Whether a bolt out of the blue or a digital manifestation of a deteriorating doctor-patient relationship, negative online reviews are an increasingly common part of the healthcare landscape. So, what do you do when you encounter one? Claire O’Leary, Case Manager at Medical Protection, advises don’t panic – use it as a chance to improve your practice.

For a number of reasons, doctors and other healthcare workers are increasingly the subject of online reviews. These are not only found on specialist review platforms, but also on popular social media sites, such as Twitter and Facebook, and search engines which offer review capabilities, such as Google. Reviews are often public and searchable, and, where they are negative, can detrimentally affect the reputation, confidence, financial and general wellbeing of doctors, as well as undermining their relationships with patients.

However, where other businesses are free to engage with, and even directly challenge, negative reviews, this course of action is not generally open to doctors, who must at all times act within the bounds of their professional, ethical, and legal duties. This, quite reasonably, can lead to feelings of frustration, anger, betrayal and powerlessness for doctors and practice staff.   

So, what is the best approach to dealing with a negative review?

Treat a negative review as you would any complaint

Review

Take time to read the review and identify the key issues that the reviewer has raised. Reviewers will often comment on aspects of care that they were happy with, as well as aspects they disliked, so ensure that you take on board the positives as well as the negatives.

Investigate

Where the reviewer is identifiable as a patient,  it may be helpful to review their chart, call logs, and messages, and to speak with other staff involved in their care, especially anyone named in the review. Ideally, any recent difficult interactions or challenging behaviour would have been documented,  which may shed light on the reviewer’s dissatisfaction, but this is not always the case. It may be easy to miss or misinterpret a look of unease or a shift in tone during a busy clinic, even without the now all-too-familiar masks, screens and social distancing.

Clearly, there may be instances where a reviewer is identifiable as a friend or family member of a patient, in which case you should still proceed to investigate the issues they have raised and make any appropriate improvements where shortcomings are found, but you should not engage with or respond to them in the absence of a competent patient’s explicit consent to do so.

Where the reviewer is not identifiable, their concerns should still be investigated as thoroughly as possible and in good faith, although you may have only limited information.

Reflect

Once your investigation is complete and you understand the issues and any root causes,  it is important to reflect on any shortcomings in the care provided, and on what actions can be taken to prevent a similar issue.  

Respond

You may wish to consider providing  a standard response for use for any negative review, which does not confirm that the reviewer is your patient but offers the reviewer an opportunity to discuss matters directly with you.  

The following wording might be helpful, for example:

Irrespective of whether the reviewer then makes contact on foot of the response, their review should be taken seriously, treated as a complaint and managed in the same way, ideally in line with your complaints policy.

If the reviewer is identifiable by you as a patient, you may wish to contact them by telephone or in writing, explaining that you have read their review. It may be helpful to acknowledge their concerns, apologise if they felt that they could not directly raise the concerns with you,  explain that you have investigated their concerns, what you found, and any action you intend to take to resolve the issues. You should be open and conciliatory and offer an apology for any shortcomings identified. You may wish to offer to meet with the patient to work through any issues with them. Where changes are made on foot of the patient raising their concerns, you may also wish to thank them at that stage for their contribution to improving the quality of the service.

Once matters are resolved, it may be appropriate to ask the patient to consider taking down or updating their review. You should accept, however, that they may not wish to do so.

Document
As with any complaint, you should document in detail any investigation, actions or communication within a complaint file, separate to the patient’s medical record.  

It may be helpful to include screenshots of the review in question, so that you have it to hand for tracking and audit purposes, as its accessibility might otherwise be subject to the whims of those providing the online platform on which it is published.

Avoid engaging directly with the reviewer online

As difficult as it may be, it is not advisable to respond specifically to a review or complaint on any internet platform, as to do so may risk breaching patient confidentiality and data protection law.

The Medical Council, in its Guide to Professional Conduct and Practice, is clear in its emphasis on the primacy of patient confidentiality, stating:

It goes on to provide more specific guidance on the use of social media, but one of the core principles is that patients should not be identified or identifiable by a doctor’s social media behaviour.

The Irish courts have also weighed heavily in favour of guarding patient confidentiality in all but the most extreme of circumstances, most notably in the 2018 case of The Child and Family Agency v AA, where Mr Justice Twomey found that patient confidentiality should not be breached unless

“…on the balance of probabilities, the failure to breach patient confidentiality creates a significant risk of death or very serious harm to an innocent third party”.

Clearly, this will usually not be the case where online reviews are concerned, however unpleasant or even unreasonable they are.

Generally speaking, where a patient has not provided consent for you to disclose their information to a third party (or, by extension, more widely), and the disclosure is not required by law or justifiable in the public interest, this would normally represent a breach of patient confidentiality. This would include, not only the clinical details of the matter, but even the fact that the patient had attended an appointment with you. By engaging specifically with the reviewer in a public forum or attempting to challenge the review, you may inadvertently breach patient confidentiality by disclosing or confirming the fact of their attendance with you, with potentially serious implications. 

Specific online engagement with the reviewer is, therefore, not recommended.

Requesting removal of a review may not be as helpful as you might think

Though requesting that a platform remove a negative review might seem like an easy solution:

•  Most platforms rely heavily on freedom of expression and benefit financially from public engagement, including in the form of reviews – they usually only remove content that contravenes their community guidelines, terms of service, or content policy. Patient reviews are most often based on their honest opinion (“Dr R rushed me out and did not listen to me”, “I can never get an appointment when I need one, don’t bother joining this practice” etc) and, as such, would not normally meet the criteria for removal.

•  To do so may require or lead to identification of the reviewer or patient, or may require disclosure of your interest in having the review removed, which may directly or indirectly lead to a breach of the patient’s confidentiality.

•  Even where a review is removed, it may be perceived by the reviewer as an attempt to silence them, leading instead to escalation – in some previous instances, removal triggered further posts by the reviewers, sometimes across a number of different platforms, which were more aggrieved in tone and language than the original reviews, and which ultimately attracted more attention. This phenomenon is sometimes referred to as “the Streisand effect”.

Where you feel that a review is inaccurate or misleading, it may be possible to flag it and request removal by the relevant platform. In approaching the platform, and only if necessary, it may help you to provide reasons which focus primarily on the potential impacts of such a review on patients of your practice; for example that patients may avoid attending despite requiring care, or that some patients may experience unnecessary distress or concern upon encountering the review. It is also appropriate to highlight for the platform the potential business implications for your practice, should such a misleading review be left on their site.

Any request should be very general. You should not include any patient information in any correspondence with the platform, identify the reviewer as your patient, or confirm that they have attended your practice. Though it is possible to flag a review as inappropriate without submitting further specific information on some platforms, such as Google, this may not be the case for all platforms.

Conclusion

Ultimately, you cannot prevent a member of the public from posting a negative review of you or the service you provide online. However, by being open and transparent in your dealings with patients, welcoming concerns or criticisms, reflecting on any issues that are raised, and making a genuine effort to implement improvements on the basis of these, patients with legitimate concerns and who value their therapeutic relationship with you may be less likely to resort to publishing negative reviews online.