the source of the opinion and decide whether or not to take that person’s comments – good or bad – seriously. Today, word of mouth is still critical to gaining new patients and building a practice. However, the form that “word of mouth” can take has greatly changed. Consumer review websites such as Yelp!, RateMDs.com, DR.Oogle, Angie’s List, healthgrades, and dozens of others allow patients to post online comments about dental providers and practices quickly and easily. Online reviews may be just as powerful as personal word of mouth recommendations or disparagements. As these website reviews become a mainstay of consumer decision making, they cannot be ignored by dental professionals. Even dentists who have resisted the movement to a robust online presence cannot escape the commentary posted on these third-party review sites. Therefore, it is important to have a basic knowledge of how to handle negative commentary and protect a provider’s and practice’s reputation. If all the comments posted on these sites were positive, clearly no one would find them cause for concern. Fortunately, according to one study of 33 physician-rating websites, approximately 88% of all comments posted were positive, only 6% negative, and approximately 6% neutral (Lee, 2013). Most consumer review websites use a grading system of 1 to 5 or 1 to 10, with the higher number being the higher rating. These sites also accept comments to go along with the numerical rating, and the postings can be anonymous. Although the vast majority of ratings tend to be positive, even one negative rating or disparaging comment can at least hurt a provider’s feelings and, worse, damage his or her reputation. Imagine how it would feel to see posted on one of these review sites: “Dr. (insert your name) is a QUACK! Avoid him at all costs!” Or “The office is dirty and the staff is lazy.” Because the posts can be anonymous, it is not out of the question that a disgruntled employee or a competitor might post something negative. It would be impossible for others who view that post to know the ill intent of such commentary. Physicians and dentists have approached these issues in varying ways, and some cases revolving around these websites have made their way into the legal system (Lee, 2013). One challenge to responding to negative commentary on such sites is HIPAA. As discussed earlier in this course, online interaction with patients is a public forum. Patients have the legal right to disclose their own protected health information, but health providers cannot disclose any of that same information without the patient’s consent. For example, if a patient posts a negative comment concerning the pain and slow healing of a dental extraction, the dentist must not respond by voicing the opinion that the patient’s heavy smoking probably delayed the healing. It may seem like an uneven playing field from the provider’s perspective, but it is the law. Healthcare professionals may still respond to criticisms with general information about their practices and procedures, but they may not discuss an individual case (Lee, 2013). Dentists and physicians have had limited success in trying to sue for unwarranted negative commentary on such websites. Attempts have been made to prosecute authors of negative comments under defamation law. Defamation is a false statement which is construed as a fact and which causes injury or damage to the character and or reputation of the person about whom the statement is made (Earle, 2021). Defamation through a written medium is called libel and when it occurs in a spoken medium it is considered slander (Sember, 2020). Libel laws could apply to written commentary on such websites. Defamation law attempts to balance the alleged harms comments have done to the plaintiff’s reputation against the defendant’s first amendment rights. Proving defamation in court can be difficult and costly. The first amendment protects pure statements of opinion, no matter how derogatory. Furthermore, the anonymous nature of many review website posts can make identifying the commenter practically impossible (Lee, 2013). ]. Bringing lawsuits against
patients for defamation could also prove counterproductive. Dentists may focus more attention on what was said by bringing it into the legal realm and placing it before the public eye. Dentists should seek professional legal advice on matters such as these if they feel their reputations may be at risk. Because defamation law is so complex, dentists and physicians have also attempted to use medical non-disclosure agreements (NDAs) as a means of preventing the occurrence of negative commentary in the first place. As patients enter the practice, they sign these agreements, which require them to limit what they can write online about the provider. However, these agreements, which seem like a good idea on the surface, are not advised because they pose many ethical issues. For instance, patients in pain may agree to anything just to be out of pain. Having a patient sign such a form at a time of extreme stress can be considered coercive. Also, these agreements are difficult if not impossible to enforce (Lee, 2013). Another ethical issue involving these sites is the practice of posting falsely positive comments. Business owners can hire companies to post falsely positive comments to these websites to promote business. It goes without saying that this practice is unprofessional and unethical and should not be allowed to occur. Connelly (2012) pointed out the following considerations related to the evaluation of healthcare services: ● The number of evaluations on average for a particular healthcare service, as compared with an entertainment venue or restaurant, will most likely be low, affording negative ratings a higher effect on the overall rating of healthcare services as compared with other industries with more frequent users. ● Healthcare services by their very nature can cause discomfort or pain. Patients have individual thresholds for pain and discomfort. Negative reviews of services that are completely within the standard of care may result simply from necessary unpleasantness arising from the services provided. Lee (2013) points out, however, that most negative comments related to healthcare services are not doctor- or procedure- specific, but related more to facilities and systems. If need be, it is possible to respond to these concerns online and quickly rectify the problems in the office. Since consumer review websites are here to stay, it is best for dentists to come to terms with them and even use them to their advantage. Lee (2013) has suggested the following strategies to help healthcare providers manage online reviews: ● Be aware of what is being posted online about individual providers as well as the practice. It might be prudent to assign a staff member to regularly search providers’ names and the practice name to find and pull up recent posts. The program Google Alert and others like it can be used to track a particular online presence and send email reports on a regular basis with information on recent online activity involving a designated entity. Internet watchdog companies also exist and can be hired to monitor online reputations and posting trends. Being proactive allows for a timely response to any disparaging remarks and also provides a way to monitor patterns of patient feedback. ● Take control and establish a positive online presence. Building a website that provides information on a provider’s credentials, practice philosophy, and practice methods can foster credibility. Posting office pictures, parking information, business hours, and other facilities-related information on the website will prepare patients for their office experience and provide information that can speak for itself should a negative comment arise in this realm. ● Encourage patients to address concerns directly with the owner of the practice. Keeping communication open and being respectful of patient concerns will enhance the doctor-patient relationship and may avert the posting of a negative comment online. Stating this “open door” policy
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