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November 5th, 2015

The Right Way and Wrong Way to Manage Patient Criticism Online

By Jeff Segal

Understatement: Not all patients will be happy with their doctors. Years ago, this problem was local and ephemeral. Today, criticism spreads online and has longevity; posing a problem and providing an opportunity. The problem is obvious. The opportunity is turning a negative online stab into a positive presence.

Let’s examine two case studies; one illustrating poor professionalism; the other demonstrating best practices for service recovery with an online tool.

A neurosurgeon was slammed on an Internet review site by a patient who posted:

“Never get to see this neurosurgeon when expected, normally is seen by the PA. I would not refer and/or recommend this physician to anyone who is a Traumatic Brain Injury, Hydrocephalus, and who have an implanted shunt [in our region]. Poor diagnosing and prognosis outcome. My input and insight on this neurosurgeon is of my own opinion, and every individual’s personal view of this physician may differ from my own.”

This patient’s post was reasonably diplomatic. Not a shred of anger.

The doctor responded online using the moniker “Idiot Patient”:

“Hey you idiot! What does “poor diagnosis and prognosis outcome mean? Go get your shunt adjusted to a lower pressure, and you have no insight so don’t talk about “my insight.” Trash talking loser. Sorry you have a brain injury. That’s my opinion.”

Contrast that response with the following case.

Dr. B. practices as a sports medicine orthopedic surgeon. A teenage soccer player with a knee injury arrived with her mom for a second opinion. She had been seen by another surgeon and was scheduled for surgery. She wanted to get back to being active ASAP, but her insurance carrier mandated a second opinion.

The appointment with Dr. B. was swift. Dr. B. told them he treats patients conservatively and prescribed a brace. Her carrier might not pay for the brace; if not, the family would be billed $300.

The girl had surgery and did well. Her mother vented on Yelp, saying Dr. B didn’t listen. Her daughter was active and did not want to slog through a trial of conservative treatment. Surgery had gotten her back to the soccer field quickly. She also complained about getting stuck with a $300 bill for a brace her daughter never used.

Dr. B., who relies on a third party to monitor the Internet for mentions, received the Yelp review and responded:

“We want all of our patients to have a positive experience with our office and it’s clear we let you down. I want to make it right.

First, let me explain.

I did agree that surgery would make it possible to regain full activity. And, if surgery was around the corner, the brace we provided would not be needed. I believed, in good faith, that your daughter was not interested in surgery -- at least in the near term, and there was a conservative option, a brace, which would allow her to walk and run, without her knee giving way. That was why I offered the brace -- as an alternative option to surgery.  Surgery, of course, was always a reasonable option, and likely a better long term solution for her situation.  But, every patient is different, and every patient has a different opinion regarding surgery versus more conservative treatments for elective conditions. And we do our best to honor their requests.

I apparently misinterpreted what you and your daughter wanted. Please accept my sincere apology. Also, I have enclosed a check for the full amount you paid for the brace.

I'm hoping this gesture will help regain your trust in our practice.

In light of this, I hope you will either remove or update your post to reflect this. Regardless, please treat this as a request and not a demand. I'll respect whatever you decide.

Finally, if you'd like to discuss on the phone, I'll arrange my schedule to do so at your convenience. Thanks.”

The mom did not remove the post. But, she did upgrade her rating from 1 star to 5 star and also wrote, “Dr. B. listened. He really rocks.”

Clearly, Dr. B’s approach (and online outcome) was far better than the neurosurgeon’s who wrote, “Hey you idiot….” Perhaps “best practices” in service recovery are only aspirational, but “worst practices” do exist.

Patients are online posting about doctors. Tapping into the online world is now one of the most efficient method to “diagnose” their “unhappiness” and fix their problems. Patients do appreciate and acknowledge full-throttle professionalism online. Healthcare providers who respond professionally reap rewards in service recovery.

Tags: Patient Involvement, Physician Involvement

Liked by rbdgswg, Matthew Katz, MD, Randall Post, Megan Rowe

Comment


Megan Rowe
@MeganRowe

Posts: 235
Joined: Nov 07, 2012
Posted by @MeganRowe, Nov 9, 2015

These responses are definitely night and day. While I’ve never encountered a doctor as bad as the first example, I meet with plenty of people whose first reaction to a negative review is, “Let’s delete it!”

In case #2, I think this is where we’d all like to be. I am curious about the online discussion of the case — I’m not sure if it’s necessarily OK, from a HIPAA perspective, for the doctor to reveal medical information even if the patient or legal guardian already has. Generally I tell people to say something like, “Really sorry about this. I think we had a misunderstanding, and I’d like to try to work it out over the phone or by email.”


Jeff Segal
@jeffsegal

Posts: 32
Joined: Oct 15, 2012
Posted by @jeffsegal, Nov 9, 2015

Agree that one is prohibited from revealing any protected health information unless the patient explicitly authorizes. In case #2, the discussion was offline. The doctor wrote a snail mail letter to the patient. And the patient responded online.

Still, it if often possible to have a conversation online as long as one understands that no protected health information (PHI) can be revealed. And remember, even acknowledging the patient is a patient of the doctor’s reveals PHI. So, if the patient has disclosed his/her name or even a picture, posting content with anything other than generalities can create a HIPAA risk

Liked by Susan Woolner


cesardel22
@cesardel22

Posts: 4
Joined: Jan 13, 2014
Posted by @cesardel22, Nov 9, 2015

I love these two examples. They have given me deeper perspective to both sides.

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