an endless back and forth and, consequently, loses interest in continuing the online dialogue. Once the issue is resolved, patients will frequently take down their comment or make an addendum that says, “The office listened to what I had to say.”

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 the improper conduct cease immediately, and suggest that if the posts don’t cease, your practice will have no alternative but to retain counsel and consider pursuing appropriate legal options.

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 as determined by a jury against a former patient can be difficult and emotionally taxing. Even if the lawsuit results in an advantageous verdict or arbitration decision, collecting the monetary damages that have been awarded against the defendant may be problematic.

Some clinicians hire reputation management companies. Although these companies might promise to remove negative posts, this claim can 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 (with protected health information redacted) and information about the actions taken to improve reported concerns. Post the information in areas where patients can see it, 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 their 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 practice, 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 written or verbal 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.
• Monitor internet postings that include your name or practice name. Set a Google alert with your practice name and clinician name to be alerted to any online posts with your name or practice name.

For additional guidance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

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