Thanks to the Internet, unhappy patients can now express their discontent for all the world to see. If you or your practice have not yet been the target of a negative online review, chances are reasonably good that you will be in the future.

The proliferation of online physician rating websites is making it easy for disgruntled patients to vent their frustrations. Because many of these websites permit anonymous posting, you may not be able to identify your detractor to address his or her concerns.

The personal nature of the medical profession means that your reputation is one of your most valuable professional assets. For that reason, you should be proactive about protecting it and should not ignore or dismiss negative online reviews.

Is it libel?
If you have been the subject of a negative online review or comment that you believe is false and potentially injurious to your reputation or your practice, the first thing you should do is speak with an attorney to determine whether you have a legitimate claim for libel against either the website publishing the information or the individual who submitted or posted the review or comment. Libel involves a false written statement that could injure an individual’s reputation. (False oral statements that injure an individual fall under the legal heading of slander.)

Do not assume that a negative comment published online is libelous. To rise to the level of libel, the published statement must be about an individual, it must be false, and it must be a statement of fact, rather than opinion. For example, the statement “Dr. Smith was rude to me” would likely constitute an opinion, but the statement “Dr. Smith is not licensed to practice medicine” would be a statement of fact. Unfortunately, most negative online comments from patients fall into the opinion category.

Holding someone responsible may be even more difficult, especially if the posting is anonymous. Generally, website operators are not held responsible for libel if the website merely distributes the statements of others and has no way to know the truth of those statements. If, however, the website operator is involved in the publication of the statement (such as a news website), the operator could be held liable as a publisher of a false statement.

Even if a negative statement or online review of you or your practice does not rise to the level of libel, you can take several steps to remedy the situation. More importantly, you can be proactive to prevent patients from ever feeling the need to publish negative commentary about you.

Address patient concerns quickly
One of the most effective ways to keep patients from posting negative information about you is to address their concerns in the office—before negative feelings become negative comments. Remember, some of your best marketing efforts can be accomplished directly with patients in the office.

Promote good customer service
How you handle patient concerns and complaints can go a long way to protecting your online reputation. Regularly remind your colleagues and staff to treat every patient with respect and take every patient concern seriously. If, for example, the patient expressed dissatisfaction with the visit for any reason at the time of checkout, the checkout staff should be trained to resolve the complaint immediately or to put the patient in touch with someone who can.

Be careful, however, that you do not try to “resolve” patient complaints by paying patients or giving them something of value. Doing so could complicate or exacerbate professional liability claims if the patient’s complaint is of a clinical nature. Sometimes, however, simply listening to the patient’s concerns is sufficient.

Monitor your image
Because even the best customer service will not guarantee that all patients will be happy with your services, monitoring your online “image” regularly is important. Every month or so, do an online search of your name and your practice’s name to see if comments have been posted. Or, see if the search engine will notify you by email if your name appears in a search. If you find a negative comment, be sure to check similar websites; a disgruntled patient may not stop with just one posting.

If you know who submitted the negative comment, consider contacting the individual and trying to understand and resolve his or her concerns. If you can’t identify the poster, you can try contacting the website operator. Many review sites require users to provide demographic information such as an email address and/or telephone number. Although website operators may not be willing to identify the user to you, they may be willing to contact the user on your behalf and see whether the user would be willing to speak with you. If you are able to address the concerns, see if the patient would be willing to retract the online comments.

Develop a rebuttal statement
Instead of getting into a war of words with patients online, consider developing a standard response to negative comments. Focus on your practice’s commitment to providing high-quality care and customer service to every patient. Do not admit fault or blame others in your practice, but acknowledge that, unfortunately, not every patient will be happy with the circumstances or outcome of care. If you are unsure of what to include in such a statement, see your legal counsel for guidance.

Encourage positive postings
You may also want to encourage patients to post positive statements about you and your practice. Distributing flyers at checkout or sending an email reminder with links to review websites can be effective ways of encouraging patients to express their satisfaction with your care. Positive comments can counterbalance any negative comments and push them farther down, reducing their impact.

Check websites’ terms of use
Some websites prohibit individuals from personally naming or attacking a specific physician or claiming malpractice on the part of a physician. The terms of use can usually be found on the website and are generally taken seriously by website operators. If you believe the posting violates the website’s terms of use, you can contact the website operator and ask to have the comment removed.

Consider legal counsel
As a last resort, consider having your legal counsel write a letter to either the website operator or, if the user’s identity is known, to the user directly. This approach should be a last resort, however, because it could spur disgruntled patients to post more negative comments.

The AAOS Practice Management Committee has developed a primer on Social Media in Healthcare that you may find valuable. It can be downloaded at no charge from the AAOS Practice Management website, www.aaos.org/pracman

Todd A. Rodriguez, JD, is a partner in the Exton, PA, office of Fox Rothschild LLP. He can be reached at trodriguez@foxrothschild.com