The phenomenon of online reviews

The phenomenon of public online reviews for virtually any product or service is here to stay.  Despite the inherently private nature of medical treatment, some patients post reviews of individual surgeons, hospitals and clinics.  Some use generic review services such as Trustpilot or Google Reviews.  Others use specialist websites such as RealSelf for aesthetic procedures.  Reviews or comments are also posted on social media sites such as Twitter, FaceBook or Instagram.

The knowledge or permission of the surgeon is not needed to post a review.  Depending on the service used by the patient, the surgeon might not be notified of its existence.  Yet over time, such posts come to form part of the surgeon’s on-line profile, and can be brought to the attention of numerous people through search engine results. 

If a surgeon has only broadly positive reviews, this is probably a somewhat helpful thing.  Depending on the type of private practice, it might encourage new patients or referrals.  It might also reassure patients of the surgeon’s good reputation, which may assist in building trust and rapport.

However, sometimes negative reviews are posted about surgeons.  The criticism is not always fair or measured.  Incision’s medico-legal helpline regularly receives calls from surgeons who are concerned about negative reviews.  Common concerns range from reputational damage, to concerns about the patient’s welfare.  In this article, we look at the key considerations for specialist surgeons if they are unlucky enough to have a negative review written about them.    

Will it ruin my reputation?

One poor review amongst dozens of positive ones is unlikely to cause any real reputational damage.  Don’t allow yourself to fixate on a small number of negative review, and do keep things in perspective.  It arguably looks fake to have only perfect reviews online (after all, fake ones can be bought), so the occasional less-than-perfect review shouldn’t matter too much.

Also, keep in mind that at the time of writing our understanding is that there is no professional obligation to monitor what is said about you on-line by patients or anyone else.  You don’t need to spend your valuable time and emotional energy searching for patient reviews about you.

The nature of your practice also makes a difference to the question of whether negative reviews could affect your reputation at all.  If you gain new private patients mainly through word of mouth recommendations and advertising activities, then too many negative reviews might somewhat undermine your efforts.  Aesthetics and some types of sports medicine might be particularly vulnerable areas.  If you gain private patients through a private health insurer, then there might be a modest impact from too many negative reviews.  But if you mainly get referrals from other doctors or the NHS reviews might matter very little if at all.

Give some thought to how important your on-line presence is to maintaining or growing your practice.  If your assessment is that your on-line profile is highly important to your practice, and if there are numerous apparently credible negative reviews, then perhaps it could be worthwhile considering the issue holistically.  It might be that the reviews indicate that there is something that could be improved in your practice, and the reviews will gradually improve once you address it.  Even if there is no common theme in the reviews that you can address, there may be things you can safely do from a PR perspective to balance out the negative reviews.  An example could be having positive patient testimonials (all completely anonymised) on your website or social media pages.  You should also consider limiting the number of ways that on-line comments can be made about you.  For example, if you use Facebook or Instagram for professional purposes, consider disabling the comments function so that patients cannot simply post on your page for the world to see.

If a negative review does happen to come to your attention, you can decide whether you need to do anything about it using the guidance later on in this article.

Have I been defamed?

Many surgeons often feel offended if a patient posts an unfairly scathing review about them online.  This is understandable, especially when you have done your best for a patient, and they are being unfair or untruthful. 

But under the current law, even if a public review is nasty, false, offensive, and could make readers think less of the surgeon, this is still not enough to have a legal remedy under the defamation laws.

Under the Defamation Act 2013, claimants (i.e. the surgeon who is the subject of the post) have to prove that the review has caused or, is likely to cause, “serious harm to reputation” (https://www.legislation.gov.uk/ukpga/2013/26/section/1/enacted). Crucially, for bodies who trade for profit, the serious harm to reputation also has to cause serious financial losses. This is a high threshold to meet, and if you can’t then you have no legal remedy. Proving serious harm in this context is likely to be difficult. The surgeon may need to provide evidence of a measurable decrease in bookings, or rise in cancellations, resulting in financial losses – and show that the review must have caused it and not other factors such as a competitor arriving.

If you might be able to meet the serious harm test, then Incision can recommend specialist defamation lawyers to get formal legal advice.  But if not, then unfortunately the laws of defamation are unlikely to assist you, however personally hurtful you find the patient’s review.

Can I get the post taken down?

This is sometimes possible, although as a regulated medical professional you must take great care in how you attempt this.

A review can be taken down by the owner of the website if it violates the website’s terms of use.  The owner of a review website is not going to remove a review just because you disagree with it – they are not going to arbitrate a genuine difference of opinion between you and your patient, nor points of factual detail in the review.

If you are concerned about a review, read the website’s terms of use first. As an example, the rules about what people can include in Google Reviews are at:

https://support.google.com/contributionpolicy/answer/7400114, and those for Realself at: https://www.realself.com/community-guidelines.

For example, if the website’s terms stated that users were not allowed to threaten violence, and a patient’s review said that their experience was so bad they wanted to smack you, then you could contact the website owner and ask for it to be removed because of the threat of violence (not because you think their experience was good).  Similarly, if the review was entirely false in that you had never seen that patient or carried out the alleged treatment, this would violate the terms of use of most of these websites.  In these situations it should not matter whether the review states the patient’s name or user name, or is entirely anonymous.

Even if you think the review violates the website’s terms of use, you still need to take care.  The existence of the review does not remove the patient’s right to confidentiality.  When contacting the website owner you must take care not to provide any confidential information whatsoever about the patient.

Should I Respond to the Review publicly?

Probably not! It would be extremely risky to provide any substantive public response to a post that you disagreed with.  Doing so would almost certainly breach patient confidentiality, and in turn risk triggering a GMC referral.  However, strongly you may feel about what has been said, it is imperative that you avoid publishing your side of the story.

If online reviews are highly important to the publicity strategy for your practice, then it may be worthwhile responding with a purely generic expression of sympathy and to invite the reviewer to contact you direct.  Something along the lines of “We are sorry to hear you are unhappy, if you would like to discuss this with us direct please email us at…”.  From a PR point of view, that could potentially reduce the impact of a negative review by showing other readers that you are engaged and concerned.  But often, it will be better to not respond at all, especially if you are in the middle of a separate complaint process with the patient at the time.

Should I Respond to the Review privately?

There are some situations where it might be appropriate to contact your patient because of a negative review.

But before you do so, make absolutely sure you know the identity of the reviewer.  Many reviews are published under user names rather than full names, and some are entirely anonymous.  If you have any doubt about the identity of the patient, then don’t try to contact them.  The risk of an inadvertent patient confidentiality breach is too high.

Similarly, if the review is not written by the patient themselves, but by a relative or friend, then it is better not to try to contact the patient.  Reviews of the ‘my friend saw this surgeon and was really unhappy’ type are just hearsay, so it would be risky to contact the patient.  That sort of post might be better dealt with by contacting the website owner about a terms of use violation.

So when should you consider contacting a patient privately about their negative review?  As a surgeon, your main concern must be the safety and welfare of your patients.  Therefore you should consider whether the review indicates that the patient needs a clinical follow up.  Perhaps the review mentions recent complications that they have not reported to you direct.  If the patient is under your care, you might need to contact them to make sure that the complications are being treated – perhaps urgently if they are describing acute symptoms.  Similarly, some reviews might indicate that the patient may be having mental health problems, so consider whether it is appropriate to contact the patient or perhaps write to their GP to ensure they are receiving appropriate care in that regard too.

You can also contact the patient privately if you want to try to resolve their complaint.  The potential benefit is that you can nip a claim in the bud before the patient gets so worked up they decide to go to lawyers.  But the potential downside is that you might exacerbate the situation – the patient might have got everything off their chest in the review and have no intention of taking it further.  Before you decide, it would be prudent to contact the Incision medico-legal service and get guidance, and in particular check whether your Insurers need to be notified first (see next section).

So what should you do if you want to bring their complaint out of the public domain and into a confidential patient complaints process?  The first step would be to contact the patient to explain politely that you have seen their review, that you are sorry that they are unhappy, and invite them to follow the usual complaints process (providing the details) if they would like.  Requests that they remove the post in the meantime might appear heavy-handed so are likely best avoided.

Do I need to notify my Insurers?

The key thing to always keep in mind if you are unlucky enough to notice a negative online review is whether the review in itself counts as a “Claim” or “Circumstance” as defined by your medical indemnity insurances.

In particular, a “Circumstance” is anything that could lead to the patient requesting compensation or referring you to the GMC.  Therefore be alert to indications that the patient feels that they have been affected financially, that they may go to lawyers, or report you to the GMC. 

Notifying in these situations can help protect your interests from an insurance perspective. The Incision medico-legal helpline team (medicolegal@incisionindemnity.com) will assist you with the process of notifying the situation as a precaution.  It does not take long, and at the same time they can provide their expert insight and guidance on what to do about that specific negative review.  If the patient does go on to bring a claim, even years later, you have the comfort of knowing that your insurers have already taken ownership of the matter at the time you first notified it.

If you are already facing a full-blown claim by a former patient, and you see that they post a negative review, you should update the Incision medico-legal team straight away.  In some situations, your policy can cover some Public Relations costs related to that claim.

Incision Indemnity

October 2020