Online Consumer Review and Rating Sites: Ten Questions and Answers Next

 

Physicians may find themselves the subject of online postings on an ever increasing number of health care related consumer review websites. Although studies have shown that most patient/consumer reviews on physician ratings websites are positive, such sites are a concern for physicians because inappropriate negative comments can damage a physician's reputation and affect his or her practice. This article discusses how physicians can manage and respond to online comments about them or their practice. 

 

 

 

Unless you routinely monitor the Internet for your online information, you will not necessarily know that you have been reviewed or rated on physician rating websites. Rating websites such as Healthgrades, Angie's List, Yelp, RateMDs, and Vitals generally gather business information from public records as well as users to generate profiles. Physicians can join these physician rating sites for a fee which may allow them to manage their profiles to an extent and monitor any comments being made about them.

 

You can search online for your name and/or the name of your practice to find out what is on the Internet about you or your practice. Practices can also set up online alerts that send links to any websites or blogs which contain the physician's name or contain predetermined keywords or phrases. If you do not want to register with physician rating sites, constant monitoring through online searches and alerts will help identify your online presence.

 

 

No. Consumers can add your business and most physician rating websites will not remove your listing from their site. However, as mentioned above, most sites provide you the ability to manage your profiles to a certain extent.

 

 

Physicians concerned about their reputation on the Internet can develop their own practice website where they can control the content and project a positive image about the practice. Physicians can provide information about the practice, what services are offered, level of experience, and generalized statements of satisfaction with your services that are representative of your patients' experiences. Having a practice website can increase the likelihood that your site will be one of the first page options patients will see when they are searching for you online. Physicians can also maintain a presence on social media sites such as Facebook and Twitter where the practice can control the online content viewed by potential patients. Such sites are more likely to show up on online searches than physician rating sites. Physicians always have an obligation to protect patient confidentiality and comply with all relevant state and federal laws. For information on maintaining physician websites and potential liability of giving advice over the Internet, see Steven M. Harris, "Avoiding legal woes when marketing a practice online," AMA American Medical News (October18, 2010) at www.amaassn.org/amednews/2010/10/18/bicb1018.htm.

 

 

A recent study shows that most online comments about physicians are positive. The study, published in the Journal of General Internal Medicine, concluded that "[d]espite controversy surrounding these sites, their use by patients has been limited to date, and a majority of reviews appear to be positive." The study examined online reviews of 300 physicians on 33 different physician rating sites and found that 88 percent of the reviews were positive with 6 percent negative and 6 percent neutral. The study indicated that the development of these sites offer patients an avenue to provide feedback and obtain information about physician performance. See Tara Lagu et al., "Patients' evaluations of health care providers in the era of social networking: an analysis of physician-rating websites," Journal of General Internal Medicine (Epub. May 13, 2010).

 

 

 

Negative online reviews can be a source of consternation for physicians but it is important to take the occasional negative review with a grain of salt. While it may be tempting to publicly respond to the negative comment and defend your reputation, it is important not to overreact, as this can expose you to liability and escalate the problem resulting in further distribution of the damaging content. Physicians should utilize patient feedback on physician ratings sites to look for patterns in reviews to learn from the comments and use them to improve the practice.

 

If it is possible to positively discern the identity of the reviewer as a patient, a physician may, depending on the circumstances, choose to communicate with the patient to resolve their grievances. The poster can generally remove content originated by them and the physician may find that by taking the time to explain their treatments and address the patient's concerns, physicians may succeed in having the content removed. While some rating sites encourage businesses to post public responses to negative comments, physicians should refrain from doing so because of patient-physician privilege and federal and state privacy laws. If a physician chooses to address a negative comment by posting a public response, the practice should limit its response to general updates about how a problem is being addressed with care not to reveal any patient information.

 

In cases where the negative comment contains information that is clearly false, inappropriate and solely inflammatory contact the site administrator. Many websites have content guidelines and terms and conditions for use and are responsive to removing a post that is clearly defamatory, attacks the physician and does not provide any pertinent information about the practice or any matter of public interest. Determining how to respond to a negative online comment depends on many factors including the nature, source, and egregiousness of the comment. Responses can range from simply making internal changes to address a problem up to legal action against the poster. Physicians should consult with an attorney before considering any legal remedies. For an article on using online comments to your advantage, see

 www.amaassn.org/amednews/2010/07/26/bica0726.htm.

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Maybe.If the negative review violates the website's content guidelines or terms and conditions for use, the site administrator will remove the review. Some sites also allow the public to flag comments for review for inappropriate content by the site administrator. However, physician rating sites have no obligation to investigate the veracity of information posted in comments and generally will not remove negative opinions or criticisms about you or your practice.

 

 

No. Publishing fake consumer reviews on the Internet may subject you to penalties and fines for "astroturfing," in which employees pose as independent consumers to post positive reviews and comments on websites and Internet message boards about their own company. In 2009, a cosmetic surgery practice in New York was forced to pay $300,000 in penalties and costs after the practice directed employees to post positive comments and narratives posing as independent and satisfied customers. See www.ag.ny.gov/media_center/2009/july/july14b_09.html.

 

 

Although the law does not prohibit asking patients to sign an agreement barring them from posting negative online comments about the practice, it is unclear whether such an agreement will ultimately be enforceable in court. Such agreements may force patients to choose between health care and their First Amendment rights of providing feedback on their doctors' performance. Additionally, some ratings websites have a "wall of shame" which lists physicians who make patients sign "gag" contracts before accepting them as patients. Such a listing may have a negative effect on the physician's reputation.

 

 

 

Probably not. The federal Communications of Decency Act immunizes internet providers from liability for defamatory statements made by a third party on their websites. (47 U.S.C. §230.) The California Supreme Court has also held that subjecting Internet service providers to defamation liability would tend to chill online speech and thus exempts Internet intermediaries from defamation liability for online republication of third party content. (Barrett v. Rosenthal (2006) 40 Cal.4th 33, 51 Cal.Rptr.3d 55.)

 

 

Possibly.In some cases, physicians may have a claim of defamation or libel against an individual who has posted a negative online comment about their practice. However, physicians should be well-advised that such lawsuits can be expensive, difficult to prevail in, and will be a matter of public record thus drawing unwanted attention to the disparaging comments that would have been otherwise been ignored or overlooked. Before considering any legal action against a reviewer for a negative online posting, physicians should consult with an attorney.

 

Physicians who sue a patient for posting a negative review online will also likely be subject to an anti- SLAPP ("Strategic Lawsuit Against Public Participation") motion to strike the complaint on the grounds that the online posting is protected public interest speech. California law protects defendants who are sued as a result of protected speech in furtherance of their free speech rights of any written or oral statements or writings made in a public forum related to an issue of public interest. (Code of Civil Procedure §425.16.) Physician rating websites are public forums for the purposes of the anti-SLAPP statute and if the patient can make a showing that the posting relates to a matter of public health interest, the burden shifts to the physician to prove the likelihood of success in the lawsuit. In a recent decision by the California Court of Appeal for the Sixth District, a dentist sued the parents of a minor patient based on a negative review posted on Yelp.com that criticized the dental services provided to the defendants' son. The court found in favor of the defendants and directed the trial court to grant the defendant's anti-SLAPP motion and dismiss all but one of the dentist's claims. However, because the dentist had evidence which contradicted the defendants' version of events as posted on the Yelp review, the court allowed the dentist to proceed with a defamation claim. (Wong v. Jing (2010) 189 Cal.App.4th 1354, 117 Cal.Rptr.3d 747.) Physicians should therefore determine whether the post is protected public speech or contains statements that are provably false prior to initiating any lawsuit. Physicians should also be aware that the prevailing party in an anti-SLAPP motion will be entitled to attorney's fees and costs associated with bringing such a motion. We hope this information is helpful to you. CMA is unable to provide specific legal advice to each of its more than 30,000 members. For a legal opinion concerning a specific situation, consult your personal attorney. For information on other legal issues, use CMA ON-CALL, or refer to CMA’s California Physician’s Legal Handbook. This book contains legal information on a variety of subjects of everyday importance to practicing physicians. Written by CMA’s Legal Department, the book is available on a fully searchable CD-ROM, or in a seven-volume, softbound format. To order your copy, call (800) 882-1262 or visit CMA’s Bookstore at www.cmanet.org.