Rate Your Physician, Rate Your Patient?

As physicians, we are taught primum non nocere (first, do no harm) during our training, we are regulated and licensed by our provincial health care authorities and recognized by our national certification board (Royal College of Physicians and Surgeons of Canada) – to protect the public, our patients. Not only are we “regulated” to ensure we do our jobs correctly (read perfectly) every day with little or no margin for error, but our performance and interactions are routinely “scored” by our patients as well.

In a previous editorial, ¹ we commented on the unprecedented forum bestowed upon plastic surgeons with social media and the internet. In the same way, patients have a unilateral ability to rate their physicians – almost with impunity. And while there is no doubt that certain outcomes may warrant a negative review, a great number of these “reviews” are predicated upon an unfavourable meeting/consultation, unmet expectations, and/or dissatisfaction with a result. And while expectations must be set at the front end, is it 100% of the time that the surgeon has failed to meet the expectations or, alternatively, that the realistic expectations were simply not understood and accepted by the patient? Thus, as a plastic surgeon, you may do your very best, utilizing all tools in your box, provide a very perceivable improvement, but still meet the scourge of a patient unhappy with the result and quite possibly, a number of other things in their lives outside of the surgery being rated.

Most of us have been the subject of an unfavourable review. If you haven’t, you are not looking in the right places or simply have not been in practice long enough! Such is life – there is no way every human encounter ends perfectly. There are numerous “Rate your physician” sites, chat forums and social media groups where patients can freely and anonymously grade your results, skills, office staff and their overall patient experience. Many of these reviews are damning, slanderous and potentially harming to your practice and reputation.

Try as you will if you feel you have been unfairly judged, it is next to impossible to have those reviews removed. The saving grace has been an evolution in lawsuits filed by surgeons against their patients for unwarranted slander – the bar is high but at least there is precedent. There have been many cases in Canadian provincial courts where physicians have been successful litigants and received awards for damages due to being defamed by patients via online rating sites. Loose lips indeed sink ships!

All of this to say, everyone has a right to their opinion. If patients can “warn” each other about physicians who didn’t produce a desirable interaction or outcome, why can’t surgeons post their anonymous reviews of an unreasonable, difficult or rude patient? Because we simply cannot. While often you’d like to “rate your patient” – this would violate patient confidentiality and, more than likely, result in regulatory reprimand if not risking your licensure. We have to recognize our position of authority and the health care relationship. This means accepting that these occasionally unfounded reviews are part of the job and carry on, unless they are factually wrong and defamatory. It is, unfortunately, a form of online bullying and one that has real consequences. A body of literature has emerged to educate physicians about this phenomenon and how to approach these situations.^2,3 Maybe one day patients and the public will realize the personal and professional impact of their online ratings on their health care providers and choose their words fairly and kindly.