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Published 11/1/2011
Peter Pollack

Take control of your digital footprint

Engaging patients online gives you the opportunity to manage your own reputation

“Patients search for information about their conditions, their medications, and, of course, their physicians,” noted Howard J. Luks, MD, who has spoken frequently on the topic of physician online engagement. “That poses a risk to doctors, particularly orthopaedists, who are elective specialists and frequently depend on referrals from patients and other physicians. Online reputation management is the process of monitoring, addressing, and mitigating what is said about you on a search engine.”

To even the experienced online user, popular Internet sites may appear to be a constantly shifting labyrinth of outlets. The roster of buzzwords changes frequently; Friendster and MySpace have been overtaken by Twitter, blogging, Facebook, and most recently, Google Plus. (See “Getting acquainted with social media,” page 33.) But although the names may be transient, the information posted to the World Wide Web can survive online for years, possibly decades. Comments from dissatisfied patients posted to blogs, Facebook pages, or websites such as RateMDs.com and HealthGrades.com can directly affect the public perception of a physician and his or her practice.

“When I talk about reputation management to physician groups or hospitals, I can frequently find examples of a HealthGrades page or a Yelp page that talks unfavorably about someone in the audience,” said Dr. Luks. “Even if I make it as anonymous as possible, it makes the point. The online world is becoming far more pervasive, and reputations are increasingly built and managed on the internet.”

Those who dislike taking part in such “social networking” may be quick to dismiss the importance of such services as time-wasters and passing fads. But they cannot ignore the impact of a negative posting. The situation is complicated by the fact that information posted online by third parties can be difficult, if not impossible, to remove. Many websites refuse to take down offending content unless it violates the law or their own terms of service. Even if a site finally agrees to delete offending content, the process can take weeks or longer.

In addition, the online service Archive.org scans and indexes “snapshots” of many websites on a circulating basis. Pages archived in this manner may remain available on the Archive.org website long after they have been deleted from the original site.

Improving your search results
Physicians who are concerned about their online reputation, however, are not without options. One of the best ways to overcome a negative comment is to maximize your own online presence and to encourage positive comments and links to your website.

Although the exact algorithms that determine the order in which search engines display their results are closely guarded trade secrets, sites that are regularly updated, with more users and more “incoming links” than other similar sites tend to be ranked more highly, resulting in their display on the highly desirable “first page” of results.

“Online reputation management is driven by search engine results,” said Dr. Luks. “The fact is that every physician is going to have a patient who doesn’t like him or her. Someone is going to write something negative. Orthopaedic surgeons who do not have a website or cross-links with other sites have no way to drive negative comments off the first page of search results.”

With this in mind, Dr. Luks encourages all physicians to set up their own websites and Facebook pages. The AAOS provides an easy “OrthoDoc” template that individuals and groups can use; it’s an excellent option for practices that don’t have the budget to hire a professional Web designer. (For more information, visit the “Member Services” section of the AAOS website, and click on “Build your own website” under “Services.”

The simplest and most common website design is the so-called “blog” format, which features easy posting of new pages, articles, and information by the site owner, and often allows readers to directly comment on information.

“I moderate all comments on my site,” said Dr. Luks. “I set up my blog so I can moderate a reader’s first comment and allow any subsequent comments from an approved reader to be posted immediately. I also think it’s a good idea to reply to most comments, whether they’re good, bad, or indifferent. Everyone is entitled to an opinion, but if patients see you as someone who cares and doesn’t run away from controversy, they’re going to develop a more positive image of you. I also have a testimonials page on my site, where patients can leave positive, unedited comments.”

In addition to creating an online environment that encourages patient feedback, it is important to link an individual or practice website to other websites. Search engines use links as a gauge of importance and popularity. It’s easy to link to the AAOS website or specialty society websites, as well as to referring physician colleagues’ websites and Facebook pages. Encouraging colleagues to reciprocate with links to the practice website can improve the odds of a physician’s own site appearing on the first page of a search.

Be carefull!
Dr. Luks points out that, although setting up a blog is relatively easy, physicians should be aware of the following issues of concern.

“The privacy laws of the United States are very rigorous and, to a large extent, pretty black-and-white. The Health Insurance Portability and Accountability Act (HIPAA) has not really kept pace with the technology, so it’s important to keep postings on general topics and to avoid posting any specific patient information online,” said Dr. Luks.

“Patients, on the other hand, may post their own personal information without violating HIPAA,” he continued. “That presents a different problem, however. If you offer someone a specific treatment recommendation, a court may determine that you have established a doctor-patient relationship with that person. It’s not wise to comment on specific treatment recommendations.”

Finally, Dr. Luks points out that physicians should search their own names in the most common search engines.

“Go to HealthGrades, Yelp, and Angie’s List as well as to other referral sites. See what people are saying; if you find negative statements, you should go to larger search engines like Google and see where those sites are ranked,” he advised. “Then start a website and a Facebook page, and Google yourself in a month to see if things have changed. It works, and it can work fast.

“Online engagement is not as difficult or as time consuming as most physicians think it is. Most physicians don’t want to do it because they’re so busy. If they understood how easy it is to take down someone’s reputation and possibly an entire practice, they might see this as part of their normal daily work schedule. It can take no more than 10 or 20 minutes a day to put up some fresh content or dictate a quick blog post or get someone in your office to post links to some online articles.

“Not only is it a way to protect your reputation when something has been said about you, but it is a good way to build your reputation by doing things that encourage patients to come to your site, because they’re going to share with one another,” he concluded.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaosnow.org

Social media can help you educate your patients
If you currently maintain a social networking presence, be sure to “fan” and “follow” Academy-driven channels on Facebook and Twitter, and encourage your patients to do the same. Daily posts include new orthopaedic research and journal studies, links to patient education, and musculoskeletal stories in the consumer media.

Links to patient-education articles from Your Orthopaedic Connection (orthoinfo.org), video and print public service campaigns, tips on injury prevention, and recent press releases are provided through the Academy’s Facebook page and Tweets. The information is designed to engage fans and followers, many of whom are health professionals, current and future patients, or members of the media.

Joining the conversation is easy; get started today in just two steps.


Type facebook.com/AAOS1 into your browser. Click “Like.”


Type twitter.com/AAOS1 into your browser. Click “Follow.”

The AAOS campaign “Decide to Drive” is also on Facebook (facebook.com/DecidetoDrive.org) (login required) and Twitter.