Managing Your Reputation in a Digital World

By: Terry Stanton

Why you can’t afford to ignore your online public profile

Physicians and restaurant owners have at least one thing in common: They both know the exasperation of feeling they are at the mercy of online review sites and the anonymous folks who post judgments of them.

At Tuesday’s Instructional Course Lecture on “Online Reputation Management,” speakers provided tips and strategies for reckoning with the “transparent world” in which the public perception of a physician’s competence can be shaped by the whims of nameless patients. The panel of speakers offered perspectives from both the side of the orthopaedic surgeon and of the largest online medical review site, Healthgrades.

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Symposium moderator Glenn B. Pfeffer, MD, introduces the panel: from left, Basil R. Besh, MD; Clay Calvert, JD, PhD; and Roger C. Holstein.

Roger C. Holstein, vice chairman of Healthgrades and its former chief executive, set the tone by telling the audience that, like it or not, online reviews are a fact of life, and the best way to deal with that fact is to understand how the system works, how to minimize its unwanted effects, and how to maximize its potential for enhancing one’s reputation and practice.

“The transparent world is good and it is bad,” Mr. Holstein said. “You can choose to fight it. You can choose to ignore it. You can choose to accept it. If you embrace it, it can make a positive difference for you.”

Own your reputation
In a survey that asked people to name the types of businesses and service providers for which “reputation” matters the most in making a choice, physicians (and dentists) topped the list along with restaurants, noted Basil R. Besh, MD, a hand, wrist, and elbow surgeon practicing in Fremont, Calif. Today, he explained, 80 percent of Americans read reviews online before selecting a physician.

Dr. Besh cited a definition of reputation management as “controlling what people see when they Google your name.” He advocated a proactive approach to the process and described a “virtuous circle” of online reputation management in which patient reviews and feedback lead to improvements in the practice, which leads to increased patient satisfaction, which leads to better reviews and higher demand for services.

Reputation management begins in the office, Dr. Besh said. Training staff for customer service is an essential investment; how the staff deals with dissatisfied patients is a major factor in determining what patients write online. “Don’t ignore upset patients,” he counseled. Patients should be offered an “easy pathway to communicate dissatisfaction,” including an email link on the practice website, satisfaction surveys, and signage in the waiting room, including the message, “If you like us, tell your friends. If you don’t like us, tell us so we can improve.”

One thing physicians should not do is ignore online ratings. “Doctor, Google thyself!” Dr. Besh implored. “Read all the reviews, including the good ones. Look for red flags, and look for opportunities for improvement.

“Unfortunately, not everyone likes you,” he said. In dealing with a negative review, Dr. Besh’s advice was, “Don’t rush. Verify. Investigate. Reach out. Be factual. Ask nicely.” Opinions vary on whether to respond online to negative reviews. Dr. Besh said that if a practice does respond, the message should come from the doctor. “Stay factual and stay polite,” he said. “Don’t get into an argument. Be sincere, transparent, and consistent, and above all, don’t violate privacy rights.”

In responding to a review, physicians should address the problem and seek to accentuate the positive. For instance, if a patient writes, “The doctor seemed rushed,” a response might be, “As one of the few specialists in town, we pride ourselves in serving as many of our patients as possible.”

One of the most effective strategies for managing an online reputation is to encourage satisfied patients to post positive reviews. “The solution to pollution is dilution,” Dr. Besh said, meaning that positive reviews dilute negative reviews and push them down the list on websites. Common mistakes made in efforts to encourage positive reviews include having patients post reviews from an office computer, as the review sites will recognize repeat IP addresses and will delete the reviews. Patients should be encouraged to use mobile devices and home computers, with a link emailed to them.

He explained that sites use complex proprietary algorithms to prevent fake reviews. Sites will filter and hide reviews that are suspicious but “not egregious enough to remove completely.” His practice will cut and paste positive reviews that have been filtered and post them to the practice web site.

Rules of the ratings game
Unfortunately, Dr. Besh noted, patients rate physicians based on factors not related to the quality of medical care. He told of one physician who was able to improve an online patient satisfaction score by 7 percent by prescribing an antibiotic to all patients who call with a complaint of cough, sore throat, or sinus headache. An orthopaedic surgeon in the audience, Johnny I. Arnouk, MD, of New York City, said that he had received two negative reviews from patients for whom he declined to prescribe narcotic pain medications.

The influence of patient satisfaction has consequences for the allocation and cost of medical services globally and for government decisions. “As pay for performance emerges and becomes more of a reality and actually affects our pocketbook,” Dr. Besh said, “you are literally seeing patient satisfaction, through an imperfect methodology, playing out as government-sanctioned increase in spending and mortality. More tests, stronger drugs, equal more-satisfied patients, which equals more pay. The biggest loser is the patient.” He cited a Forbes headline: “Rating a doctor is bad for your health.”

Mr. Holstein explained that the “transparent world” has created enormous marketplaces characterized by accessible data, user profiles, user-generated content, and a disruptive effect. Health care is a vast marketplace but is one that is singularly opaque, he said, meaning that consumers cannot obtain objective evaluations of quality and value or compare prices, as they can in shopping for products like cars or appliances.

Several forces are driving increased transparency in health care, including high-deductible plans, emergence of public and private exchanges, narrow networks, and increasing availability of data, all of which push consumers to demand information upfront about cost and quality.

Mr. Holstein, who previously served as CEO of WebMD in the early days of the Internet, proposed four guiding principles for succeeding in a transparent world.

One, “data must be accurate.” Twenty percent of physicians make some kind of a change each year, and online rating sites commonly have inaccurate information for physician addresses and telephone numbers. At Yelp, the probability of finding a physician with an accurate address or telephone number is 46 or 49 percent; at Google it is in the high 60s. Physicians may find it worthwhile to contract with a reputation management firm, such as ReviewConcierge or Reputation.com, to monitor the more than 100 sites on which a doctor may be found and ensure that information is accurate and up to date.

The second principle is that “Everything that can be scored will be scored.” Consumers are twice as likely to prefer doctors with experience, outcomes, and satisfaction information, Mr. Holstein said.

The third is “Personal information matters, a lot.” “Consumers and [referring] physicians want to know who you are,” he said. Physician websites should have photos and videos of the doctor, personal stories, and published articles and research.” One online capability that many practices do not provide is access to the physician’s calendar and scheduling.

Finally, “Information needs to be discoverable,” meaning it must be easily found in a search.

Mr. Holstein concluded with the following “three things you can do to manage your reputation in a digital world”:

  • At a minimum, make your data accurate.
  • At a modicum, provide sites with objective and personal information.
  • At a maximum, make your calendar accessible.

Dr. Arnouk, the audience member who had been panned online for not prescribing opioids, has been in practice for about 3 years since fellowship (in sports medicine). “Being a young physician, when I first started, I got a little too crazy about my online reviews,” he said. “If I had 40 patients, I know 38 of them would leave happy, and if I had one patient who was not happy—because he didn’t get this medication or whatever—that would bother me. We can create a horrible paradigm by acquiescing to our patients.”

The moderator of the ICL, Glenn B. Pfeffer, MD, of Cedars-Sinai in Los Angeles, recalled his supremely frustrating experience of trying to contact a human being at Yelp as he sought to find out why all of his 5-star reviews had been filtered out. Not long after, he had a chance encounter with a Healthgrades executive on an airplane, and he asked her why the online review environment had to be so adversarial. The meeting led to interaction with the California Orthopaedic Association leading to action by Healthgrades to respond to surgeons’ concerns with steps that included cleaning up the database, which was riddled with inaccuracies, such as inclusion of chiropractors in the orthopaedic surgeon category.

Dr. Besh said a negative review could have a positive result. “Not all bad reviews are bad,” he said. “Have faith in the consumer, or in the aggregate of the consumer. When people read, ‘I wanted my pain medication and the doctor wouldn’t give it to me, and therefore he doesn’t care and I am going to give him only one star,’ that’s going to have the effect of keeping the pain-med seekers out of your office. People who want an MRI every time they have pain—do you really want them in your office? Stick to your principles. Practice ethical medicine.”            

Also speaking at the ICL was Clay Calvert, JD, PhD, a lawyer and a professor at the University of Florida, who addressed legal issues and remedies regarding online reputation management. Look for coverage of his presentation in the monthly edition of AAOS Now.

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