Pearls: How to Address Negative Online Patient Reviews

From movies to mechanics to medicine, most us now rely on online reviews before trying something new. Physician rating websites such as Vitals® (https://www.vitals.com/) or Healthgrades® (https://www.healthgrades.com/) offer our patients a prominent forum to rate their experiences with us as their doctors, and these sites are becoming increasingly important for patient referrals. Indeed, the Internet has fundamentally changed the way we interact with the world around us. A 2012 JAMA survey of more than 2100 patients found that 59% thought physician rating sites were “somewhat important” to “very important” when choosing a new physician [2]. A more-recent survey of more than 2400 patients found that 82% of patients use online reviews in evaluating physicians, and 72% use them as their first step in finding a new doctor [3].

Most of the ratings our patients leave on these sites are positive. In a study of 2185 reviews for 131 orthopaedic surgeons across four prominent websites, Bakhsh and colleagues [1] found a mean rating of 81.8 out of 100. Similarly, Ramkumar and colleagues [5] found the mean rating of 506 orthopaedic surgeons (27,792 individual reviews) to be 4.1 of 5.

Yet many of us have experienced an unhappy or dissatisfied patient who chooses to voice his or her displeasure through one of these sites. Low ratings have specifically been associated with negative comments regarding perceived surgeon competence and affability [4], but also with factors beyond the traditional patient-doctor relationship such as office staff, office conditions, practice characteristics, and cost [7]. Given the relatively low volume of online patient ratings for most orthopaedic surgeons, one dissatisfied patient can have outsized influence over our perceived professional competence to new patients (Fig. 1), and can negatively impact patient volume and revenue.

Fig. 1.

An online patient review from Google Reviews is shown. Because there had only been four reviews from the previous five years, the single negative review impacted the overall physician rating from five to 4.6 stars. (Google and the Google logo are registered trademarks of Google Inc., used with permission).

I’d like to share a few strategies I have considered in response to unfavorable online ratings.

Address the review outside the public forum. While most ratings sites will remove reviews that can be proven fake or that use profanity, sites generally won’t remove a patient review simply because the physician disputes the accuracy or legitimacy of the complaint. Many review sites allow physicians to respond directly to patient complaints in the public forum, but the ability to address specific comments (such as not ordering an MRI) can be limited in many cases because of patient confidentiality. It’s probably best to avoid direct responses to patients online unless the negative review clearly relates to a nonclinical issue such as a malfunctioning air conditioner in the waiting room. If the patient identifies his or herself in the review, some physicians have found success by calling unhappy patients to solicit constructive criticism on what, if anything, can be done better in the future [8].

Consider a third party. Reputation-management firms have experience managing online reputations of various businesses and can help identify, collect feedback, and respond to negative reviews almost instantaneously. While there are several firms that cater toward physicians such as MD Connect (https://www.mdconnectinc.com/) or Practice Builders (https://www.practicebuilders.com/), the value and efficacy of these services are unclear. A 2015 survey of 312 members of the American Society for Surgery of the Hand found that only 3% of respondents reported paying a professional service to improve their online ratings [6]. Practice size and costs may limit resources available to engage a professional service, but most practices and even solo practitioners should be able to task an administrative assistant to keep an eye on their online reviews on a regular basis.

Change the denominator. Most orthopaedic surgeons positively impact the lives of hundreds or thousands of patients every year, and while it may initially seem uncomfortable or even unnatural for us to specifically ask our patients who have had positive experiences to provide their own feedback, many patients are willing to do so. This is happening more commonly than many of us realize. Approximately 30% of hand surgeons surveyed in 2015 made these requests of their patients [6], a number which has likely increased since that time. There are various mechanisms for this, such as emailing clickable links to popular review sites, adding these links to your practice’s website, or handing out cards with web addresses to these sites at the checkout desk.

To my surprise, most of my total hip and total knee patients are comfortable and familiar with the idea of online reviews, which confirms that the world around us indeed has changed.