Not infrequently on our online Facebook communities for physicians, we see the question of what doctors should do about negative patient reviews. Unfortunately, part of being a physician these days is being reviewed online, and as doctors know, what patients choose to post is not always fair or accurate, or even always a review of the physician themselves. While we all understand the helpful role patient reviews can play in the decision making process for potential patients searching for their next physician, many of us also worry about the weaponization of this “review” function to get what a patient wants, regardless of whether it is reasonable, indicated, or in the patients’ best medical interest, or to complain about something a physician may not have control over, such as required co-pays, insurance denials, or how a patient responds to a particular treatment. Therefore, even the best physicians in the world are always going to get bad reviews. The problem, of course, is the ability to hurt a physician’s reputation, their practice finances, and, not always insignificantly, a doctor’s feelings when they truly had tried their best but there was a circumstance beyond their control. In many cases, the physician may feel powerless to respond without revealing patient details that could lead to legal issues. Below, we’ll cover how to handle bad patient reviews and what can be done about them.
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What are common reasons patients post bad reviews?
To state the obvious, patients that post bad reviews are unhappy about something. The problem is that something may or may not have anything to do with the physician or the way that they provided treatment. For example, the patient’s expectations may not be realistic or in their best interest (for example, prescribing antibiotics for a viral illness). Another example is when patients are upset about the current healthcare landscape and get upset about the length of their visit, insurance company practices such as co-pays and deductibles or prior authorizations, or other things like staffing shortages. Many times, we as physicians are frustrated about these things too! Regardless of the reason for the dissatisfaction, they sour the patient experience and the doctor patient relationship.
Of course the other reasons why patients may get upset may be completely justifiable, such as long wait times, mistakes made by the physician or their staff, canceled appointments, or less than ideal interpersonal skills.
Why do patient reviews matter?
First off, nobody likes seeing a 1 star review. Most physicians are people pleasers, and also take a lot of pride in their work and try their hardest to do right by their patients. To put that effort in and then find that the patient didn’t appreciate it not only hurts your feelings, but can also contribute to your feeling of physician burnout.
Depending on your practice environment, patient reviews could also matter for a number of additional reasons. Reports show that over 80% of patients rely on online patient reviews when choosing a doctor, so these have a significant impact on the growth and reputation of your practice.
If you’re an employed physician, patient satisfaction scores and how patients rate or review you could be a part of your performance review or a part of your bonus compensation structure. If you are in an RVU based practice, if negative patient reviews hurt your reputation and your ability to build a practice, you’ll have less patients come and see you, which will hurt your compensation as well.
If you are in private practice and paid based on how much income you generate, bad patient reviews can harm your ability to grow your practice and your reputation. These will affect your finances from a cashflow perspective, your ability to bring on new employees and partners, and ultimately the valuation of your practice.
Additionally, a bad patient review, if not handled tactfully, has the potential to amplify and eventually expose you and your practice to potential liability or legal proceedings.
Lastly, and it’s important to keep this in mind, bad patient reviews are important because they give you an opportunity to see the service you provide from the patient's perspective. In many cases, these can offer ideas for process improvements or problems that need to be addressed, so try to be objective about a patient’s review and see what you can learn from it.
Keep bad patient reviews in perspective
The other advice we would give is to keep the patient reviews in perspective. Most patients understand that if the vast majority of your reviews are positive, one or two bad reviews shouldn’t sway them from considering you as their doctor. Everyone knows that you can’t make everyone happy and even the type A med student in you likely knows that if you are seeing enough patients, not everyone is going to give you a five star review. More likely than not, the bad will soon be outweighed or ousted from the top position by other incoming reviews. Part of this is just the nature of the business, and everyone other doctor that your potential patients are looking at will also have a handful of bad reviews. If they only go for physicians that have all good reviews, they’re going to limit their potential doctors pretty quickly.
What should you do when you see a bad patient review?
As we said, patient reviews matter, so a key component of online reputation management is making sure that you handle them in a professional manner. This requires grace, the ability to project forward to how the patient will handle your response, handling bad reviews with grace — and this requires both tact and foresight.
With that in mind, the following suggestions have been echoed several times by members of our physician community.
Do not respond out of anger. Take a second and breathe. This will avoid impulsive responses that come across as unprofessional, spiteful, rude, or otherwise reflect poorly on you or your practice. Also make sure you gather the facts around the patient’s experience and make sure your office didn’t do something that warrants the complaint. Put yourself in the patient’s shoes and try to understand where they’re coming from. You may still very well be very much in the right, but you want the person to feel heard and taken seriously when you respond.
Respond in a timely manner. While we literally just told you to breathe, don’t wait weeks to respond. This could only further aggravate the person complaining to find additional online patient review sites or other places to complain, or cause them to escalate something to a lawyer or by reporting you to the medical board. If the reason for their complaint was a misunderstanding or something easily addressable, this would be particularly unfortunate.
Be careful not to violate HIPAA. Don’t acknowledge the patient’s identity, that they are a patient in your practice, or the particulars of their medical history, even if they have stated their name and what they were seen for. See the dedicated section on this below.
Try to have a conversation with the patient in a non public forum. You or your office staff could call the patient and have a phone conversation or ask them to come into the office. Ideally you will resolve the issue or misunderstanding and the patient will take down or edit their review to show that the issue was addressed or that they had misinterpreted something.
Be objective and make changes as needed. Put yourself in your patient’s shoes. Try and see if there are reasons that they should be upset, and address any issues or areas for improvement with your staff or practice.
Do not ignore the patient review. While the golden rule of not saying something if you don’t have something nice to say may seem like a good policy for life, to an outside potential patient looking in, it may appear that you don’t care enough to address a patient’s concern. Having a generic and professional response will show your patients that you are at least paying attention and trying to do something to optimize the patient experience.
What about HIPAA concerns when responding?
We are not lawyers, so when in doubt, always ask your or your employer’s lawyer. The rule of thumb here is that you cannot reveal any information about the patient or that they are your patient. This applies even if they have given information about themselves in the review they posted or used their real name in the review - you cannot say anything about them, their identity, or the specifics of their treatment plan without their explicit permission to do so.
This is why so many responses to bad reviews are generally pretty generic, with something along the lines of saying that you care but that the patient should reach out to you. Many practices put together a template for these responses that include something like, “All feedback is important to us, but in order to comply with confidentiality regulations, we are unable to respond publicly. We would, however, love to discuss your concerns further. Please contact our office at [email address] or [phone number].”
If there is a particular complaint that is a common one, you could also have a generic templated response for that complaint that doesn’t reference any of the particulars of the patient situation. For example, if it’s a complaint about not giving antibiotics when the patient wanted one, you could have a response that says it’s your practice’s policy to abide by your medical society’s guidelines about prescribing antibiotics only when there is a bacterial infection. Another common response you could have about something like wait times would be to say something along the lines of, “While we make every effort to stay on schedule and avoid long wait times, our practice policy is also to try and accommodate emergencies in order to provide the best care for our patients. Some times this may affect a patient’s wait time, but please know that we would try our best to do the same for that patient if they had an emergency. If you want to discuss this further, please contact us at [phone number].
Again, take the advice of your attorney when crafting these statements or others.
What are other best practices for handling bad online patient reviews or lessening the impact of bad patient reviews?
It’s important to have a system in place to even know when a bad patient review is posted. This could be managed by your practice manager, but even you may want to keep an eye on these reviews as they are such a big part of how you build your practice. Make a point to regularly review all reviews that are submitted below a certain number of stars. You can also set a Google alert for your name or your practice’s name so you can see if your practice is being talked about outside of the traditional ratings sites.
Additionally, have your own internet presence. Having your own website, social media, and being cited in articles or other media will allow you to own your online reputation better. These will likely rank higher in search engines than the generic patient review sites like Healthgrades, Vitals, RateMDs, or Yelp.
Be proactive about encouraging patients to leave patient reviews for you (as long as done in a legal way). As we all know, people are quick to complain, but not as quick to give praise. You want to make sure that the online patient review scores are representative of your entire patient population, not just the dissatisfied ones. Many practices hire companies to help manage and make it easy for patients to leave reviews. You could also have signs in your waiting area or check out desk asking patients to do so, have your staff ask the patients to review you after you leave the room or when they’re checking out, and so forth. These will quickly offset any negative reviews (since we all know you’re actually probably great at your job!).
Lastly, again, make changes based on the input that you received or the lessons that you learned. These really can be opportunities to improve.
Conclusion
While online patient reviews are very important, they shouldn’t be the reason that you lose sleep. Do for the patient what you’d like done for you if you were unsatisfied with a service, but also realize that you can’t please everyone. Make sure everything you do is HIPAA compliant, and when in doubt about a particularly dicey situation, consult your practice attorney for guidance.